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Home My WebLink About3578-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CEI~TIFICATE E)F OCCUPANCY Tills CERTIFIES that the building located at ........... :~'. ............ Street Ma~N~/.~£~'~Ti BlockNo ~ Lot No conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~...~.' ...... , 1~(. ~ursuant to which Buildin~ Permit No ......... dated ........................ ~ ~ ~ , 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 The certificate is issued to ~ ~ ~ ~L ~ ~t~ ~t (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval FOlt~ NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3578 Z Permission is hereby granted to: . . ............ ~1~ .:{I~.~,. .................................. ........... ~~s~..~.~.....:.....~ ....................... to ~:.~.t .~.~,.,.~.~..~..~.~.a.~'.e~...~,.~..~~ ........................ .................................. · '~~., A~ .-~...O~/~:~..'...,,L .,:..:~ ....... ~.........:.L ......................... pursuan4' to application doted ............... ...... ; ........... ~'~'~.....~;.. 19...~-/~..i and approved b¥,,the Bb'[Iding. Inspector. I~OK~Y[ NO. ! ?OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~ .~'7 ~-- APPLICATIOn'4 FOR BUILDING PERMIT 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 application. c. The work covered by this application may not be commenced before issuence 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 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 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 applicable laws, ordinances, building code and regulations. (Signature o/~-,6ppli2zfnt, or name, if a corporation) ..... ...... (Address of op~cant)~-- ~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buitder. ........... ........................................................................................................................................................... Name of owner of premises /~..~./~..~.~./.~..'.Z.. ....... '~..,......~':..~...I../..l~ ........................................................................................ If applicant is a corporate, 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.:/..~.. ........ ~'..~.. .... Street and Number. .~..~.~./...~......l..~...~.. ........ /~.~.~....~. ............ ~r.$ ... /. ....................... Mur4cipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. × t ngu a d cuponc ..... ........ ..................................................... b. I ntended use a nd occupancy'/.~.~.../~.~. ......... ~..~.~'-~.. ~ .................................................................................... 3. NatUre of work (check which applicable): New Building .......~... ....... Addition .................. Alteration Reppir .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estifl~ated Cost ............................................................ Fee t (to be pakJ on filing this application) 5. If welling, number of dwelling units .......... /. ................. Number of dwelling units on each floor If g.orage, number of cars 6. if Eusiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front ...... .44'.e..~....~. .......... Rear ................................ Depth Height ........................ Number of Stories Dir~ensions of same structure with alterations or additions: Front ....................................Rear De~th ................................ Height ............................ Number of Stories ................................ 8. Di4ensions o1: entire new construction: Front ...................... Rear .............. Depth ....~,....~ Height . ................... Number of Stories 10. Date o~ Purchase ........ /'...~...~..~. ..................... Name of Former Owner ~.. ............................ ...~... 1 1. Zode or use district in which premises are situated Does proposed construction violate any zoning law, ordinance or regulation? ...'~...R Name of Architect ...................................................... Address ............................................ Phone No. Na~e of Contractor .................................................... Address ............................................ Phone No. PLOT DIAGRAM I_ocat~e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property I nes. Give street and block number or description according to deed, and show street names and whether in :erior or corner lot. t STATE OF{ N EWe.)COJ;~I~, ~/~(._ COUNTY]OF ..'~,4~Y~;~ ..; ...... ...~.~....../~;¢.....~: ........................................ being I(Name 6f indi, fiduol signing application) abow; named. He is the ...... duly sworn, deposes and says that he is the applic (Contractor, agent, corporate officer, etc.) of said other or owners, and is duly authorized to perform or have performed the said work and to make and this appldahon; that all statements contained in this application are true to the best of his knowledge and belief; that the w~)rk will be performed in the manner set forth in the application' filed therewith. Sworn to Idefore me this Notary Pu~.~....q~..:../.{~.C~r~.... County of applicant) ~ ~ J/ MARION A. REGEN¥ ~- ~J NOTARY PUBLIC, State of New Yorg Re. 52-3233120 Suffolk Coun~,,~ Term Expires March 30. 19/2~