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Home My WebLink About3591-zNO. 4 TOWN OF SOUTHOLD BUILDllqG I~EPARTM ElqT TOWlq CLERK'S OFFICE SOUTHOLD, lq. Y. CERTIFICATE OF OCCUPANCY No. F&..,3.;~4,.1. .............. Date ................ ~agua~t~..2~, ................ , 19..~9. THIS CERTIFIES that the building located at 4$~..,l~n~e~.J~ne, .................................... Street Map No ....................... Block No ....................... Lot No ......... G:ee~o:t;.,...~.e~/...'~'~o,1;~ ............... conform~ substantially to the Application for Building F~ermit heretofore filed in this office dated ........................... ,~.~g. tl~S~..2.S, ............... , 19...1~.T. pursuant to which l~uilding Permit No.....3..~.~..~....~ dated ................ ~L~cJtl~...2~ .............. , 19.....~7 wasissued, and conforms to oll of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ............ L~ &va.t,e.. ~n~...~am~L.~.~.. ~'w~,l~%nc~ .................................................................................. The certificate is issued to ............ J~e~..C:,...JeJls~l. .................................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ?OWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3591 Z Permission is hereby granted to: ....... ...e~...~....r~..r...~.~.,.....&Z~..I.e~ ~ ......... .r~.....l~z.e.~. ....................................... ....... ....JIIU~~....~-Z~....i ...................... to ~½~..~......~.S.~.~..~.e..~)....~..~..e...~..*.~.*.., ~...~..~.....me~me at premises located at ..~.....~l;~..~l~'J,~llJ .................................................................................... ..................................... I~mmmim:lrt, e../~,,.,.. £~ ........................................................................ pursuant to application dated ......................... ~ ......... ~. .......... , 19..~.., and approved by the Buitding Inspector. ·" Building I~spec~ 1 ............... File in duplicate NO. ! Fee - $5.00 addition to bldg. $10.00 new bldg. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Dote ....... ...................... , 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 issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o 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 sh~ll 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 o Building Permit pursuant to the · Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ' Regulation% 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. State whether applicant is owner, lessee, agent, archi (Address of applicant) 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/Ivill be done. Map~o.: ................... ~...~ ............ Lot No.: ........................ Municipali~ry State existing use and occupancy of premises one, tended use and occupancy of proposed construction: b. Intendeduseondoccuponcy .......... ......................................................................... 3. Nature of work (check which applicable): New Building ' .................. Addition .................. Alteration .................. Repair .................. Removal .................. DemolJtian .................. Other~Work (Describe) ........................................ 4. Estimated Cost ..........~,~./.¢~c ........................................ tee ...................................... : ............................ ...................... (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 ......'T..., ................. Regr ...... ;~ ........................ Depth .....~.....'~.. ...... He ght ........................ Number of Stories ............................................. ~ ......................................... Z ...... '~: ......... Dimensions of same structure with alterations or additions: Front ......... ~..~..: ...... ~.~ ........... Rear ..Z ........ ~....~....~./.. Depth ...; ............................ Height .~.:f.'.~...~ ................ Number of Stories 8. Dimension~ o~ 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 ........................................................ 1J. Zone or use district in which premises are situated .................................................. .~ ......................................... 12. Does proposed construction violate pny zoning law, ordinance or regulation? ................ ~ ........................................... 13. Name of Owner of prem~se~ ~? ........................... Address Phone No ..................... Name of Architect ...; ....................... ;.. ....................... Address ............................................ Phone No ..................... , ;.,/ , !' , ~. ,j-~' Name of Contractor ...~ ................................................ Address ............................ ~ .......... Phone No/4....~...]...~.~.; PLOT DIA6~M Locate clearly ~nd distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from property lines. ~ive street ~nd block number or description according to deed, and show street names ~nd indicate whether interior or corner lot. STATE OF NEW YORK, ~- c e C~)UK, FI'Y OF ............. __ ..-~ .................. · ;~ ................................................................................... : ........... being duly sworn, d~oses ~nd says t~t he is the ~pplicant (Name of individual signing application) above named. He is the ............................................ :.....~ ....................................... ~ ....................................................... (Contractor, a~t, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed ~ said work and to make and file this application; that all statements contained in this application are true to th~ b~st of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ Nota~ Public, . ........................................................... Coun~ (Signature of applicant)