The URL can be used to link to this page

Home My WebLink About4471-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. C£RTIFICATE~ OF OCCUPANCY THIS CERTIFIES that the building located at Jl~.~lJ[.a[,~ ........................................ Street conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................................... JjJ. l~JJ.~.,...~..,.,, 10.i~... pursuant to which Building Permit No, ...~...~.~...~.... dated .................................. ~p~,....2~.., 19....J/l~ 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 ...... The certificate is issued to ...~J~LIIIII...~JJ~II~IJ .......... IJ~J~lJ~. ........................................................ of the aforesaid building. House ds ~'30 ~ovn sTstem ~03 G~pt P,Oe (owner, lessee or fenant) ...........'l~'~'~'~'"'"'~'~'~'i:~I' - BuiJding ~n" spector ..................... FOlt~ 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? 4471 Z D~e ...................................................... $.e.~.t ~ ,19 ........ 69 Permission {s hereby granted to: ................ ~.~ e~ ..~T.o~.. ~v~..¢o~... J~C ~e ........... 9~.3,.,..~..-~ ..................................... .................. ~z~e~.~ ........................................ to ........... ~d...~..~d£~oz~..om..~¢~i.~g..~lw~ll.~ ................................................... at premises located at ................. ~...].;1.~t,..~15 .......... [~.O.~...~.....D..~.....,.{~...... ~..u.~.~. ................................ ........................................................ G~e.e~o~.~ .................................................................................. pursuc~¢ to application dated ................................ .~..~J.~.....~. ........ , 19...6.~.., and approved by the Building Inspector. Fee $..,~.~ ............ Building Inspector TOWN OF SOuTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ~ C( A~raved ........................................ , ....................... Di~ppr~ed o/c ............................................................... .................... ~-~....~..-~..-~-......I .................................. APPLICATION FOR BUILDING PERMIT ......................................... INSTRUCTIONS a. This application must be completely filled in by typewriter 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 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 inspection throughout the progress of the work. e. No building sh~ll 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 o Building Permit pursuant 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 with all applicable laws, ordinances, building code, housing code, and regulations. · (Add re;~:' ;~" '~'~ii~ ~ii ~' .................... State whether applicant is owner, lessee, agent, architect, engineer, general confroctor, electrician, plumber or builder. ....... _.,_ .................. ........... Name of owner of premises ....~.~....~...~/....'~... ........ ..~....]L~...~....~.~.....~.. ................................................................................. If <~,~corpo~ignature of(~~cer. ........................... .~. ....... ~ ...................................... ~// (Name and title of corporate officer) 1. Location of land on which pmp~ed work will ~ done. Map No.: ............... ~ ............. Lot No.: ....~. .............. Str~ and Number ...~.~.~....~.~.~.~.~ ........ ~ ................................................................ ' ~I ~ ~0 ~ 2. State exi~ing use ana ~cu~ of premiss and intended use and ~cu~ncy of pr~os~ con~mcti~: a. ~i~ing ~e and ~c~ancy ....... .~.~.~.~ ........................................................ b. Inte~ed use and ~cupancy ....... ~ ~ .. ~.~ ~ ~ ~. ~.. . 3. Nature of work (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 an each floor ............................ I..,f garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. D mens ons of ex st ng structures, if any: Front .......... ~.....~.. .......... Rear ........ .~'~...-..'"..~ ............ Depth ........................ t~ Height Number of Stories ............~ ..................... ................................................... ~ ........................ Dimensions of same structure with alterations or additions: Front .......... ~.c~ .................. 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 .......... /.....~...o.. .............. Depth ................................ , 10. Date 'Of Purchase ........... /.~..~....Z....-~.. ....................... 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? ......... ..~../l.e~;. ...................................... 13. Name of Owner of premises .~..~.,~.~.~..~F-/~Address ...~...O..~...E~..~....~..,~..~.~P~o~n~Nc~i~.~.~...../....7..~..'.~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...'~..~..~%1~'..~..~.,..~.~...~ ............ Address ~/.~.'~.t~..~....~....~.~...~one Nc~-...T..7..~.P.,~. 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 YORK, ~ e e COUNTY Of ..: .......................... $~'~' ......... ..~..~.~,Lg..~. ....... ~..~.......~..o,..~.~/..~...~%... ............................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ..... C~:..'~/~..~..~..~.....~...~..~.i~;.~r~..~....~.../~.~..ns......~...~.~...~...~.C~.~.~..~ ....... -) (Contractor, agent, corp6rate 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 all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ,~ ...... ...... ....... ,rt.' ........... . ..................... Notary Public~.L,/,,~A¢.2~.~-~.J(~.....,. County ~ ~ (Signature of applicant) ............... NOTARY pU~L , No 52.8[~5850, Suffolk( CoJ~llty - Te;m Exp!re~ March 30,