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Home My WebLink About4542-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No~.3894 .................. Date ........................ ,T~..~ ......... ~ ......., 19..~O. THIS CERTIFIES that the building located at ..~$&~,l..~t,..~,O&d .................................. Street Map No. N&s,,..l~t,~.... Block No ....................... Lot No...~.1 .......... C~13,t~h~j~le ....... ~,Y, ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................... NOV ....... ~. .............. , 19...~i pursuant to which Building Permit No. ~.2~... dated ........................... ~O.V. ......... .~[ ......... , 19....~.¢~ 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 ........ ........ .q.~ve, t, e.. ~z~e .. ,f~n~;t.~.. cl, vel..~ .~r~ ........................................................................................ The certificate is issued to ....~.~l~.lteCl..~la, klll~ ................. 0~'te~' .................................................... (owner, lessee or tenant) of the aforesaid building. House ~ 692F Building Inspector I:'ORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT Ot',l THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 4542 Z Permission is hereby granted to: ...tl~,,..ab.l.e~,a....a~..~..g~.. at premises located at ................. ][~..~,....~14111~,i...~PO~l~l.~-JO~,,e...~ll~ ............................. : ....... ..................................................... Iia~ma..~,lat..ae~ ......... ~~m ........... :. ..................... Building Inspector. Building Inspector APPLIGATION FOR BUILDING PERMIT 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 ~reas, 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 in whole or in part for any purpose whatever until a Certificate of Occupancy shall liave 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. 'Fhe applicant agrees to comply with all applicable laws, ordinances, building code add regulations. ..... p. .... ....... ........ ^iia';;ss of State whether applicant is owner, lessee, agent, arc,~ect, e~neer, general contractor, electrician, plumber or builder. Name of owner of premises ........... ~ ~ ........ ...~....~ ........................................................................................... If applicant~is a corporot%,~ignature of duly authorized officer· ................... ................... 1. Location of land o_~n which proposed work will be done. Map No: ........ ;~ ..................... .....~ ....... Lot No: ....~'.../. ........... Municipality 2.State existing use and occupancy of premises and inten~e~d,~,u~z.~d Occupancy of pr. aposed construction: a. Existing use and occupancy ..................................... .~..~...~;~...~-~r,;8' .................................................................... b ,nte.dedus. a.'o u onc · a cc p y ...................................... :.7.r.~z.~. ....... ~....; ...................................................... 3. Nature of work (check which applicable): New Building .................. Addition / Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... /zy', ~'~::~ -00 Fee 4. Estimated Cost ....................... ~ ............................................................................................................................. (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 ...... .3...2. ....Rear ......... .3....Z, ........... Depth Height ........... .~-..~..~ .......... Number of Stories ...........~, ................................................................................................ Dimensions of same structure with alterations or additions: Front ............. ~..Z. .............. Rear ....~. ......................... Depth ......... ..3...5~... .............. Height ............ ~.~.. ............ Number of Stories ............~ .......................... 8. Dimensions of entire new construction: Front ............................Rear ....... ~.....~.../. ........... Depth ......~. ................... Height ............ ..Z..~. ........... Number of Stories ........ .~. ................. 9. Size of lot: Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ................. ~ .................................. 13. Name of Owner of premises ..... ~ .............................. A ............... ,~ ...................... , ............................... Name of Architect ...................................................... Address ............................................ Phone No ..................... o Name of Contractor z~c6~e ~¢~ Address ..~........~...~...~'~.;~h~..~ ...... Phone No. PLOT DIAGRAM Locate clearly and distinctly all bu Id ngs, 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 ndicate whether interior or corner lot. ° STATE OF NEW YORK, ~, S.S COUNTY: OF ............................... ~ ' ,~ ~ ~"~ ?-~.q~: ....... bain duly sworn, deposes and says that he is the applicant ....... ,....-;...,..-....~. ·., ........... g . (~ame of individual s~gnmg app.cahanl above named. He is the ........ (C;~';'~,"[~';t/ of sa d owner or owners, and is du.ly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this a.ppli.ca.tion.,are t.m.e _.to t.h.e, be.st of .h. is knowledge and belief; and that the work will be performed in the manner set torth m me app.ca~on ~led therewim. Sworn to before mea thiS..of ~ · · n .......... / '/u ........ .................................... Notary Public, ~~. '~"~'p~~ O(Signature of applicant) -- ~' ,/ No. 52-8~.~5850, ~ruffolk'"~°U,~J~ Term Expires March 30,