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Home My WebLink About3942-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. Z.~.~'~ ...... Date ......... l~eb.. 8 ........... , 19. THIS CERTIFIES that the building located at .. l~' A~. & '3' S~ ....... Street Map No.fi.,][ ,~t~.Block No ........... Lot No.. ~.... ~..N,][., ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... $~ .... ~.., 19. ~ pursuant to which Building Permit No..~.. dated ........... ~/.~y .... ~.., 19.68., was issued, and conforms to all of the require- ments of the applicable provisions, of the law. The occupancy for which this certificate is issued is .. 'l~l~*e~' ~e' £~n~.].,V 'dW®~"r ~T~g ..................................... The certificate is issued to . R~.ol~ .~pls~o~ ..... 0~r~' ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ouse 18 0 -- Building Inspector / ! FORM 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 PULL COMPLETION OF THE WORK AUTHORIZED) N? 39 2 Z Permission is hereby granted to: .................. .~..c.!~. ~...~...'.o: ~.~.~.~....~... ............... ....................... .t~.~.....~.~.~...&~ ....................... to .... ~.....~.....~ ~..t.~.~.....~.~...~.~...~.t. ~...~.~.t.~,~.~ ................................................... at premises located at ..... ~.O...~...~......~.:.~.t:.~..~l...~-,l~,~ ......................................................................... .................................... ~'.~'...~.~ ....... ]~,~e~ ....]E,Z, .................................................................... pursuan¢ to application dated ...................... .~...~..~. .......... ~ ................ , 19...(a..~..., and approved by the Building Inspector. Fee $..~.,.~ ............ TOWN OF SOUTHOLD BUILDING DE.P,A. ItTMENT SOUTHOLD, N.Y. 'I'~' I Examined ....... , 19 ........ · ^ ved ........................................ , Pe it Disapproved a/c .~ APPLICATION FOR BUILDING PEItMIT Dote ....................... : ............ ~/Z.l .~.... .......... / INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin~ 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 s~oll 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. ^PPLIC~TION IS HEREBY/v~DE 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 all applicable laws, ordinan bui ing c e, ~/q~/d r~gu~ti0ns~ / {.%ign!ature at app leant, or n~me,/ff a corpo/mt.~n),< _ /-'- (~clress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor electrician, plumber or builder. ................... .......................................................................................................................................................... Nome of owner of premises ...... ..C... .~. ................................................ : ................................................. If applicant is o Corporate, signature of duly authorized officer. (Name and title of corporate officer) ~. Location of ~ond on which p~o,ed wark w~I~ be done. ~ap No.: ........................................ Lot Na..' ...~.. ............ I£E , w .............. Street and Number ............... .~.. ....................................................................... ........................... / ~unicipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ....... ~.~.~..~.. .......... ..~.,d.../~. ...... ..~./..~'..~....~....~...~.....~.~ ..................... ~ ...... ..:.:~... ...... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .............. .~.Removol .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ./.~...6..~. ......................................... Fee .......................................................................................... (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 ..... './. ......................................................................................................... C~[~ions of same structure with alterations or additions: Front ........... ~ ..................... Rear ....~...~.. ~;. ~' ~ ~,, i , ' .................. D~pth ...~.. ......................... Height ...../..~'.. ................. Number of Stones ........ /. ...................... 8. Dimensions of entire new construction: Front ....... ~..~.../..i .................. Rear ,.../..~.. ................. Depth ....~..~....~. ......... ! He ght ./..~.. Numl~er of Star es ./. ........................ 9. Size of lot' Front ...... ..~... ................. Rear ...... ~...~ ................... Depth 10. Date of Purchase ....../..~....~../. ................................ Nome of Former Owner .......~.~..~..,....'L.~'...~',~../.,~....A.. ............ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction v o ate any zoning] aw, ord nonce or regu at on? /~....o. ................ - ...................... 13. Name of Owner of prem ses ~1~../~.~...~. ~Z~'~dress/~.~.~...~.~..,~/.....~....~,......../~...~..~h~o~ne~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 YORK, } c c COUNTY OF ................................ $ ~"~' ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (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 before me this ........ ......... .................