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Home My WebLink About3515-zFORM 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...],92 .... Block No ............. Lot No..~.~ ..... ]~atti~lcL' .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~...1.~.. ~., 19.~.?. pursuant to which Building Permit No.. ~. ~ dated ~...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 1~.'~..O~. :f~lY..c[~.X:LI~g ....................................... The certificate is issued to Cathe~J..~e. ~.ylo~ ........ 5w~e~. ......... .. ~ ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ]'i.~t~. ............. . ............ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. ERTIF'Ir'!.ATE OF FIOOII~=ANOY THIS CERTIFIES that the building located at . .l~'e~ .l~a.~ .............. Street Map No...~92 .... Block No ............. Lot No. ~.~.~'~ ..... l~e.%~l~tck .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~1~... ~... , 19 ~.. pursuant to which Building Permit No.. dated .......... ItlP. e...l~ .... , 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 p .2~..It.~0..O~. :~a~:[~.~r..~/~.~1,~. ,g The certificate is issued to ~''' ; ..... :"' ~ C,~ · , (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ll..~io .......................... f .... ~ .~..~...'f: ................ 7...' ......... Building Inspector FOI~'II NO. i TOWN OF SOUTHOLD ' BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTliOLD, N. Y. BUILDING PE Pu~.IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 35~5 , Z: Permission is hereby granted to: ................ (l~t~l=e:. 1~.1~ .......................... pursucm¢ to application dated ........................... ~...tJ/;l~......~ .............. , 19.~/..., and approved by the Building Inspector. Fee $..:.~t10 ........... ' Building Inspector FOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMt~NT TOWN CLERK'S OFFICE .~....~. SOUTHOLD, N. Y. Exam d /O' ine ................ lC2 ....... ,. ~pproveo ........................................ ~y ........ rerm~ No .............................. Disapproved ~ ......................................................... . ..................................................... ..................... App, cot on ............ APPLICATION FOR BUILDING PERMIT Date ........ ~ ..................................... ~-~' I9_.~?.i ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su6mitted 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 coYered 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 puFpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applic.able laws, ordinances and regulations. ....... ..................... (Signature of applicant, or name, 0f a corporation) ~ (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises .......~¢~-~L,4....../~.,...~.'.~.~..~-(~'.~, ............................................................................... Name of If applicant is a corpoFate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No; .../...~....~.;.: ........................... Lot No:~-.~..Z.~?.~..... Street and Number ...... ,,.~../2~...0. ....... ~/'~..~'..~. ........ ~.~...,~:.:.,/ ....... ...~....~~ .................................................... / /wunicipadty 2. State existing use and occupancy of pr, errti,s~s and intended use and occupancy of proposed construction: a. Existing use and occupancy ...............~. .............................................................................. b. Intended use and occupancy .............. /~..~......~'. ........... ~'. ................................................. 3. Nah~re of work (check which applicable): New Building .................... Addition .................... Alteration ................. Rep, dr .................. ~Removal .................... Demolition .................... Other Work (Describe) .................... ~<,u~, ~ Fee , 4. Estir~ated Cost ........ Z~ ......................................................................................................................................... (to be paid on filing this application) 5. If d~elling, number of dwelling units ............. ~ ................. Number of dwelling units on each floor ......................... If g~rage, number of cars ................... . ....................................................................................................................... 6. f b~siness, commercia or mixed o~ccupancy, specify nature and extent of each type of use ................. [ ......... 7. Dimensions of existing structures, iff any: Front ...... ~ ............... Rear.....~ ................ Depth ...~ ................ Height ........ Z~ .............. Number of Stories ........... ~ ....................................................................................... Dimensions,of/ some structure with alteratio~ or additions: Front ......... ~..~, ...........Rear ..... ~.~ ................. Dep(h .....~.~ ................. Height ........... ~ ................. Number of Stories .......... n tru tlon Front ~ Rear ~'' De th 8. Dimensions of entire new co s c' : ......... I. .................. J ........ ' ......... P ......................... Height ........ .~/..' .............. ~umber of Stories ......... ~ ................. 9. Size~ of lot: Front ...........~,..~ .... Rear ....... ~.~.~..~ .......Depth ..Z~. ............... __ 10. Dat~ of Purchase ....... .~..~.~.1......~.~ ............ Name of Former Owner ~.~/~.~.~..~.~.~.C~(...~Z~.~ 11. Zon, or use district in which premises are situated ....... ~.~J.d.~.~.~.,..~..~ .................................................. 12. Doe~~ proposed construction violate any zoning law, ordinance or regulation? ......... ~...' ................................ 13. Na~e of Owner of prem,ses.~..~.~Z~.~.~Address ~.~..~.~.~ .......... Phone NO~.~.~ N~e of Architect ........................................................ Address ............................................ Phone NO .................. / Na~e of Contractor .................................................... Address ............................................ Phone NO .................. / PLOT DIAGRAM Locah clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr. property li~es. Give street and block numbers or description according to deed, and show street names and indic, whether in:erior or corner lot. ....... ~ , N.x~ ¢~ STATE OF NEW YORK, ) S S. ~ .~ _~ ' COUNTY )F ............................ ) ~,' ................. j. ............................................................................. being duly sworn, deposes and says that he is the applic~ (~ame of individual signing application) above nam~ d. He is the .......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said ow~er or owners, and is duly authorized to perform or have performed the said work and to make and f this applic~tion; that all statements contained in this application are true to the best of his knowledge aqd beli~ and that t~e work will be performed in the manner set forth in the application filed therewith. Sworn to b, fore me this ~ ~ ~. /~ , dav of ~ .................. 19...d.7... .~?~~of oPP ....................... ~ ~-~ '"'~" ""} .... ~ ~0TARY pUBLIC. State al ~w .. Notary Pul ~, .... [. ........... ~. .......... ~orm ~pir~s X~ c~ ~.