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Home My WebLink About4203-zFOF~f NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .... ~,~.~OZl..,~,~Ze .......................................... Street Map No ..... ~ ............. Block No. ~r ................ Lot No..Z,~ ......... ~l, lr,~;tl~k, ...... .l~,,.~e .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. Harr~.h .......... ~1~....., 196~)... pursuant to which Building Permit No. I+~,,~)~rZ .... dated ...................... ~l~e~l ....... '1~ .......... , 19.~/.., 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 ........ ........................... P.~.~rat~..c~n~. · ~%m.l.t ¥. · ~lue t..I..~ g. ..................................................................... Yhe certificate is issued to '~OU:~'g...[~9~I'(~..&..,~.~'~ ............. ~e~ ....... : .............................. [owner, essee or termnt) of the aforesaid building. ~ouse # ?IF Building In~3~ctor ...... FORM 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) lq? 4203 Z O~te ....................... ~ ....... ~ ........ , ~...6.~. Permission is hereby granted to: ............... ]~a..I.e~ae~ ................................. ............... ~t .~J..t,.~e~, .......................................... to ...... ~u~ld..~..~ ~.t~c~..e~ ..~m.. ~t,~u& ..6~.e:Ll2~ug ................................................. at premises located at .......... ]~O~..~.~'e .......................................................................................... ........................................................ ~ t.t.i.tueII;....~.¥.~ .................................................................... pursuan,t to application dated ......................... ~.~. .......... 'J..~.. ............. , 19...6.~.., and approved by the Building Inspector. BUILDING TOW'N Cv~w"S OFFICE SOUTHOLD, N. Application No..~..~ · .~. ....... ~ Approved ........... ......... ,19. ~' Permit No .................... Disapproved a/c ..~.../ ......- .--..... APPLICATION FOR BUILDING PERMIT Date .... .~.~: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plotplan showinglocation 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 part 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 In spector 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 shall be occupied ~r used in whole o~ in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS ~17~y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Oounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to cum ply with all applicable laws, ordinances, building code, housing code, arid regulations. ~ .~...~. (Signature of applicant, or, name if a corporation) State whether applicant is ow~neL lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ..................................... . ....... ~ ........ ~ ........................ Nameof ,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 be done. Map No ................. Lot No .............. Street and Nu .................. Munic~palit 2. State existing uSe and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ....... ~/~D~_F_ .................................................... b. Intended use and occupancy ........ /~-~.; ............................................... 3. Nature of work (check which applica,ble): New Building ........ Addition ........ Alteration ........ Repair ......... Remov~.~ k~~._~ Demolition ...... ~'-"~ Work (De~ribe) 4. ~imat~ C~t ~' Fee ~ - (to be paid ~ fil~g this appli~tion) 5. I~ dwelling, number of dwelling units .......... Num~ of dwelling uni~ on each fl~ .... [ ..... - ~ ~arage, number ~ c~ 6.. If. busings, .~m~cial ~ mix~ occupancy, spec ify nat~e ~d extent of ea~ t~e of use .............. 7. D!mens~ ~xisting s~ctur~, ff ~y: ~nt ... ~.(/. ..... Re~ ..... ~.' .... Depth .... ~ ....... Height ................ Number of stories ..... ~. .................... ' D~ensions of ~me s~ct~e with alt~at~ans er additions: ~nt ..... ~q ...... Re~ .... ~..' ...... ~p~ .. ~ ~ ' Height ~- ~ N~b~ 0f S~es ..................... 8. Dimensions of entire ~w ~ns~ion: F~t ................. Rear .............. ~pth ............ HeiSt ............ Number of S~ ............................................................. 9. S~ of ~: Front ................ Rear ..... ~ ~ ........ ~pth ............... 10. Date of ~ ............................... Name ~ F~er Owner ............................. 11. ~ne ~ use disWict in whi~ p~mi~s ~ situa~ .................................................... 12. ~s pro~ con.ion vicine ~y ~ing law, ~r~ or re.latin? ........................... i3.... N~e ~f O~f premises ..................... Addre~ .............. ........ P~e No ............ Nme of ~ite~ ............................. ~dd~ ...................... Pb~e No ............ ~e, ~ ~n~ac~r ..................... ~ ......Addres~ ....... k'i.'~ ....... Ph~e No ............ . PLOT D~G~~ ~~'~ ~ ~'~' ~ate ele~ly ~d di~ly all ~din~, whether existing--or ~s~,~ and ~n~ ~1 ~back ~ens~ns f~m ~y lin~. Give"s~eet ~d~k num~ ~ des~pt~n ae~g to de~ ~ show ~et ~ and indica~ wh~ inte~~ ~r ~ ~t. ~ . [ STA,T'~, OF ~ YORK, )S.S. cOUNTY OF ...... : ...... ~ ~' ~- - -----~' being duly sworn, deposes and says that he is the appli- (Name of individual signing apRlic~ti~n) cant above named He is the (Oontr~etor, agent, .corp~, ate offider, etc.) of said 0~r~,~r owners~'and is duiy .a~ized to .perform Or have per~o~aed: the ~aid :WOrk and to make and file this application; that all statements contained in th is application a~e true to the best of his knowledge and belief; and that the work will be perfmuned in the mann er set forth in the application filed therewith. Sworn to before me this ~~--~~~'~ .~ ~, .... ........ · ! .I'll. ....... day Of Notary Public, ..... .~..~. J..~... Oounty o ................ NOTARy PUBLIC, State of New York