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Home My WebLink About3194-zTOWN OF. SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..... ~lltd.dl, f~i;o~l..Road~...l~¢~, ................. Street Map Nb ......~ .......... Block No....~ ........... Lot No ..... conforms substantially to the Application for Building Permit he~ei'ofore filed in thi~ office doted .............................. ~,~lg~illZ..;L~ .............. , 19.6~.. pursuant to which Building Permit No.....3.~.~..~.~ dated .................... /~.Ug.U~.t...,'L6 .............. , 19....~ was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is'. ....... ......... i .......... ~e~...one...#~.~y...~.e.~.~. ~,~g ...................................................................................... The certificate is issued to ....... ~d~t~,~l. et~..~.e...~.~j~]~,.~.l~l .............................................. (owner, lessee or tena:nt) of the aforesaid building. ll.D. ~.4o lS66 FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 319 Z Permission is hereby granted to: ...... ~...a..Z..s...e.~r...~..~.~,~.~.%~ ........................................ ............... ~/la~.~..S.t ............................................... ....................... .G..v.~ .e. nl%O.~.¢. ................................... to ..... )~uild... n~w...one.. £ami[~.....¢h¢~ l.l.~ ~ ............................................................................... at premises located at ..... E ./S.....ivLicLd, e~Ltoz~..tloac!,..Ex.tezcti~t~ ................................................... .............................................. .Gr~.e zzDo:n.t.r ..N. ~ Y.,. ............................................................................... pursuant to application dated ................................ A.~f~..~s.~.....:l.~ ..... 19.66..., and approved by the E~uilding Inspector Fee $.ID.~O.Q ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure (Gfve deed location) located have been inspected by this department and found to be satisfactory. District ~gine e~ District Engineer NO. ! Examined ~/. (~ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............. ..~. ............ Approved ........................................ , 19..!.....Permit No..3~.~...~.......~.... ....... D isapp rove~~... .......................... ............................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitfed in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adioining premises or public streets or areas, and giving a detailed description of layout of propertymust be drown on the diagram which is port 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 port for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance 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, os herein described. The applicant agrees to comply with oil applicable tows, ordinances, building code and regulations. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... .............................................................................................................................................. Name of owner of premises ..... ~.~..,,~..~......~, ................ ,,~.~:~.~. ................................................................................ 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 dane. Map No: ............................................ Lot No: .................... Street and Number ............... ~.~..~.~.~tL~ ....... ~.~. .............................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existin, g use and occupancy ............ ..~ ................................................................................................................... b. Intended use end occupancy ...................................................................................................... 10. 11. 12. 13. Locat property Ii whether in Na!ure of work (check which applicable): New Building ..~_.. Addition .................. Alteration .............. Repj:ir .................... Removal .................... Demolition .................... Other Work (Describe) .................................. Est?ated Cost ......... .~....~..~. ............................. Fee ...................................................................................... ~ (to be paid on filing this application) If ~welling, number of dwelling units ....... ~..'~. ......... Number of dwelling units on each floor / If garage, number of cars ....................................................................................................................................... If I~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dirr.~nsions of existing structures, if any: Front .......................... Rear .......................... Depth ........................ Hei!lht ............................ Number of Stories ........................................................................................................... Dirt ~.nsions of same structure with alterations or additions: Front ................................ Rear Dep'h .............................. Height ............................... Number of Stories ........................................ Dim-~nsions of entire new construction: Front ....... ~..~.f.8..(L... Rear ....... .Z/...2..~..~...~;.... Depth ....... ]~.~ .......... Hek. ht ...... ,~l~.f.. ............... Number of Stories ....... ./..~.. ............. Doi , of Purchase .......~¢...-'~,.._~.../....~...M ...................... Name of Former Owner Zode or use district ir~ ~"" --wh~cch/premises are situated ...... Doels proposed construction violate any zonina law,~ ordinance or regulation.:) ........ ..~..~.... Na~ne of Architect .........,~ ........................................... Address ............................ . ............... Phone No. " PLOT DIAGRAM '"- / ; clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr, ~es. Give street and block numbers or description according to deed, and show street names and indi ~erior or corner lot. STATE OF COUNTY above no~ of said o~ this app/ic and that t NEWCV~OR~ ,. /~ '(OR ' S.S. )F ,~.~,~,~%,.... ~ , .... (Contractor, agent, corporote officer, etc,) ~e,r or owners, and is du'ly authorized to perform or hove performed the said work ond to make ond ~tion; that all statements contained in this application ore true to the best of his knowledge and beli ~e work will be performed in the manner set forth in the application filed therewith. Sworn to E efore me this ........... ........ -- ' . .