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Home My WebLink About3673-zFORM NO. 4- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~ .~ ..... Date .......... ~[~l~h~'.. 9 .... , 19.6?- THIS CERTIFIES that the building located at ~$t -~,[Ol~. &-~ .......... Street Map No.. :~ ...... Block No...~. ...... Lot No. ~ ..... ~t:[~lak ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~l;obol~.. ~.., 19.6~ ~ursuant to which Building Permit No..~7~.~ dated .......... ~t;' ' ' ~[~ ...., 19. ~?, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . l~vato .one -£~i-~y' d~olli~[ ...................................... The certificate is issued to .. l~%h. 1~[,~1~l ....... ~1~o~ ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... ]~.,..E,, ...................... Building Inspecto'~ TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFiGE SOUTHOLD, N. Y, BUILmNG PERMIT' ,(THIS PERMIT MUST BE KEPT ON THE pREMI~£S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) pursuan¢ to application dated ...................... jj~j...~ .......... ~;~....i ...... , 19.~.., and approved by the Building Inspector. ~Fee $~,0,0..~ ............ · Building 'Inspector FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENTI TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined ..................................... , 19. .. Approved ........................................ , ........ Permit No .......................... Disapproved (Building InspeCtor) Application No....~....~...?...,~.. ....... APPLICATION FOR BUILDING piERMIT Date .~. ............ , I .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ilk 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 9n the diagram which is part of th s app cation. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will jssueia 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 or used in whole or in part for any pu]rpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION 1S HEREBY MADE to the Building Department for the i~.suance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y;)rk, and ofher applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or f~r removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances,~uildi?g code and re~qlations. . ........ ............ (Signature o~ opmicant, or name, t a corporat on) ....................... ....... ; (Address of applicant) -- State whether applicant is~__~r, lessee, agent, architect, engineer, general contractorI electrician, plumber or builder. ............................... i ......................................................................... Name of owner of premises ...... ~ ........ : .................................................................... If applicant is a corporate, signature of, duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done~ Map No.: ........................................ Lot No.: ........................ Street and Number ..~...~. ~ '~*~'Z Z.~..~.,~.. ~ .../-~'......~.. ............................................... Municipality State existing use and occupancy/J ~/ ~ ,,°f premises and intende~J~use anc~ occupancy of proposed construction a. Existing use and occupancy .~.~./-,~../~.~.~J~.~..~'~../.~.~/~.~--~..~.. ..................................................... b. Intended use and occupancy /.Z i/ ~ J! 3. Nature of work~heck which applicable): New Building .................. Addition ......~.. Alteration ..~ ....... Repair ........ ~/.~ ........ Rer~)val .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........ ~"~/~-..~....~......~...~....~..t..¢....O. .................... Fee .............. ' ............................................................................ (to be paid on filing this application) 5.If dwelling, number of dwelling units ........ 4~......~....~.......Number of dwelling units on each floor ............................ If garage, number of cars .............. ~.~ .................................................................................................................. 6. f bus ness, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of.o~.~istin~,~ structures, if any' ................... Front ~ ~%.~. Rear ~.~ ..... Depth ~%. ¢. Height .~..~.~T.~. ..... Number of Stories ...... ~J~ .................................. ......................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number~ _°f Stories ..................................................................... / __~ ~ ¢, ........ ~ ...................................... 9. Size of lot: Front ........~.~.( ....... ~ear ...... ~.~...: ..............Depth .....Z~..~..~.~.. 10. Date of Purchase .............. Z~ ........................... Name of Farmer Owner~..~.~.~.~:%~'~----- .......... 11. Zone or use district in which premises or¢e situated ............................................... .~. .................................................. 12.. bees proposed'constr~ction v~e any Z~ing Iow, ordinance or reg~ion? .~ ............... 7'~ ........................... 13. Name of Owner of premises~.:~Z~.~.~ ...... Address ~..~'~.~ Name of Architect ......... ~ ......................................... Address ............................................ Phone No ..................... Name of Contractor ~:~,,~.~~ddress ...... ~Z~Z~ ....... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Giye...~tre~t,:~nd block number or description according .to deed, and show street names and indicate whether interio~ 0r~,~or~:r ~ ~:,,.,,~ /~ ~ ~ ~ ~ / ............... b0ino du}y sworn~ doposos ~nd s~ys that he is the oppl}c~nt .............................................................. .............................. .......... (Controct3h oOent, corpo~te officer otc.) o~ s~id owner or owners, and is duly outhorized to- perform or hovo performed the s~id work ond to m~ke ond file this ~pplicotion~ thot oll statomonts cont*inod in this ~ppllcotion are truo to tho best o{ his knowledoe ond belief~ ~nd that the work will bo performed in the marmot set forth in the opplicotion ~led thorewith. Sworn to before me this . Z~ day of ..,O~ ~ ¢ ~ , 196~ fi/ ..................... ................ .............. ~ot~ubli~ ........... ~..~J.~ ............ County ~ . a~*R[~ ~Ouo~tUr~o{ ~plicont) '~" ~ ~ ~ Public, State of New YO~ ..... ~ (~ Com~l~Jon ~xpires March 30, ,- '~?) .:.b~ 7'