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Home My WebLink About4241-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ............. Street Map No...X~ ....... Block No ...... ;l~g..Lot No. JClg ..... 0.r;~.¢!r$.~....N.,.Y.., .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. Al~lcil..~O 19~).. pursuant to which Building Permit No. ~2[~,~, Z, dated ....... Ap~.il...i. 1 ..... , 196.~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....P.~.$~.a.t.e.. ~.e..~.a.l~.i.~.y..d.w.e..~,~..i.~.g .................................... The certificate is issued to ... ,~.o~1~..D.o.~r~?.~ ...... ~,.~..~¢ .I' ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~,,t~, ............................. FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? Z Permission is hereby granted to: ................. ..o.;'.~.'.~t ................................................ ot premises located at... . . . T:J. llaje. Lane .............................................................. .Qrle~t ................................................................................... pursuc~t to application dated ............................. A..l~lj,:~ .......... ~0'"" 19~.., and approved by the Building Inspector. Building Inspector FORM ,NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL~RK'S OFFICE SOUTHOLD, N. Y. Approved ..................... 19 .... Permit No ................... Application No ................. Disapproved a/c ................... (Building Inspector) APPLICATIQN FOR BUILDING P~-RMIT Date .................................. 19 .... INSTRUCTIONS a. This applicati, on must be completely filled in by typewriter or in ink and .submitte~l in duplicate to the Building Inspector. b. Pl. ot plan showing location of l~t and ~f buildings on premises, relationship to adjoining premises or public streets ~r areas, and giving a detailed description of layout of p~operty must be drawn on the diagram which is part of this application. c. The work covered by this applicatk~n may not be commenced before issuance of Building Permit. d. Upon approval of this applicati.~n, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept ,.~ the premises available for inspection throughout the progress of the w, ork. e. No building shall be occupied or used in whole o~ in part f~r any purpose whatever until a Certificate Occupancy shall have been granted by the Building Inspecl00rr. APPLICATION IS ~¥ MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Opdinance of the Town of S.3athold, Suffolk Omlnty, New Y,0~k, and other applicable Laws, Ordimances .or Regulations, for the construction .~f buildings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, ................................ ' ' " (Signai~;; ~f'.;pp ' , ' rpo ' i (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ~ ~_~x~_~ ......................................... ' ................ Name ,o; '~;~;;':; ;;~i;e~ ii i~'.~.., t~.~?.'~.~'~'~ .............................................. If applicant is a corporate, signature of duly auth,orize d officer. (Name and title of corporate officer) 1. l,ocation of land on which proposed work will b e done. Map No ................. Lot No .............. Street and Number ' -~-'~ .~. · .' .................................. ......... ~r - · · Municipality 2. State existing use and oceupaney ,of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy -~ ' ................................ b. Intended use and occupancy ....~:~....: ......................................................... 3. Nature of work (check which applicable): New Building ........ Addition .....~... ,~te_ratio_~ ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) . .A:zY4Y.~. ·~. 4. Estimated Co.st ...~.~..~.',.~..~. ................... 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 ~vr mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: Front . .. ~.~. ! ..... Rear ....~..~.. ~ .... Depth . .~.--..~ ....... Height ... ?..z/. ,. ....... Number of Stories ... ~ .................................................. Dimensions ,of same structure with alterations or additions: Front ..... ~. ?. f .... Rear .. ?.?..'. ....... Depth ..... .~..~. ....... Height ...... .~.~/../ .....Number of S~ories ...?/YT.. ............... 8. Dimensions ,of entire new construction: Front .... .~...~. '. .......Rear ....2c..~.. '. ..... Depth f. ?../ ....... Height ...~. ~ ....... Number of Stories ............................................................. 9. Size of l, ot: Front .../...o.o.., ...... Rear ... ~ f..v/.. ..... Depth . ./. ?..~..'. ...... 10. Date of Purchase ............................... Name (~f Former Owner ............................. 11. Zone ,or use district in which premises are situated.....~f.~... ............................................ 12. Does proposed construction viola'q~ any z, vning law, ,ordinance or regulation? . ~ .................. 13. Name ,of Owner .of premises--.z/l.: ..~.~ .... Address .... .g~..~ ....... Phone No ............ Name of Architect . .~ddress Phone No ............ Name ~of Contractor ~.'~iii iiiiii iAddress i iiii.'.~.'~iiiii Phone No.~.2.?.~.~. ?.~. f PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ,or .proposed, and indicate all set-back dimensions from praperty lines. Give street and block number or description according to deed, and sh~w street names and indicate whether interior or corner lot. Ob~ STA'r~ OF NEW YORK, )S.S. COUNTY OF .J.'~.,~..~'.o..g ~.... ) .......... 7.~..~. ~.....~..~..~.~.~../~. ................. being duly sworn, ,deposes and says that he is the appli- (Name of individual signing application) cant above named. He is the ......................... ~.q.~..7.~..~.( .7. p..~. ................................ (Oontractor, agent, corporate officer, etc.) of said owner or ,owners, and is duly authorized t.o perfarm or have per~orraed the said work and to make and file this application; that all statemehts contained in this application are true to the bess of his knowledge and belief; .and that the ~rk will be performed in the mann er set fortM in the application filed therewith. Sworn t.o before me this ..... /..~...-~?. .... day of .... ~..~./..~ ...... 19.~. ? Notary Public, . Gounty ~/(Signture of applicant) FLOYD F. KING, NOTARY PUBLIC, State of New Yofl No. 52-7267800 Suffolk Count~, Term ~xplr~ Match 30, 19~0