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Home My WebLink About4295-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at Lupron..Pt. l~oad ........... Street Map No. L~pton. Pt · Block No...Xx ...... Lot No ...... x~ ...l~attttuak... ~.¥,... conforms subst~ti~ly to the Application for Buil~g Pemit heretofore fil~ M tMs office dated ............ ~y .... ~, 19..6~ p~su~t to which B~ding Pemit No.. ~ Z dated .......... ~ay .... ~6-', 1969' was issued, ~d conforms to ~1 of the req~e- ments of the applicable pro~sions of the law. The occupancy for which this ce~fficate is ~su~ is .Pr$~te. ~e. f~ly..d~g ....................................... The certificate is ~sued to . ~obe~t. B~o~ ........ ~e~ .................... (owner, lessee or ten~t) of the afores~d b~l~g. S~olk Co~ty Dep~tment of He~th Approv~ .... N,R, ........................... House ~ 123~ FOI~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~295 Z Building Inspector. Fee $ ........................ , ..,z..:: ~ ~::. "~z~... ~.,.-~...\zC~.. ~ ................... Building Inspector Disapproved a/c ~ ............................................~i ...... ......... . ....... ....... APPLICATION 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 showin.g, 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 proflerty 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 BuJ. ldlng Inspector .will issue a Bu, il.dJng Pe. rmit to the applicant. Such permit shall be kept on the premises oval able for inspect[on throughout the prngress at me 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 pu_rsu~..nt to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y, ork, and other .appli,c. able La~., Ord[ .nanc.e.s o,r Regulations for the construction of buildings, additions or alterations, or Tar removm or aemodtion, as narein aescriDea. The applicant agrees to comply with all c~pplicable laws, ordinances, ybc)ilding code~ housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...... ~::>......~....~..~...~.. ....... ...~....~...../'=---. f...~..../....~..,.~.../-.-.=..'~. · ............................. If applicant is a corporate, signature of duly authorized officer. '~' (Name and title of corporate officer) 1. Location of land on which p~ work will b~,_done. Map No.: ...................................... ._.Lot No.: .,?.., .............. Street and Numoer .......................................................................................... '~i~t'l~' ................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. ,-- and ....... ............ ................ ........................ 3. Nature of work (check which applicable): New Bu td~g ;.., ............. Addition .................. Alteration .................. Repair .................. Removal .................. Demol'itio~; ................. Other Work (Describe) ........................................ 4. '-tim~ C~. ....................... /.. .............. ;...., ........... ~ .... ,..'~....~ ................................................................... ..~.N (to be paid on filing this applicotion) 5. If dwelling, number of dwelling units .../....../~.../~...../~.~..Z:. umber of dwell, lng units on each floor ............................. If garage, number of cors ............................................................................................................................................. 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 ......~.......'~....". Heiaht ...... .~....~ ....... Number of Stories ............................................................................................................... Di;~nsi~;~s o, ,me st cture o,t.r ,ons,or odd,t,ons: ront ........ .ear ................ Depth ............. ~...O. ............. Height ......... ~ ............ Number of Stories ............. ./....~.,,~... ....... 8. Dimensions of entire new construction: Front ................................... Reor ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... ""7'_ · 0 0 t {75-./..~"1.~< o ~. S~e o, ~ot: Front ....... ../...C..~ ......... Rear .......... l ..................... ~p h ........................... ~0. ~te o+ P-rchose ........................ ./.~..~..-.:-Z.....~ ........ r~ o~ ~o~er ~ner ..... ''..r:.~.~..,y..q ........ ~.?.....e....-~...W..... ~. Zone or use d~str~t ~n which ~rem~ses are s~tuoted ...................... ~...: ....... ~.~~ ............................ 12. Does proposed construction violate any zoning law, ordinance or r.e~ulation? ......... ~ ...... ~ .................................. 13. N ......f Ow ...... ~ ..................... ! ~jO~l~o~ hJ.~'. / Name of Architect ............................. ../, ................... Address .~.~.. ...... J.I...~..~-~ .............. ..... Phone No ..................... Name of Contractor .................................................... / Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or pr,.~osed, ,and indi,cat, e all set-/oock climensic.~..- .from property lines. Give street and block number or description accoramg to aeea, aha snow street names and ~namote whether F~terJor or comer Io ~.~'~T' I~/~ ~ STATE OF NEW YORK, ~ e e COUNTY OF ................................ ~'~* ............... . .............................................................................. .= duly , __~___ and says that he is the applicant (Name of individual signing application) ~ .../~....~:....A~:....~.... - above named. He is the ....................................................................................................................................... (Contractor, agent; corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perforr~, the sai.d, wo,rk a,nd.to .make and file this application; that a statements contained Jn this application are true to the host ot his Know,eage and belief; and that the work will be performed in the manner set forth in the applicatlj~rrlfiled therewith. Sworn to before me this )~_ ~'~. ~ / ~ Notary .............. Z...~... day of ......................... ~',_ ~/-,-/~ ..~.~.....~....., 19~,oun~y~'~l:~p~~ licant) :.....:.. ...... ..................... p~ic,. ......................... .,~..~,~ ...... ~^,¥ ~,~,c. s,,,~ o~'~,~'" "' "~ ~l~rm [xpires JJarcJt 30,~ ~