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Home My WebLink About3964-zTOWN OF $OUTHOLD i BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~l.~;&~l~...JJ~.~ ........................................... Street Map No ....................... Block No ....................... Lot No...~.,.. F~81~.t,..~J~i~.~.~.I~...I~.~...~.....Y..O..~...~. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................... ~.~i.l,~...~.J~., ...................... , 19..~.1~.. pursuant to which Building Permit No...3..~.~..4.....~.. dated .............. ~'~¥...].9, ..................... , 19...~.~., was issued, m~d conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ........ ~r~$~g...p~;L.. ~a~ee~r.¥.. ~tx. uet~e.) .......... ! .......................................................... The certificate is issued to .......~l~:~J~..~l~a. Ez. ill~el~t:l...; ............................................. (owner, lessee or tenant) of the aforesaid building. FOF~'~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMEN'I TOWN CLERK'S OFFICE SOUTItOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORJZED) N? 3964 Z Permission is hereby granted to: .............. ~,s~..~.~....~mm~t,S, ........ ........... ~ ....... ~s~e,~,,...~,:: ................. ............. ~ ....... ~l.~.~Z., ............... ; ................. pursuont' to application d~'ed .............. i ................. t~;.....:~[~!....., 19.~., and opproved by the Building Inspector. Fee ~..~.~ ............ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Approved ........................................ ,19 ........ Permit 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 premises or public streets or areas, and giving a detailed description of layout of property must be drawn 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 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 Lows/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, ordinance~kbuilding).~j . ~/7//~c°de' housing code, and regulations. ~ (Signature of applicant, or name,/~_ _ /~. if a corporati~,~ State whether applicant is owner, lessee, agent, architect, engi.neer, gener ctor, electrician, plumber or builder. 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 b~done. Map,No.: ............ ~ ................~.. I.ot No.: -.~f: .................. Street and Number ............ ~.z~/~.........~...~........~..'' .................. ..~.~..~..~~ ..................... Municipality 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 _,~c_c[!Tc"~c~, ............ 'd- *~''' ' -~ ......... ..~...~ ........................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Altqrotion ....... ~. ...... 4. Estimated Cost '~-oo o ~ ...................... : ..................................... Fee .......................................................................................... (to be paid on filing this opplicotion) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of oars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................ .~ .......... 7. Dimens ons of ex st ng structures, if any' Front ~ Rear .~..0.. r~o,,,~, )~ He ght ........ /...~... Number of Stor es !.. ....................................... Dimensions of same structure with olterations 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 ........................................................ Nome of Former Owner ........................................................ 1 1. Zone Or dse district in which premises are situated ..................................................................................................... 12. Does proposed construction<~'~ ~,,]~-~--~'vi'~°lote any z~,ning I~w, ordin, Lapce or :~0~"'~-'~--./. ~x/// .......................................................... 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. Z,o'F STATE OF NEW YO.J?~, /l/),~'~SS COUNTY OF ...... ..~..(~. ~..f '' .. . ................... being duly sworn, deposes and says that he is the applicant (N me of 'ndividual 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 gpplication filed therewith. Sworn ta.b~fore me this , /~ _ / ...... day of Notar Public ~4~' ~ .4~¢'1~.A..~_,~,-. F_,ISJ~,~.~_ .../.../.~.,.~...~.,Z'.~ ............ Y , I~L~iI~'i~ n~. I~~unty (Signature of applicant) ¢~UALIFLL~ IN NASSAU COUNTY_