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Home My WebLink About4415-zlrOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..... '}~B.T[~Tt~'"~tt~ ................................... Street Map No....~1~ .............. Block No .....~ ............. Lot No~x~X ...... ~Ct~'~tt~C""~¥~' ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. ~.I1~13S~'"11' ........... , 19.~.. pursuant to which Building Permit No..~j.~,... dated .................... .&t~EI=S~;...~t .............. , 19.....6~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 ........ ................ Px'i'va~e'"orze" ~'~m~"~" d't~'"t i'nE ................................................................................ The certificate is issued to ...}~3,..&..HTS.;....~O~LtT.~.]~L%l:Z,(~.~.~.~.~j.j;~eo~I;~i .............................. of the aforesaid building. House # 1690 ~"+' Buildin~ In~'ector"'~ ................. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FElt, MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4415 Z Dote .............. , ............ ~ ....... 11., 19..IJL~. Permission is hereby granted to: at premises located at ................... ~l~dl~..~ill~l~.~ ......................................................................... ............................................................... II~t~t~Ml~ ....... ~1.~ .......................................................... pursuant to application dated ............................. ~i~ ....... .~ ........... , 19.J~., and approved by the Building Inspector. Disapproved a/c ............................................................. (Building I~spector) APPLICATION FOR BUILDING PERMrI' ~' INSTRUCTIONS a. This application must be completely filled in by t~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 public streets or areas, and giving a detailed description of layout at praperty must be drown on the diagram which is port of thle 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-~pection 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. ~i B .A..PPLI~CATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the u~ain.g. :one Ordinance of the Town of Southold, Suffolk Count, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, adclJtions or alterations, or for removal or demolition, as herein described. The applicant cgrees to comply with all applicable laws, ordinances, building 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. ..................................... .................................................... ........................................................................... Name of owner of premises ...~.~,.....~......~....~,~ ...... .~..C~..~...~. .......... ..~...~...~....~'....~). ................................................... 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. Jg~ap No.: ......... ...~...~ .................. Lot No.: ..I..~.....~'.....].~. ..... Street a~/Number ~..~1~.~...~,..~....~...1~......~....~.~.~ ....... ...~...]~[i.i.l~a~.li~..~,.L ............ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:"~-,ff a. Existing use and occupancy ......... L~....~..-~...(..dr...~......~:)...~..~ ...(~L~ ......... u .............................................................. b. Intended use and occupancy .... .~.~..~:.L .(;L..~....F~.....~. ~....~.....L~... ......... .~L...~....~......(~..' ........................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .... ,~..,~..~......O.......~.. ............................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ................ l .......... Number of dwelling units on each floor ............................ If garage, number of cars .................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 6. ~ ~2.. Rear ~ ~ Depth ,.~ ~ 7. Dimensions of existing structures, if any: Front "7 .............................................................. Height ........ l...~.. ........ Number of Stories ...... ~. ......................................................................................................... Dimensions of same structure with alterations or additions: Front .......... ~.....~...~..... Rear ...~.....~..t~ .... ! Depth ..... ...~...~ .................. Height ...... Z...~.. ............. Number of Stories ..... J ........................ 8. Dimensions of entire new construction: Front ......... e~..~. ................... Rear ........ ..~....c./. ........... Depth '"~'F .......... : Height ..... Z..'~-........~N, umber 'of Stories ..... /. ....... ~). ........................................ ~.~: ................................................ 9. Size of lot' Front ,,/'.~....O. Rear ..... ./...~.. .................Depth ...... /. ...... ~... ........ r' · 10. Date of P~,rchose"iii'.~-'.:~IIII'Z.~''~- ....... ~..~.~'~-.,~ Nome of Former OWner .. -~)...(././~.-~'..~(/-..../~.~L .~'.....~.-.. .... 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.~.....~ .~..U...r...~... Address ~./Jl.~../..~../~..~..~...,4}./,i/~T~-,~?. ~[hone No.,~..~..~....~..~./..~..~' Name of Architect .......................... Address ............................................ Phone No ..................... Norr~ of ~ontractor CJ-~...'ff. ............. :~z..~. ..................... ,~aaress ~-. ....................................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block number or description according to deed, and show street nameS and indicate whet~er interior or corner lot. STATE OF Nk-~Y~ · COUNTY OF ...................... ~~ .............. being (Narne of individual signing ppplication) above n~med. He is the ..................... ~ ............ ~-.~'~]'~'~fi~'~'~[i ............... of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke ~d file this application; that all statements contained in this application am tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ........................ ....... ................................. Notaw ~ublic ~~'~~~un~~ (Signature of applicant) ~ '~ No~5~0, Suffolk Cou~ ~ I~ J Term Ex~re~ March ~, 1~ duly sworn, deposes and says tho¢ he is the applicant