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Home My WebLink About3162-zI~ORM 1~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I"OWN CI;ERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE ElF OCCUPANCY No. Z.. ~.~..0 ..... Date ................ ~.~tO.~Ol~,.. ~.., 19.(~4~. THIS CERTIFIES that the building located at . WIS...~.P~a~.(.~Oh. t~t). Street Map No.. ~ ...... Block No ..... ~ .... Lot No.. ~... ~O'~'IQ~ .... ~.~. ...... conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated ............ ~1'11~r ....J.~., 19.6~. pu.rsu'ant to which Building Permit No. 3J~6~ .~. dated ............ ~l~r...~1.~ .... 19. t66, was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy f~or which this certificate is issued is .... ~.~i~ .012~. fal~i~y- ~lt~ ....................................... The certificate is issued t~o .~1~I~..It~.80hOl~ ...... ~ ........ ................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Appzoval ..... I~.~....~.*. ............................ Building Inspector FOE~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLER[('S OFFICE SOUTHOLD, N, BUILDING PERMIT (THIS PERMIT MUST BE KEpT ON THE PREM SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3162 Z Permission is hereby granted to: pursuant to application, dated ................................... ~.~.~.~D~ ....... [~ .... 19..(~(~., and approved by the Building Inspector Fee $" ~ j'f}O ............ FORM NO. 1 Examined ...~-./.........~1 ............... , Approved .................................... , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Permit No ................................. Application No..'.~..../....~.~..~ ....... 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 location. c. The work covered by this application may not be commenced be.fore 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 o certificate of Occupancy shall have been granted by the Building Inspector. .. APPLICATION IS HEREBY MADE to the Building Department for the issua.nce of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 all applicable lows, ordin¢l~ces and regulations. ~, ................ (Signature of applicant, or name, if a corporation) "~~"~'~Addr~ ''''''~''Of app~ ............... i~)~ ~ .......................... State wh~aRplic~nt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ......................................................................................................................................... Name of owner of premises .... ~"~'~t ..... .......................................................................... if applicant is a corpa~ate, signature of duly authorized officer. (Name and title of corporate officer) I. Location oF land on.-w.b/~propos~ed work willie done. Map No: ..,~.~ .............. [ ................... ._~kot No: .................... Street and Number ............... .~.....~.~...~.....~ ..........................~.~ .............. ~.....~ ........................... Municipali~ State existing use and occupancy c~f-p~ises and intepded use and occupancy of proposed construction: a. Ex~stmg use and occupancy ............. ~;.,~.. ................... ~ ................................................. .~ ........................ b. Intended use a cc pa cy .......................................................Z ........................... ..~./ ........................ 4. 5. 6. Natq[re of work (check which applicable): New Building .................... Addition ........... Alteration. Repair ................. --~ ~ ~---~"~Rem°val .................... Demolition ......... ~...._~Other Work (Describe) .................... Estirrated Cost ...'""....~..~.~....(~.....O...,...O...~. ................... Fee (to be paid on filing this application) If d~elling, number of dwelling units ...........~ ............. Number of dwelling units on each floor .......... ! ................. If ga 'age, number of cars ............................................ If bt~siness, commercial or mixed occupancy, specify nature and extent of each type of use .................... Dime:nsions of existing structures, if any: Front ............................ Rear ............................ Depth ............................. Heig(~t ............................ Number of Stories / Dime`nsions of same structure with alterations or additions: Front ................................ Rear ........................ Depth ................................ Height ................................ Number of Stories ..., ............................ ..... c~ R r D me, ns ons of ent re new construction: Front .......... ~ .............. eo ........~. .................. Depth ......~ Height ....... .~...-. ............ Number of Stories .......[ ....................... Size df lot: Front ....L~..~.,...~..(~... Rear ............................ Depth .../.~...'~...~..~..~.. of Purchase ........................................................ Name of Former Owner or use district in which premises are situated .... ~roposed construction violate any zoning law, ordinance or regulation? of Owner of premises ........................................ Address .......................................... Phone NO. of Architect .................................................... Address .......................................... Phone NO. of Contractor'~;~.. '(~.(~.../~...~.I~. ...... Address ..~...(~.~...~.-..~..¢..Q~. ...... Phone PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions .~s. Give street and block numbers or description according to deed, and show street names and indicat ~rlor or corner lot. Locate property lin whether int, Date Zone Does Nam Nora Nam / STATE OFINEW YORK COUNTY q .......................... ) S.S. ................... ~ ............................................................................. being duly sworn, deposes and says that he is the npplica~ (N;me of individual signing application) above nam~. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly nuthorized to perform or have performed the s~id work end to moke and fi this applice:ion; that ~11 statements contained in this application are true to the best o~ his knowledge end belie and that th work will be performed in the menner set forth in the application filed therewith. Sworn to be'ore me this .................. ,...