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Home My WebLink About3957-zFOBM NO. ~ TOWN OF $OUTHOLD BUILDIN(; DEPARTMENT Town Clerk'8 Office Southold, N. Y. Certificate Of Occupancy No. Z .353A .... Date ........July .......11, .... , 19. ~9 THIS CERTIFIES that the building located at .Sunset. Lane ............. Street Map No ............. Block No ...........Lot No. G~aport,. J~..]fork ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....Ruby ..... 1~o..., 19.6g. pursuant to which Building Permit No. ~957. Z. dated ....July ......1~o ...., 19.$~t, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thins certificate is issued is ... pr~.va~ .ona .£~lJ.y. ~ell~.r~ .................................... The certificate is issued to ........ ~o~gl. B~t ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Inspector BOUle ~ 925 Sunset limo 'rOWN OF SOUTHOLD BUILDING DEPAitTMENT-~ TOWN CLERK'S OFFICE Application No ................... .~.. ...... APPLICATION FOR BUILDING PERMIT Date ............................................................ , 19 ............ 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 pr.emises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which ~s port of thie application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this app, lication, 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 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 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, ordinc~nces, building code, housing code, and regulations. ~ - f (Sight, re of appli~,~nt, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, eng' ~r, general contractor, electrician, plumber or builder. .................................. ...................................................................................................................................... No, eo'ow-erof premi,e, ..... ....... ............................................................................................ 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 done. Map No.: ............... /~ ................. Lot No.: ~ Street and Number ..:.~...~.......~...~...~....~..~.~.......~....~.~...~.~ .............................. ...~..~..~...~.,~..~.,..../.~...c.~,.. ................ ~ ! '~ ~,~" Municip61ity / 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~ ........................................................................................... b. Intended use and occupancy ................................................ ~.-.. ........................................................................ 3. Nature of work (check which applicable): New Buildir~g .................. Addition ....~... Altermion .................. Repair .................. Rain. oval .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............... ~'.~...q.~ ................................ Fee .......................................................................................... ~ (to be paid on filing this application) dwelling, number of dwelling units ........ ~ ........... Number of dwelling units on each floor ~ ..................... 5. If If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, speci~ oature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..........~....o~.. ............ Rear ..... .~,~ ..................... Depth ..~,...<~.. .......... Height .................. ~ ..... Number of Stories ........ ..~....~...~.. ............ i ....... i ....... ii ........ ii ..................................................... Dimensions of same structure with alterations or additions: Front ...... .~.~...~.~..~ ........ ;; ..... Rear ....~..'~'..~...~.../.~.. ...... Depth ................................ Height ............................ Nu, m~er of Stories ................. v ............. 8. Dimensions of entire new construction' Front ~ ~.. Rear ~ ~ D~n~, //~ ,~ Height .................... Number of Stories ......... .~..~.~ .................................................................................................... 9. Size of lot: Front ....... ~.,5.~.; ............ Rear ..... ~..5~.~ ..................... Depth ....,?.~,.~ ................... 10. Date of Purchase ,..,~./~.~.;~.;..~..,~../.~..~,.~... ........... Nome of Former Owner ...~...~,,,,/.~.....~).;~/...~,~.,.~..,/.',.7'.,~. ..... ] 1. Zone or use district in which premises ore situated ..................................................................................................... ~2. Does proposed construction violate any zoning law, ordinance or regulation.;> ............................................................ Name of Owner of ...... Phone Name of Archite~t ...................................................... 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 NEV~OI~I~_ e~/' (Nome 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 rnoke and file this application; that all statements contained Jn this application are true to the best of his knowledge and belief; and that the work will be performe,~ the manner set forth in the application' filed therewith. Sworn to/b~l~ me this ~ ~..j~, ............. ..... .. Notary Public, ~UBLIC State of Hew YO ....... ~'~g~,ture of ai;~licant) ........... " Commission Expires Marcn