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Home My WebLink About3995-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.Z.~6~ ..... Date .............. ]~0.~'.~ ~l.~. .... , 19.~.9. THIS CERTIFIES that the building located at . ~. 8~ll¥~t®X'. A~ .... Street Map No~.~l~e~d, ... Block No ........... Lot No. ~ .~. 1~.~ .~ ..... .g.~ .~..h.o~.....~.,.~..e conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... eTgl~... ~ ~..., 19.6.~. pursuant to which Building Permit No..~0..~... dated ........... A~I~.. ~i6.. ,., 19..6.8., 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 .. I~1'S.V~,$~. g&~&g~..(&~.e.~$0lry..b~l.d.~)..?..ap.p.r..o.v.e.d...by...B~..a.~....o.f Appeals The certificate is issued to .... ,l_~l~n .W .. ~ ...... 0vnel, ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...~.:R: ............................. FOIL~i NO. '; TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3995 Z Permission is hereby granted to: ................ ................................... to at premises located at ........ ~,~I.~..I~..~...A'3II,~..,~....Mm~.e~{~{III~ ..................................................... ......................... ~t.....lt.~3J~r~.taz., A.~ .............. ¢}~bn~....~ ...................................... pursuant to application dated ......................... ~..~......~. ,~ 19.......~., and approved by the Building Inspector. Fee $..~.~...~.. ............ Ruilding Inspect~ TOWN OF ~OUTHOLD BUILDING DIP&RTMENT TOWN CLIRK'~ OFFICl $OUTNOLD, N, Y. Examined ........................................ , lg Approved ........................................ 0 19 ........ Permit No ............................. Disapproved a/c .............................................................................................. Application No ............................ (Building Impector) APPLICATION FOR llUILDIN~ PERMIT ' /-(' Date ................... ....t~:r.;;..I .......................... , 19.-..'.r..~' · INSTRUCTIONS ~ This application must be completely filled in by typewriter or in nk and submitted in duplicate to the Duilding .: Inspector. · b. P at plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets ! clreas, and giving a detailed description of layout of property must be d~wn on the diagram which is part of th s opplica! on: JC. The work covered by this application may not be commenced before issuance of Building Permit. ~d. Upon approval of this application, thee Building inspector w I issue cl Bui d ng Permit to the appl cant: SH~:h P~it J~ LSholl be kept on the premises available for inopection throu, ghout the progress of the work. JJ~ e. No building shall be occupied or used in whale or,~ part for any purpose whatever until a CerHficate of Occup~ll~:~ / J'lallhavebeengrantedbytheBuildinglnspector. [~APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant t° thi L ~Bu ding Zone Ordinance of the Town of Southold Suffolk County, New York, and other applicable Law. s, Ordin. anc.e,s t'."Re;,u ntions for the construction of buildings additions or alterations, or for removal or demolition, as herein clesc~j~efl l~i Th~%~licant agrees to comply with all appl,cable laws, ord,nances, budd,ng code, housing code, and regulations. ii . ............... ~....d.~ .......... :,: ........ :...I.....:..~..,,: ................................ ~ (Signature of applicant, or name, if a carparatian) te whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builcl r ~I~. ......................... ~.,~..~,:..~....~../.~.. .................................................................................................................................. ...... .~::: ......... .~..~.~..L~ ................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) · Location of land on which proposed work will be done Map No,: ..... L.., .~.:..~...~.~ .................... Lot No.: ..../..,:;,...~ ~l~ Street nnd Number. ..................................................................................... ~,nici'-"-~'i't'~ ................................. ~'" 2. ~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~...J.~:.~.//I.,.$..~. ................................................................................................. :. h. Intended use and occupancy ...... C~/~...:/.~..~...~...~*.'~., ....................................................................................... }. proposed Construe*;2 [~.,, Uated .......................... ' ............. [.~ ....... ~ .......... .... n ~{~ote any zoning /ow, ordinance Or~regulotion;~ ' Jf ~.C ..................... ·qume of ~ner of premises ~ ~ ~. ~ .................. "', ................... ,..' ..................... hen ~. ' Z NOme of C~trocfor Address. e ~o ~ ...... ' ...... ~ ..............Address ............. '.'.' ............................. ~hone No ................. ~ ................ ~ne No .............. Lace? clearly and distinct y - ~.~. PLOT DI~G~M ~Y. hnes. Gwe ~,,~1~ url~ o~ ~mber or aescr/ption'accor~, [ '[~f~ or corner lot. ~ ' " '~;cofe oil set-~ck dimensions frorr ~w street names and indicate .......... STATE OF NEW~ Y.i;::ID~J I ~' 1 ¢ ¢ ....... '~ ~ 'g ' g app 'cation) 'doiy sworn, d~ses and says that he is the applicant of said owner or owners, and is duly authorized to peHor~ "' ' ' or 'have performed the said work and to ~ke a.nd file this application; that all statements contained n thi~ppli~ati6n are true to the best of his knowledge and belief; and that the work will be per~ in the manner set f~/i~ the application, filed therewith. Nota~ Pub c n~' ............................. ................................... ~ ~ (Signature of applicant}~