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Home My WebLink About3679-zFORM NO, 4 TOWN OF SOUTHOLD: BUILDING DEPART/~EN'I~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCI. PANCY No ....~,..32~6.'; ........ Date ............ ~l,l~aalt, ..2.T., .................... 19~8... THIS CERTIFIES that the building located at ..~lO~t,,la..l!,Cl~(1 ............ ~ .............................. Street Map No ....................... Block No ....................... Lot No...80t~.ho.l.~l,...l/ael~...Y03:~. ........................ conform~ substantially to the Application for Building Permit heretofore filed in this office dated .............................. O~.tobel'...24r ......... , 19.~.. pursuant to which Building Permit No. dated .................... O~t:O~:~e~..~,5, ........ , 19...6~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for wh!ch this certificate is issued is ........ ..... ~x.~.vate..one...:eamL~,y...c~e,l,~l,:l. ng .............................. :. .......................................................... The certificate is issued to '"aea~'~ee"'~°clgell~e~t'):'~'"i~;~L'"'; (w e, o tenant) of the aforesaid building. TOWN OF SOUTHOLD BUILDING DEPARTMEN'I! TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT '(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: to at premises located at .~/~J..J~L~..~J~ ............................ .......................................................... .. ........................................ ~t,t~t .....JtJ¢~ ......................... ~ .................................. . ....................... pursuaW: to application dated ............................ ~Jj~Jj~....~....., 19...~., and approved by the Building Inspector. Fee $ .............. i Building Inspector .............. ~~ .......... & ...... ..~ .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. '' 19 r Permit No ~ ,4, ,vvroveu ........................................ , ........ ................................. Disapproved o/c .............. :~,~n~. ..................... Application No. '.~.:!i...~...r~.. ........... APPLICATION FOR BUILDING PiER,MIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in i~k and submitted in duplicate to the Building J nspector. b. Plot plan showing location of lot and of buildings on premises, relati~)nship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust be drawn (~n 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 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 shall be occupied or used in whole or in pa rt 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 a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y~rk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, builSing code and regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...................................... ;z...i ............................... ~'. ............................................... If applicant is a co~orate, sjgnat, g.~ of duly ou,~thoriz,ed officer. ........ (Name and title of corporate officer) Location of land on which pzo~osed work will be done. Map KLo: ............................................ Lot No: ................... Street and Number ................... ~'nicipality i .................................. State existing use and occupancy of premises and intended use alnd occupancy of proposed construction: a. Existing use and occupancy ................. ~...Jf~.....~.:~ ...........~ ......................................................................... b. Intended use ond occuponcy ................ ~I~...~:..~.~'~.. .................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................... Re,~oval .................... 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 on each floor ............................ If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any; Front ......... .-~...7'..~ ......... Rear Height ....... ./..~...zl ............. Number of Stories . .. / ...................................................................... Dimensions of same structure with alterations or additions: Front ......... ?.~.] ............... Rear ...... ?...~...~ .................. Depth..,...........................x7'~ ~ Height .......... ~..~...: ............ Number of Stories ..........~ ........................... 8. Dimensions of entire new construction: Front ......... ~..~.. ............. Rear ...... ~..~. ............... Depth ............................ Height .......... ~..~...~. .......... Number of Stories .......... /. ................ 9. Size of lot: Front.~..~..,/?...~...~. ........... Rear ............................ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ..... : .................................................. ~ / 11. Zone or use district in which premises are situated ................ /Z'./~z,~.~:~.~.~.. .................................................... 12. Does proposed construction~, ~ ~, ,--vi°late any zoning law, ordinances__ ,,,~~°r regulation? ......... ,~ ...................................... 13. Name of Owner of premises ~,~/,~..,~'~'..~..Address ..~'.~..~,..~..~.~..t~..'.~hone No ..................... Name of Architect ............................. .~ ......... :: .......... Address .....,~ ....... .~ ............................ Phone No ..................... Name of Contractor L~.z,~.~,..'~..~ .......... Address ........... 7.:..~. ......... ~q/. ......... Phone 1~.:~....~..~4...~..~..., PLOT DIAGRAM Locate clearly er)d distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YO~I~,, COUNTY OF ~..-~:...~..'~.. ...... / S.S. ~~ be ng duly sworn, deposes and says that he is the applicant (Name of individual signing application) abow; nomad. He is the ~~ ........................................... (Contractor, agent, corporate 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 app cat on; that a statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth n the appl cation f led therewith. S worntobej ..~.f°re me this' ....... ~ ~O~n¥ '~$'~;11;~'$a,~,: ,,I [~,~,, t',,,.~, \ .......................... ~ ............................................. (~)~~~, . County (Signature of applicant) Notary Public, . .............. .~.t,~o~ ...................... ITcrm