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Home My WebLink About4004-zFOI~M NO. 4 TOWN OF SOUTHOLD 1~,UILDllqG TOWlq CLERK'S OFFICE SOUTHOLD, Iq. Y. CERTIFICATE OF OCCUPANCY No....Z..32.7.6 .......... Date ............ ~...S.e~tembe.~...:L3.. .......... , 19....~..8. THIS CERTIFIES that the building located at ...[~l~a.;tl~..~Q~ ............................................. Street Map No ....................... Block No ....................... Lot No...F, as.~..~ta:.~,lR,...~....~.g~..k. ................. conforms substantiaUy to the Application for Building Permit ~eretofore f ed in this office dated ....................... ~tl.~U~$.t;...~.~ ..................... , 19...~).. pursuant to Which Building Permit No....4..O...O...~.....Z. dated ............ ,P,~,lgU~t;...23.~ .................. , 19...61~., was issued, ahd conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ The certificate is issued to ........~v~,...~..~J[X'.~..~,~,]9.~l~...~..~ ........................................................ (owner, lessee or tenant) of the aforesaid building. ..... r ........ Building I~nspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENTi. TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT ; (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z Permission is hereby granted to: ....... ;IB4~..~/,~....~4~,JL..W&I~ ~.~.. ................... ~ ....................... ~ ................. ......... at premises I~ated at .......... ~..~ ................................. ~ ................ ~ ............ ~ .......................... ................................................. ~Jt..a~....-~J, ......... ~ ........ ~ ........ ; ...... = ................................ ................................................................................................. .....,. ................. ,~ ............................. : ......... pursuoni to application dated ......................... ~ ......... ~ .........~...., 19.~., and approv~ by the Building Inspector. Fee $~.[~,.,'~... .............. FORM NO.I TOWN OF SOUTHOLD BUILDING DEPARTMENTi TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ....................... ~..~ ............. , 19..~..~.... Permit No ........................... .. Disapproved a/c ............................................................................................ .. (Building Inspector) ~ Application No.....~..!...~..?...¢..~ ........ APPLICATION FOR BUiLDiNG P~RMiT INSTRUCTIONS o. This application must be completely filled in by typewriter or in i~k and submi'~ted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to od oining premises or public streets or areas, and giving a detai ed description of layout of property must be drown qn the diagr0m which is part of this application. c. The work covered by this application may not be commenced beforb issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progrejss of the work. e. No building shall be occupied or used in whole or in part for any pu~rpose whatever until o Certificate of Occupancy shell have been granted by the Building Inspector. · . f .; . . . APPLICATION IS HEREBY MADEto the Budding Department or the ~s~suance of a Budding Permtt pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y~rk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or far removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, h6using code, and regulations. ............ ................. (Signature of applicant, or name, if o corporation) .... ........ .............. (Addres~ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......~r~.f....~.. ........ .~.~..,ff~.. .............. (~o.O....ilC ....................................................................... . 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 .......... ~...~(~v~ ......................................................... Municipality 2. State existing use and occupancy of premises arrd intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~,~ ............................. .~,! ................. j ...................................................... b. Intended useandoccupancy .......... .~~ ......... ~2~.~. 3. Nature of work (check which applicable): New Building .................. Addition~.......~...~...~..~eration .................. Repair .................. Removal .................. Demolitian .................. Other Work (Describe) ........................................ 4. Estimated Cost ~1..~.~. ................................. Fee ~'. O~ (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 .... /..~ ....................................................................................................... Dimensions of same structure with o.lterations or additions: Front ...... ,~.,~.....r .................. Rear ...~....O....../, ............. Depth ....... ...~..~ .................. Height ....~....~ ................ Number of Stories .................. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of bt: Front ........ I1...7. ............. Rear .....4~...~..~....~'..L ............... Depth ...~..~.~..~. ....... 10. Date of Purchase ........................................................ Name of Former Owner .,i/~/~..~....~.....~...~ ...... 11. Zone or use district in which premises are situated ............................................... ;j.) ................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~1/.?.. ................................................ 13. Name of Owner of premises .~...).Ll~.g.r~.....~;~.~( ........ Address /~//~l: .~...~..~..~....~'~Phone No.Z~.~.~..:.~.?...O...?.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~.V~4,..rf~......(~...~I.J.A~.~' ........ Address ..~.¢...q.~0.~.....~)/~ ........... 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. ~ 11 ?' STATE OF NEW YORK, ~,c COUNTY OF ................................ J' .... ............ ~.l~,~). ....... : ...................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application~, ~. 0 ~,. 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 fodh in the application filed therewith. Sworn to before me this 9 (