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Home My WebLink About4324-zFOBM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .l~/O0.da.~,i;L'* .D~,Y.e. ........ Street Map No. ~ ........ Block No..~..-~,. ..... Lot No. :X~Xx. F~g.~ll;%l~k..~, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .J~..~..., 19.6~. pursuit to which Building Permit No. ~32~.~.. dated ........... 4~.e..~ .... , 19~., was issued, and conforms to all of the require- ments of the applicable provisions o~ the law. The ocCUPancy ~or which this certificate is issued is . ~.. ~..~. ~$$~g. ~..~ ...................... The certificate is issued to ~.~!~m..~ ~. ~$9~ ...... ~Q~ ....................... (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department o~ Health Approval ~ ,R, ............................... UNDERWRITERS CERTIFICATE No~.~ ........... ............................. HOUSE NUMBER . .3~ ......... Street .. ~qO~C~f$. ~ ..................... ......... ........... FOl~I ~0. ~ 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? 4324 Z D~te ~11~ I~ m 69 Permission is hereby granted to: .................. ;~..~ ~ :~.~...&:...~.~.3..e~. .................. at premises located at ........................... ~'~.~.)...~°..9.~.°...]:~.:.-.¢;...~:!r.~.e.. ................................................... ................................................................... ...~...~.t.~..e.~ .......... ~.~.~., .................................................... pursuan¢ to application dated ........................... ~..'~.~ .......... ~ ........... , 19...~.~, and approved by the Building Inspector. Fee $ ........................ Approved ........................................ , 19 ....... , Permit No ...... .~. ........... .~..'... Disapproved a/c .............................................................................................. BUILDING DEPARTMENT ~ ' ' I . / SOUTHOLD, N.Y. q'/~/'7~ App,,.,. ................. ........................... APPLICATION FOR BUILDING PERMrr INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plo? plan showing location of lot and of buildings on premi~es, relationship to adjoining premises or public streets or areas, aha giving a detailed description of layout at property 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 Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for ir'Aoection 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 have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pureuant 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 w~th all applicable laws, ordinances, building code, housing code, and regulations. ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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.: ........................ Municipality ....... 2. State existing use and occupancy of premises and intended use and occupancy of propo~cl construction:. a. Existing use and occupancy ................................................................................................................................. .. b. Intended use and occupancy ............................................................................................................................. ~... 3. Nature of worth-(check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... ~'..~...../..~..¢.....~.. ........................... Fee ...................... ..~...'~...'....~... ....................................................... (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 some structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ./..~.......~... ....... Rear ............. ../..~..~....'~.. Depth ...... ./....~........~-..~... Height .....~...//~:.....~...~.'. Number of Stories ..................................................................................................................... .9. Size of lot: Front ............................ Rear ................................... Depth ................................ 10. Date of Purchase ........................................................ Nome 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 ............................... : ........ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF (Name of individual signing application)/' 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 oil statements contained in this application ore 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. Swam to before me this · ...... aoy of ......... ............... , ' , ·" _~a'o j ,,~'/'~ ~ :~ ,..~/...~.~r~r~./..:..~ ..................... Notary Public,~.~.~d~f~.~,ount~ (Signature of a~l~/' ..