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Home My WebLink About3894-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE. SOUTHOLD, N. Y. CERTIFICATE OF ocCUpANCY THIS CERTIFIES that the building located at ....O~.~O.O~l.,.DZ'.:l.~/.e ................................... Street Map No ....................... Block No ....................... Lot No ....................................................................... conforma substantially to the Application for Building Permit heretofore filed in this office dated .............. .~..~.....~..0.~ ................................. , 19~..1~ .... pursuant to Which Building Permit No...3B9.~..~ dated ....~.~......~.~ ................................ , 19..~..8...., was issued, amd conforms to oil of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ................ ~..z...*..¥.~..e.....o.~.e, ... ~..*..z. ~... ~..e..Z...z.,t.,~.~. .................... i .......................................................... The certificate is issued to ........... ~..~.~..~..~.~...°..~.~.e.~'.....(...o~...~...e..~,). ........................................................ (owner, lessee or tenant) of the aforesaid building. Building Inspector / FOEM 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? 3894 Z Petrol§sion is hereby granted to: at premises located at ..~./~.....(}~j~..J~ .................... ! ......................................................... ................................................ ~e.~t~e:i~.:.....~ ~ ~ .................. ; ..................................................... :... pursuant to application dated ........................... J~.~...... ...... JL~...J....., 19...~, and approved by the Building Inspector. Building Inq:~ector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE .*, SOUTHOLD, N. Y, Examined ............ i.'.. i~L...~!.~...!.., 19 .... ~ Approved ........................................ , 19 ........ Permit No ............................ Disapproved o/c ....................... ~::.~.~- .......~::::~ .......... :~~ {Buildin~ Insp~c Application No ............................. INSTRUCTIONS o. 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 befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue b Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progrejss of the work. e. No building shall be occupied or used in whale 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 iS~Suance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ¥0rk, and other applicable Laws, Ordinances or Regu at OhS, for the construct on of bu Id ngs, additions or alterations, or fbr removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. .... ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~..WC~~.....~.'.~ .............. i ......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) · I. Location of land on which pro,~osed work ~11 be done.. Map No.: ..... i ................. : ................ Lot No.: ........................ Street' and Number .................................................................................................................... Municipality 2. State existing use and occupancy of oremises and intended use and~ occupancy of proposed construction: o. EMstin9 use and occupancy .................................. ~ ................ 4.....~. ................... ~.. ................................................. b. Mte~ded use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition .... Iter o ................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4/ Estimated Cost ............ ~,,~..0..I .................................................................................................. :. ..................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ...~ ............ ~..:. .................................... :....: ...................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with a.lterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate,gny z,oning law, ordinance or regulation? ......................................................... 13. Name of Owner of premises ...Address ............... Phone No ..................... Name of Architect ....... ,,, .................................. .~ ........ Address .......~............ Phone No ..................... Name of Contractor ....... Address Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ¥.ORJ/.,,. ~S S COUNTY OF ..... .,u..~..~..~,.~.,~. .......... ,f . . ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the CO~C~O~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application, filed therewith. Sworn to ~efore me this , .~ ..... .~'.~ ......... day of~..~.~l ............................ , 1 ~.. ~, // A, ~, Notary Public ]..}..(.~Af~..~~.~ ..... Count'y (Signature of applicant)