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Home My WebLink About4220-zFOl~i i~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT '~OWN CLERK'S OFFICE SOUTHOLD, N. Y. P.£RTIFII2ATE: OF OP..P-UPANCY THIS CERTIFIES that the building located at .~.. :..~..~.o...O.~..~..~...~1~...!~...~Street Map No ............. Block No ............. Lot No...~..~.~;~,~;.~.,..~.~g..~'~k ......... conforms substantially to the Applicati. on for Building Permit heretofore filed in this office dated ..... .~..~..~....~.~.~ ........ 19. ~.~l pursuant to which Building Permit No...4.~.~.0. ~[ dated .... .~.1~..~.1....1..~ .......... 19.~..~., 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 .....[~..1.~.~.t..O...0~..0...~...~..J..~'...¢~..0.~.1. ~_¢_¢_~ ........................................ The certificate is issued t.o .... ..1~..~....!~.:.~.~ ..8~..~..tl~. .................................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ......................................... Building Inspector 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) N? ~220 z Permission is hereby granted to: .................. ........... ............................... ~.~...P,. ......... ~!..!.. ~.i..L..--..,~. ~~a' ................................................. ,~,~,...~...7..!...t..Z...u c ~< to .................. 6..,0..~ ................... ~..C:....r~..~.<L.g.../...K. ................................................................... atpremiseslocotedat 2tO(_.) ~7 /1~e ~/~.. ~P'~P /Ot~7~'L~ ~'~ ....................................................................................... ~..A..~...~..~...g.C.~ ......................... pursuan.t to application dated ............................ d ........ ~..~.(X ...... , 19..~.~ and approv~ by the Building Inspector. Fee $.....~ ............. Building Inspector ~F,O, RM ~NO. 1 TOWN OF SOUTHOLD BUILDING I~EPAR'rM~NT TOWN CLW~RK'S OFFIC~ SOUTHOLD, N. Y. xamined ........ / .~., 19 .... Appravecl ......... l...~.~.. ,19 ~ Permit No .... .~....~...'~...~...~.. Disapproved a/e .!~ ....... (Build4ng Inspector) Application NO. V~ ~ ~ APPLICATI(XN FOR BUILDING P~RMIT Date .................... .~././'.~...~.. 19..~. 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 l~t and of buildings o n premises, relati~a~ghip to adjoining promises or public streets or areas, .and giving a detailed descripti.0n of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may n~t be qommeneed before issuance of Building Permit. .d. Up(m approval of this application, the Building In specter will issue a Building Permit to the applicant. Such permit shall be kept ~n the promises available fo r inspection throughout the progres~ of the work. e. No building shail be occupied or used in whole c~ in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspecttor. APPLICATION IS I-I]~-~Y MADE to the Buildi~,n..g Department for the issuance of a Building Per~.. it pursuant to the t~uild~ng Zone Ordinance of the Town of Southold, Suffolk Oounty, New York, and'other apphcable Law~, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for romoval or demo- lition, as herein described. The applicant agrees to corn ply with all .applicable laws, ordinances, building cede, honsing cede, and regulations. ~ (Signature of al)plicant, ox name if a oorporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .................................................................................................. Name ,of ,owner of premise~ /4// J~>-~ H' ~:~. .~ /t/] ] ~ If applicant is a corporate, signature of duly authorize d .oTTicer. (Name and title of corporate officer) 1. Location of land on which proposed work will b e done. Map No. :...~ ......... Lot No .............. Street and Number~.( ..... ~..?. '~'Q......~..~. · .'~..~. ..... '. · .~. - ,~..x'~ ~..~- h' '~'/' -/----' '/~'~' · '~ ............ ~'> Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy .................................................................... ~.1/ b. Intended use ,and ocCUpancy .~/. 3. Nature of work (check which applicable): New Building ........ Addition ........ teration ........ Repair ......... Removal ........ Demolition ........ Other ~ (Describe) ...................... 4. Estimated Cost .......... 3 .................. Fee .... .___'/fo'~; ' iia '~'iii'~6 ~i~:~i ...... 5. H flwe~ing, number of dwelling units .......... Number ~f dwelling uni~ on each fl~ .............. H garage, number ~f cars .......................................................................... 6. H busin~ comm~ci~ ~ mix~ occupancy, specify nature ~d extent of ea~ t~e of u~ .............. 7. Dimensle~ of existing structures, if any: F~t .............. Rear ............. ~pth ............. Height ................ Number of Stories ........................................................ Dimensions of ~me s~cture with alterat~ns or additions: ~nt .............. Re~ ............... Dep~ ................ Height ................ Numb~ 8. Dimensions of entire new constm~ion: F~t ................. Rear .............. ~pth ............ Hei~ ... Z~. '. .... Number ~ S~ories .............. ~ ............................................ 9. S~ of ~t: ~ont ................ Rear ............... ~pth ............... F~er zOwner ............................. 10. Date of ~rc~ ............................... Name of .[_[[~ , ~' ~ ~q.'l .......... 11. Zone ~ use dis~ct in whi~ premises are situat~ ............................ 12. D~s pro~ co~ction~olaie,~Y ~w,o~in~ orf~i~/;~ ....................... 13. N~e of Owner.of p~m~ses ..................... Addre~ .................. ~ P~e No ............ Name of ~chite~ ............................. ~ddre~ ...................... P~e No ............ N~e ~f Con. acer .~...~.~ ........ Address ...~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or .proposed, and indicate all set-back dimensions from property line6. Give street and block number or de scription according to deed, and show street names and indicate whether interior or corner let. STATE OF NEW YORK, )S.S. COUNTY OF ..............) ......... . .~..,~. ..... .~..~..~..~..~: ....................... being duly sworn, de~s~ and ~ys ~at he is the appli- (Name of ~divid~l signing application) c~t a.~ve n~ed. He is the (~ntra~r, a~t, ~ate ~icer, etc.) of ~id owner ~ Owne~, and ~ duly auth~r~ ~ p~orm or have pe~ ~e ~id ~k ~d ~ make ~d file th~ application; ~at ~1 statements ~ntain~ ~ ~is appli~t~n ~ t~e to the best of h~ knowl~ge ~d belief; and ~'at ~e ~k will be pe~ in ~e mann er set fo~ in the application filed ~e~with. Sworn to befo~ me ~is ..' ......... /. daY N~ ~~ .......... ~ ~nty ~. 52-8125850, Suffolk Co~y ~tm ~pires Ma~ch 30,