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Home My WebLink About4374-zFORM NO. ~ TOWN OF SOUTHOLD BUff.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certifi te Of Occupancy THIS CERTIFIES that the building located at .l~. ~iddle. ~ ........ Street Map No ....;~ ......Block No. ~ ....... Lot No.X~... ~.o~ttko~d.. I/,]/, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............Jvl.~ .. 9.., 19.69. pursuant to which Building Permit No...~.3 .~... dated ............July. · · · ~., 19.6~, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for Which this certificate is issued is ... Pe. iva~e. (&~cesso~¥)..toel. shed. & .storage. bldg ................ The certificate is issued to ....... ~h01~.~. ~ol'Y.i$ ..... ~ll~t~ ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ .N...R... ....................... ...... ........ ~O]~U~ 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? 43T Z Permission is hereby granted to: ~ . ............. ~ ~ ..~.~,le....A~;~..:~l:baa.. ~1~ ........ .................. A~.ue~o~e. ......... I~,,~.~ .................... to ......... )l~.~.a....~1~..~.¢..e***~. ~ ~.¢.t~:...~,1,~I:L~ ............................................................................... at premises located at ............... ~4~........~;l,~,tR..~t~.~,..*(-~F.)· ..................................................... ............................................ ~t~,....~l,~o .................................................................................. pursuant to application dated .............................. ~,.~.....~ ............. , 19.~1~., and approved by the Building Inspector. Fee $.-...~[4~.00 .......... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ ,I9 ........ Permit No ..... ..~. ...... ~) .~......~ .... ~ Application No ............... ..~ ........... Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PERMIT ........... ....................... 7. INSTRUCTIONS a. This application must be completely filled in by b/pewriter 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 pub c streets or areas, and giving o detailed description of layout of 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 Perm t to the applicant. Such permit shall be kept on the premises available for inspection throughout the progr=-~,s of the work. e. No building shell be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. B .A.P,.PLI~CATIO~N,IS H.£REB, Y,/V~DE to .th_e Bu. ilding Department for. the issuance of a Bud ng Perm t pursuant to the uilaing cone urainance at me ~own of 5outhold, Suffolk County, Nev~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, ordinances, bu!lding code, housing code, and regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent., ~rchitect, engi.neer, general contractor, electrician, plumber or builder. Nome of owner of premises . .~..~'~'/~ ....~....~ ............................ 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 he done. Map No.: ........................................ Lot No.: ........................ Streel' ond Number ............................................................................. 2, State exi~ing use a~ ~cu~ of pmmi~ and in~end~ u~ a~ ~cu~ncy of pr~ ~i~' a. ~isting u~ a~ ~cu~y ~~ , . ............... b. Intend~ u~ and ~cu~ .................... ~...=.....:..~.~ ........................... 3. Nature of work (check which applicable): New Building .... ..~,~ ....... Addition .................. Alterotion .................. 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 cots ..................................................................................................................... : ....................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Pear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with olterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ~ ...................... Rear ........ /...~. .............. Depth ...... .2~...O.. .......... Height ........ ~.~ ....... 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 ....~.D...~...../~...e..~.L~. ........ 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-bock dimensions from property lines. Give street and block, number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NL~O~,fl ~/' _ ( e e COUNTY C~ ........ ........................................ I. ...... I ............ x:......* .......................... being duly ~wom, d~mes ond ~oy, t~ h~ i~ t~ ~ppficon~ ~bove nome& He i* th~ ............... ~.mm.~..u...~ ............................................................................................... (C~tmctor, ag~t, co,orate officer, ~c.) of said owner or ~ners, and is duly authorized to perform or h~e perfo~ed the ~id work and to ~ke ~d file this application; that all statemen~ conta;ined in this opplic~ion are tree to the best of his knowledge and ~lief; and that the work will ~ performe~in the manner ~t fo~h in the ~plicati~ fil~ therewith. ........ ........... Notaw Public~~.~~ Coun~'~~'""(~;~ '~"~ii~ ............................. ......... ~ .... ~ ~'" ~plres March ~, ~