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Home My WebLink About3947-zFO~ NO. 4 TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. CERTIFICATE OF OCCI. IPANCY THIS CERTIFIES that the building located at .Oa~..Av.~t~a~L~.~e..~oatc% ............. Street Map No ....................... Block No ....................... Lot No. ~$.~..B..~.,....~.~.~.t~.Q~,.~,.....N.I~......~.~J?]~ conforms substantially to the Application for Building Permit heretofore filed in this office dated .................. ..~.~D.~....~.., ............................. , 19..~./~1.. pursuant to ~vhich Building Permit No ................. dated ....... ..~..~.,.~.~....9.~ .............................. , 19.~..0...., was issued, a~d conforms to all of the requirements of the applicable provisions of the law. The occupancy for wh)ch this certificate is issued is ........ ..... ................................................................................ The certificate is issued to .....~,,~.,W,~,,,~.:~,~,~.IiI~.:J-~.,.JOT~/,{ItlI~ ........................................................... (owner, lessee or tenant) of the aforesaid building, 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 FULL COMPLETION OF THE WORK AUTHORIZED) 3947 Z Permission is hereby granted to: at premises located at .........~lJ..~I' ................. IJ~l~llll..J~.....~,o~t,~ ........................................ pursuan¢ to application dated ................ e~MII..~....~I.~' .......... , 19..~1~, and approved by the Building Inspector. Fee $...~.~..(~ ............ Building Inspectd[r Examined ................ , 19 ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , ..... Disapproved a/c .................................................. ~ ................ -- APPLICATION FOR BUlLiNG PEI AIT Dote ............ .................. INSTRUCTIONS Thi~ll~plication 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 efproperty must 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 u~l 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 pursua.nt4o the Building Zone Ordinance of the Town of Southold, Suffblk County, New York, and other applicable Laws, Ordinaflces or Regulations, for the construction of buildings, additions o~ alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations. ~'~ '-/~) / (Signature of applicant, or name, if a corporation) (Address Of applicant) State,whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. '~ll dpplicant is a'~orporote, signature of duly authorized officer. ~ .' (Name ~d title 'of corporate officer) ' I Location ~f land ~ofl which proposed work will be done. Map No ......................................... Lot No.: ...... : ................. Municipality .~ r 2. State.existing use~ and occupancy of premises and intended use and occupancy of proposed const...l~on: ....... ~........7~.~ .... 3. Nature of work (check which applicable): New Building .................. Addition .....~.... Alteration .................. Repair .................. Remaval .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..~..I.l~.~.~..,.~.C~ ............................. Fee ...... .'~'.....~.?..~..1~... .............................................................. (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 ...../.~....L .......... Number of Stories ...........C~.~..~.. ........................ ; ....... ;.~, ............................ ~.~..~..;...;..~.; ..... Dimensions of same structure with a,lterations or additions: Front ....~.~'.....~ .................. Rear ............... ..~.. ......... Depth ........~..~...~ ................ Height ~):tt...~. ............. Nurn, ber of Stories ...... ..;~.. ................... 8. Dimensions of entire new construction: Front .................. ~ ............. Rear ....~S:) .................. Depth .......~.. ............... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ......... ~'-.~ ............. Rear .............. .'7...~.. ................ Depth .......... /...~....~. .......... 10. Date of Purchase ........................................................ Name of Former Owner ..~.?~.~../..~.,e~.~..12 .......................... 11. Zone or use district in which premises ore situated ...... ~. ........ .~...q..~.'~:~, .................................................................. 12. Does proposed construction violate any. zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ~..g~.~....~..~.J../.~-Ct'C~..~.. ....... Address '~g.~.~..~,.~ ................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor/~/,~/.~.~/'.....-f.J~.'~..-['.c).~,~. ...... Address .~_~1~..C~,~./,¢C~. ............ N o./~..~......~..~'..?~/ Phone 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, COUNTY OF ................................ ~' ~'~' .......... ...~.~......~....2~..,.~ .......................... being duly sworn, deposes and says that he is the applicant (Nai~e~lr individual sign/~ng_a~ above named. He is the ................................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said awner or owners, and is duly authoriZed to perfarm 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 mannee set fo~h~ in the application filed therewith. Swo~efore~..~ mo this (Signature ~ EesidinE in Suffolk Coun~ Commission ~pJres March 30~