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Home My WebLink About3833-zF4~RM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENi' TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~.~.~..o...h..~..?.~...l~...o..a...d. ................................... Street Map No ....................... Block No ....................... Lot No...~,~..~..~..~.~...f:..~.~?..~...~.?.*....~.?....~?.:~ ......... conform~s substantially to the Application for Building Permit heretofore filed in this office dated .......................... .~.~..~..~.~.......3. ..................... , 19...6..8... pursuant to which Building Permit No. ,~..3..8...3.~....Z. dated ............... ..~.~.~.]',......~.. ................... , 19....6...8., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ........ ~.~...t..v..a...t..e.....o......e....~ ~..z.y....~..e..z..z..~....~ ...................................................................................... The certificate is issued to .......... .C..h...a..~...~..e..~.....H...o..tl~.e..~.,...(...o~...~.,.~..~...) ...................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FOP~I NO, ~ TOWN OF SOUTHOLD BUILDING DEP~,RTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ~ BUILDING PERMIT (THIS PERMIT MUST'BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ' 3833 Z Permission is hereby granted to: Building .Inspector. ,Fee $...~*0~1 ........... et premises Iocoted at'..~.,...~.~OJ~..]~:-~' ' ,..= ...............: ...................................................... :., ....................... O~t..~.~..:: ....... :....= .......... ........... , ........................................................ ....; pursuan¢ to application, doted'. ............ . ......... ;.,..;..~.~.~..3. .............. , :19..,{~,· end approved bY thor · Building I n~pecf0r/ /': TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....~ ...... Approved ........................................ , 19 ........ Permit No ................................ Disapproved a~..........~.~ ..... ............................................. iiii.iiiiiiiii 5 ..Z,..,. .., iiiiii....i ......................... Application No....~....~.4~..~ ........... INSTRUCTIONS a. This c~pplication 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 propertymust be drawn on the diagram which is part 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 Jn whole or in part for'any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspef:tqr.. 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, ordi~a~ce~ bui~l~ing code and regulations. ,~ . ,? / ...... .......................... ..... (Signature af applicant, or name, if a corporation) ~' '~'~ 6'~''~ ' ~/:~ ~} ~( I ~') (Address of applicant) State whether applicant is owner, lessee,~nt, architect, engineer, general contractor, electrician, plumber or builder. .................................. ........ ............................................................. Name of owner of ............ : ......... .... : ............................. .......... Z...~ ......................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) h Location of land on which proposed work Will be done. Map No: ............ ~ .......................... Lot No: ...' ....... ~. .... Street and Number ........................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. fixist~n~ use ~nd occuponcy b. Intended use ond occupancy ~~ ~ ................ 3, Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4, Estimated Cost .................. ~ .................................... ~' O r,2 Fee ~ t) (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 ................................ ~.i ~/ 6 Depth . 7. Dimensions of existing structures, if any: Front .........................Rear ........ ..~. ............... .~.....~.. ................ He ght Z'.. ~ Number of Star es / ..... Dimensions of same structure w tho terat ons..Or.add t ons.:..Front...........~.......~.................Rear.......~...~....................__ ..........., ..,..... ,,,.,,,.;,.,...:~,,.,. ,.,,, ........,.......~...:.,....,...,.....,., Depth ...... ~>...~.. .............. Height ......... ~...~. ............. Number of Stories .............. f. ........................ 8. Dimensions of entire new construction: Front ........ ./....~... ............ Rear ....... ~....~.. .............. Depth .....f....~,.. .............. Height ....... /....~... ............ Number of Stories ...... ~ .................... 9. Size of lot: Front ........./~.~.. ........ Rear ........ C~ ......... Depth ......./..~. ............... 10. Date of Purchase .............. /..~,...~....~.. ......................... Name of Former Owner 11. Zone or use district in which premises are s tuated ..~ ~:~ 12. Does proposed construction v o ate any zon ng aw, ordnance or reaulalion~ ]3. Name of Owner of premises ............................................. .~ ................. Ph e No ..................... Name of Architect ............/ ............................. : ........... Address ............................................ Phone No ..................... Name of Contractor ...... i~.~. ....... Address ..?...°.,.~.~...~...~....JZ....'~.. 'hone ~xlo./..~.-~. .............. 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW (YORI~ ~ ~/~ / c c COUNTY OF ....~f °'~' ~ be~n ........................... ~.~....,........~....~..~, ......... 'g duly sworn, deposes and says that he is the applicant (Name ofiffdi~dual signing applicatio/p~ above named He is he ..................................... .'>,~2......'~....~ .................................................. (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 application filed therewith. Sworn to be~___m,e this ~~ (~ 6~._f.,,~/~' Notary Public, . ........................................................... County (Signature of applicant)