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Home My WebLink About3717-zFORt~I NO. 4 TOWN OF $OUTHOLD ' BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at $~.(~.....~:[~.Q...~ ....................................... Street Mop No ....................... Block No ....................... Lot No ................... ~g. hg.~)...~.t~.~ ................ conform~ substantially to the Application for Building ~rmit heretofore filed in this office doted .................................. ~ ....... ].~ ............ , 19.~.. pursuant to which Building Permit No~]~..~... d~ted ........... '. ......... ~[~ ......... ~ ........... , 1~ ..... was issued, and conforms to all of the ~equirements of the applicable provisions of the law. The occupancy for which this ce~ificate is i~sued is ........ The certificate: is issued to ..]~[i~'~et~..[~s~..c~:..~g~&fe ............ O.~le[~ ..................................... (owner, lessee or tenant) of the oforesoid ;building. h TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERM!T MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3717 Z pursua:o¢ to application dated...............................~..~..~-'~... ....... ~J~ ............ , 19.~.~..,. and approved by the Building Iqspector. .Fee $.~..0.~ .Q..0. .......... ] Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM at IT MAY CONCER~N: TheT~ d~al facilities for a structure located ' .~/ (Give deed loca~n)t have been inspected by this department and found to be satisfactory. TOWN O1: $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ..~.~~ APPLICATION FOR BUILDING PERMIT Application No..i.~....Z~'...~. ........... 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 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 location. 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 part for any purpose whatever until a Certifical~e of Occupancy shall hove 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 York, and other appllcable Laws, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances and regulations. (Signature of applicant, or name, if a corporation) ............ ....................... (Ad,ess of applicant)~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.....~..,~.*...~ ..... ..~....~~ .......... !..~...-'""~' ~ .................................................... If applicant is a corporate, signctu~'e cf c'uly au~?criied offiUcer. (Name and title of corporate officer) .... i 'e' e Ma-No ..~...'~ ~..~..~t No ~-- ]. Location of land on wmcn proposed work W II D aah . b~ : .............................. : .................... Street and Number .. '~.....G~.P.~,...,..~.....~..~....~. .~.. ..~.,....~~.c~.~ ..... h ' .~.?. Mur0d[iJpality ~ 2. State existing use and occupancy of premises, and, in_tended use and occupancy of proposed construction: a. Existing use and occupancy.....~...~...~.. .......................................................................................... b. Intended use and occupancy.......~......~..~.....~....~TT..~....~.....,~..~z~_/1 ~/)__ C-)~ .................................. ~J 3. Nature of work (check which applicable): New Building.....,k'~ ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........... ~.~.....q..~':...~. ........................... Fee ... .~..O... ~ ....................................................... (to be paid on filing this application) umts ................................ Number of dwelling units on each floor ............................ 5. If dwelling, number of dwelling ' 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 ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ .~.....'~. ........... Rear ........ .~....~.. .......... Depth .....~.....?. ............... t Height ............ ~T. ............. Number of Stories ...... ~...: ........ 9. Size of lot: Front ..... ~,....~....~..../. ..... Rear ....... Z....~.....~.. ...... Depth ....../.....~......~.. ........ 10. Date of Purchase .........../.....~. ......... ~. ......................... Name of Former Owner ..~...-~v,~4~,,~j~ ]1. Zone or use district in which premises are situoted...I.~.......~.....~..t ................................................ 12. Does proposed construction vio[at~ any zoning law, ordinance or regulation? ..... ~....Z. ................................ 13. Name of Owner of premises...g~..:.'~.D.,...(.~i.~...Address ..~~....~...:.~..:Phone NO ..................... Name of Arcl~itect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor.~..~..~..~f......~'¢r~...,~'.~ ..........Address ...~.....~:...~.....~.:fJ)hone NO ..................... PLOT DIAGRAM Locate clearly and 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. ilo /00! STATE OF NEW YORK, ) S S. COUNTY OF ....................... .....) ... ......being duly swam, deposes and soys that he is the applicant (Name of individual si~ning application) above named. He is the ............................................ ..~'~....". ......................................................................................... (Contractor, agent, coqborate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all 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 in the application filed ther,c, with. Sworr. kto be~ me this, ~' f