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Home My WebLink About3138-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. r. ERTIFII~ATE OF OCCUPANCY THIS CERTIFIES that the building located at0alg .I~. · .tg~l~ ,~o1~$. 1~-.. Street Map No.~l'~ .1~3~ No ............. Log No, conforms substantially to the Application for Building permit heretofore filed in this office dated ........... ~'l~r - '~8 , 19 f~,. pursuant to which Building Permit No. dated ............ ~.~e ' ' ' '~' 19 ~., was issued, and conforms to all of the require- ~nents of the applicable provisions of the law. The occupancy for which this certificate is issued is .l~l, tV~;e. Oltl~. f~l~lily. <i,/fei.~il~g ....................................... The certificate is issued to . 'D~o~;hy' ~l~ff, e~' ....... ()~t~,~; ........ . .....,', ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... ~,.~.. ................... Building Inspector FOI~M NO. TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 3138 z Permission is hereby granted to: .......... 8e~.t.'~ho~e~ ............................... : ....... ; .......... et premises located at ..~LO¢..~.~..&...~6 ......... .~B~y&O~.~..~e.l~e~ ............ ........................................... ........................ Oe~..~..We~'~...~ho~..{)r .............. -~o~t%boi~-f--.Dr~.~ ............................................ pursuant to application dated .......................... .~.~7~)-~.....~. .............. , 19~..., and approved by the Building Inspector Fee $...~'.,,.QO ............ ' ' 'Bghding Ins~;ctor "'~ ......... FOI~M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , ]9 ........ Permit No ............................. (Building tnsfpector) APPL'¢ATION BU,LD,NG P .M,T 0 Date .......... ~. .............................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The Work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose, whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code and regulations. /// (Signature of applicant, ¢f/,~6me, if o corporation) .... ./.::..zz ........... z ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~'::?Z,-¢. .......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...~..~..,/......~.7.~:.../¢_. ..... Lot No.: .¢...~..:.~-...2:...~. Street and Number ...C~4E~r~r.~¢..4,Z .................f~... ~..~.~.¢/4.2 ~ ....... '~'~'~ Municipality'J"¢¢¢" .............. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... ~t:~, ~.~.~.,~.~, ..... ~,~.~r,~.~.-~..~.~./, ......................................... b. ~ntended use and occupancy ............... .~Z~.~..~...~'~ ~ .................................................................... ; ......................... 3. Natt re of work (check which applicable): New Building .................. Addition .................. Alteration .....~.....'. Rope ir .................. Removal .................. Demolition .................. Other Work (Describe) 4. F'stil ,ated Cost .,, .~,..~.'~'r-)~' ................................... ~ ~* Fee , (to be paid on filing this application) 5. If d~,elling, number of dwelling units .............i .............. Number of dwelling units on each floor If g~. rage, number of oars 6. If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dim,'ensions of existing structures, if any: Front ...... ~..~. .............. Rear ........ .;~...~... .............. Depth ..'.~.~ ........ Hei ht ...... ~..:. ............. Number of Stories ....... Dimensions of same structure with alterations or additions: Front ......... .~.-...~,. ................ Rear ...... .~...-...~. ........ Depth .......... ..~...~ ............ Height / ~-~ Number of Stories 8. D~m'ens~ons of entire new construction: Front ........ ~ ........................ Rear ......... ~ .............. Depth '~ ~'~ Hei!lht ...~.-~. .......... Number of Stories ..... 9, Siz~ of lot: Front ....... ./....~.....(<'. ......... Rear ....... ./...~.....c?. .............. Depth ....... ~......~... .............. 10, Dar of Purchase ........................................................ Name of Former Owner 1 1. Zen . or use district in which premises are situated ........... ~.. 12. Doe proposed construction violate any zoning law, ordinance or regulation? 13. Na~e of Owner of premises*.~...~., .,c)/~...Address .,~;4~:~:z~.~...,~.~... Phone NoZ~Z~.../..-.~..; Narhe of Architect ...................................................... Address ............................................ Phone No. , No+e of Contract /~..., ...Address .~....~..~..:.~/....~...~. Phone N. / j PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, end indicate oil set-back dimensions property li,nes. Give street and block number or description according to deed, and show street names whether interior or corner lot. STATE COUNTY nar NEW YORK, ~S S Name of individual ~ed. He is the g duly sworn, dopes is and says that he is the opplic (Contractor, agent, corporate officer, etc.) of said o¥ nor or owners, and is duly authorized to perform or have performed the said work and to make and this applk ation; that oil statements contained in this application are true to the best of his knowledge and belief; that the w)rk will be performed in the manner set forth in the application filed therewith. Sworn to I: ~fore me this fi-~ , z ............ ~...~-'.... day of......~ .................... , 19...~..~. ~ /./'. Puj~lic, aunt (Sign of applicant) Notary