The URL can be used to link to this page

Home My WebLink About4416-zFO]tM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .. ~. &.~ ................. Street Map No. ~10~ ..... Block No.. x,~ ...... Lot No. :1~ ...¢~4thogtm.. li.]~. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ J~l~.. ~$ .... , 19~. pursuant to which Building Permit No...~.1~... dated ......... A~II~....11 .... , 19.69., 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 .... P~$Vat,~ .a,o~mmoxT. · (.Ite~agt). -b~l~-d~J~ ....................... The certificate is issued to . .~ala & .C3.i~.~e. Fal2~Qk ..... Ol~e~. ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......... ]~,]~, ...................... Building Inspector 637o FORM NO. ~ TOWN OF $OUTHOLD 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) Permission is hereby granted to: ................ ............. at premises located at ............... ~.~ll~,&..Jil~J~lJ~lJ..J~ ................................................... pursu~ to application dat~ ........................... ~ ....... ~J ........... , 19.,~ and appr~ by the Building Inspector. Fee $....~eJJJ .......... irO~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEIIK~ OFFICE sotrrHoLD, No ¥o Examined Approved ............................. (~ ~.:. ....... , 19..~.~... Permit No ........ ,,,~,...t~...!....~...'~ Dimppraved a c ...................................................... .;;;:;.. .................... APPLICATION FOR BUILDING PERMIT I~~',....~.....! .......................... ,19..~. 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 of property muSt be drawn on the diagram which is port of thie application. c. The work covered by this application may not be commenced before-issuance of Building Permit. d. Upon approval of this application, the Budding Inspector will fssue a Bu,li~lng Permit to the applicant. Such permit shall be kept on the premises available for inspection 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 pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable L~ws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant cgrees to comply With all applicable laws, ordinances, building code, housing ~:ode, and regulations. (Signature of applicant, or name, t:l~i~.corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. ..................................................................................................................................... Nam, of aw.r of p mises ...... ................................................................... If applicant is o corporate, signature Of duly authorized officer. (Name and title of corporate officer) 1. Location of lond on which praposed work wilJ be done. J~AapNo.: ................ and A.../.... 2. State existing use and occupancy of premises and intended use and occupancy of. proposed construction: 0. Existing use and occupancy ........ ....... ...--~........~.......~...I.....~...~....'~......~...~, ................ b. Intended useandoccupancy .............. --...~.....'~....~.....~...~.../~...~.. ......... ~..../~..?...C'tL, .................... '. .............................. 3. Nature of work (check which applicable): New Buildi 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 .............. ./...~...~...?......' ....................... N~me of Former Owner ...'~..~.-~..G...~ ............................ 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate an~.~_~i~daw, ordinance or regulation? ........ ,,/~.....r2. .......................................... Name of Owner of premise~;7,))e,~'.~a:~,~/..~'~.rT'..~.e. ~"Address. ~ ~.~. ../~.~.. Phone NO ~ ~ 3. Name of Architect ...................... ~:: .................... Address ............................................ Phone No. -.7. ................ Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from 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 NEW ~RK~ ~Z ~¢ e - ' -' COUNTY,~-~"~,"~,"~,"~,"~_~/ ~F '~'," , _~OF -..~d~ ~'~'~' ............... ...~..../~.~ ................. ~ing duly sworn, d~es and says t~t he is t~ applicant (Name of individual si~ning ~lication) above named. He is the ............... :..., ..................................... ~ ........................................................................ (~ntmctor, ag~t, co~orate officer, ~c.) of said ~ner or owners, and is duly authoriz~ to ~rform or h~e perfo~ed the ~id work and to ~e ~ file this a~lication; that all statements contoin~ in this applicati~ am tree to ~e best of his ~l~ge and ~lief; and that the work will ~ performed in the manner ~t fo~h in the ~plic~i~ fil~ ~r~ith. Swom~.~to ~fo~ me this ~ ...... ~~'~ .........