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Home My WebLink About4325-zFORM NO. 4 TOWN OF SOUTHOLD' BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy THIS CERTIFIES that the building located at ...~.~.~, .~,a$~ ,$,t;',e.e, .t; ....... Street Map No... ~ ....... Block No .... ~ .... Lot No...X~. ..... ~.0.~,t.l~.9.1.cl....~.,~.,. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........~1.?? .... b. .... , 19.6.9. pursuant to which Building Permit No...~..~.. dated ............ .~.t~..¢~ ..... 4, 19.6.9., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... .A.O. 9.e.s.~.0ry' .~ .~.~.a.~..~g..(.~?. 9.ay..~g.~.).., ............................. The certificate is issued to ...89~t.h. 9.Z.d..S. aY.~..g~.. ,~.a/.~. ........ ~.e?. .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... FOR~ NO. ~ 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? ~325 Z Permission is hereby granted to: .................. ~t.c ~ g~e ........................................ to ......... .~_~;~.~.. ~,c~...~:,~: ~ .t.~ .. ~ ~,,~ ~ .............................. . ........................................................ at premises located at ................. ~J.~..~J....&...~O~.~..i~'g ........................................................... ....................................................... ,~..o_a. ~.~g.~ .~. ........... ~.,.~,,. ............................................................... pursuon,t to application doted ........................... ~.~t~g ............ ..~ ......... , 19....J~, and approved by the Building Inspector. Building Inspector ~FORM ,NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL~RK'S OFFICE SOUTHOLD, N. Y. Examined ~...~.-~ ........ , 19 .... -- Application No ................. Approve~d .~ .................. , t9 .... Permit No. ....................... .'. '.'~ '. '. '. '.'. '. '. '. '. '. '.~'. ................ APPLICATIOiN FOR BUILDING PERMIT ate ................. INSTRUCTIONS a. This applicati.on must be completely filled in by typewriter or in ink and .submitte,d in duplicate to the Building Inspector. , b. Plot .plan showing ],ocation of ~t and ~.o~ buildings o n premises, relationship to adjoining premises or public streets ~r areas, and giving a detailed description of layout of property must be drawn .on the diagram which is part of this application. . c. The work 'covered, by this application may not b e cqmmenced before issuance of Building Permit. ~d. :,U, po.u approval ,of t~his applicati,3n, the Building Inspec%Sr will issue a Building Perrn~it to the appli~ah~. Such permit ~hall be kept ~3n the premises available for inspecti'en ~hroughout the progress ,of the work. ~ e; No building shall be occupied or used in whole o~ in pave f,o~ any purpose whatever until a Certificate ,of OcCupancy sh,all h.ave been granted by the Building Inspector. APPLICATION IS HERF_~y MAYBE to the Building Department for the issuance of a Building Permit pursuant. t.o the Building Zone Ordinance of the Town of Sc~uthold, Suffolk C~unty, New Y~rk, and other applicable Laws; ~Ordiaances ,or Regulations, for the construction ~3f buildings, additio~s or alterations, ,3r ~or removal or demo- lition, as herein described. Tl~e applicant agrees ~o com ply with all applicable laws, ordinances, building code, housing code, an, d regulations. .............. (Signature a~ applicant, or name if a corporation) ........ ............ (A~ess of hpplican~) State whether applicant is owner, lessee, agent, architect, engineer~ general contract~z, electrician, plumber or builder ............................................................................................... Name ,of ,owner of premises ......... ~ ............................................. If applicant is a eorp.o~ate, signature of duly auth~orized .~f£icer. (Name and title of corporate officer) 1. Location ,of land ,o.n which proposed work will b e ~one. M.ap No ................. Lot No .............. Street and Number.....~?..~..~..~....~..~.~. ~.. ......... ~.c~Z...~..~. ....................... Municipality 2. State existing use and .~ccupancy of premises and intended u~e and ,occupancy of proposed eonstruction. Existing use and occupancy .................................................................... Intended use an~d occupancy ......................... 10. 11. ~2. Nature of w,ork (check which applicable): New Building ........ Addition ........ Alteration ....... Repair ......... ~/val ........ Demolition ........ Othp~ W~ork (Describe) ..................... 'E,stimated Cost-, ,,... ~. ~.., ................... Fee .... .~'...~.il..~..r~. .............................. (to be paid ,on filing this application) If dwelling, numbe~ ,of dwelling unit~ ,.. ~ .... Number .of dwelling units on each floor ............. If garage, number of cars ...... ~..~.? .................................................. If business, commercial ,o~r mixed occupancy, specify nature and extent of each type of use ........... Dimensions of existing structures, if any: Fr'znt .............. Rear ............. Depth .......... Height ................ Number of Stories ....................................................... .Dimensions ,of same structure with .alterations ,or additions: Front .............. Rear ............... 'Depth ............... Height .......... Number of S?uories ..................... Dimensions ~of entire n,ew construction: Front . .~.~..~. ........ Rear .~..~..Z ...... Depth ~,~. f. .... 'Height . .l~. ~... Number ~f Stories .. '~Z;'/: ....... . /~ / , 'Size of lot: F'ront ... :..~./f ...... Rear ..... ]. ........ Depth . .(~t-.~ ......... ~ ~-~ :Date of Purchase...,.~2~.../~.~. ~. ........... Name ~f Former Owner . Zone .or use district in which premises are situated ............................... ~j,~ ................ I)oes proposed construction..~ ..~ .-. ..fl.i'°late- any z,3ning law,;ordinance~or~re~ulatilml ...... ~r~... ....... _. ..... :~... Ph.~ne · . Address Ph,~ne No ............ Name of Architect ..............~-~ i~~i¢ Name 'o~ Cont~'acPo.r ~5~....~~ .... Address th.one NoY~..~..~.~.~..'..,/~- PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ,or ,proposed, and indicate all set-back dimensions from property lines. Give sweet and bl.ock number ,or de script~on according to deed, and sh~w street names and indicate whether interior ,or co~ner }or, .7' STA : OF v Ypr . COUNTY OF .~./..~W..c. 7. ) (Name ,of individual signing applicati, on) . cant above named He is the 13 ............................ (©ontractor, agent, corporate officer, etc.) of said owner ~or ,owners, and is du y auth~orized to pevf~zrm or have perfiormed the said w~c~rk and to make and file this applicati, on; that all statements contained in th is application are true to the best of his knowledge and belief; and that the w, ork will be performed in the mann er set ~orth! in the a~pplication filed therewith. Sworn ~o before me this ................ day ,of . .. 19. N,3ta2y Public, ©ounty (Signture of applicant)