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Home My WebLink About3605-z~ORM N~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEI~K'S OFFICE SOUTHOLD, N. Y. OEI~TIFIOATE OF OOCIUPANOY THIS CERTLIglES that the building located at . l$&~r, ll[O&d ................... Street Map No ............. Block No ............. Lot No. conforms substantially to the Applicati,on for Building Permit hereto~ore filed in this office dated ......... .8.~p.~;,..6. ....... 19.t~i?. pursuant to which Building Permit No.Z dated ......... 8.~.P~..~i ....... , 19. ~i7, was issued, and conforms to all of the require- merits .of the .applicable provisions of the law. The .occupancy f. or which this certificate is issued is .... l~].Vat;~..one. £~mtJ4t. d~ell:[nq ....................................... The certificate is issued tn ...... ll. og~l,~.S, ool~elL..0~I105. ............................ (owner, lessee or tenant) of the afore,said building. A/*, f~") ~ ,Suffolk County Department of ttealth App,r,oval ......................................... FOllOW NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THI§ PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~ 3605 Z Permission is hereby gronted to: .............. ................... ~..~. ~..i ........... ~....: .................. pursua~*'to application dated ............................... ;.~.~.....'.~ .......... , 19...~,, and appro~'ed by the Building Inspe~:tor. Fee $.'~''' Building In~pectorJ ,' r . ~ FORM NO. 1 TOWN OF SGUTHOLD BUILDING DEPARTMENT TOWI~ CLERK'S OFFICE SOU~'HOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. Application No. ,~.....~..?....~.. 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 Buildi,ng Permit. d. Upon approval of this application, the Building !nspector wilt 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 Certificat~ of Occupancy shall have been granted by the Building Inspector. APPLICATION IS H.EREBY MADE to the Building Department for the issuance of a Buildin~ 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 demo(ition, as herein described. The applicant agrees to comply w~th all apphcable laws, ordnances, bu Id ng code and regulations: ................. ................... ................................. (Signature of applicant, or name, if o corporation) ............... G~.e~n~.e=.~ .................................... ~. ...................... (Address of applicant) , ',. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 'l Name of owner of premises .....D...O.~..~..O...O..~..~...~. ......................................................... ..................................... i .................... 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.: ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propqsed construction: a. Existing use and occupancy ..... .~i'~.~,~ .......................................................................................................... b. Intended use and occupancy ........ Sa~$..'d..iCh..&D.-.~d~$..t,$~ ...................................................................... 3. Nathreof work (check which applicable): New Building .................. Addition .... ...Z~...,~.. ...... Alteration Rep? r .................. Removal .................. Demolition .................. Other Work (Describe) 4. Esti~nated Cost ......... ~,~,~.Q..~.~ .............................. Fee ..... ~'..~.0...0.... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .O.~ ............... Number of dwelling units on each floor If g~rage, number of cars ................ ~0,.~1~ ................. ' / 6. IF IJ)usiness, commercial or mixed occupancy, specify nature and extent of':eoch type of use 7. Dimensions of existing structures, if any: Front ............................ Rear ........... i" ................... Depth He~?ht ........................ Number of Stories ........................................................ Dirr)ensions of same structure with alterations or additions: Front .................. : ................. Rear Del~th ................................ Height ............................ Number of Stories ................................ 8. Din~ensions oF entire new construction: Front ......~.....]L6 ..................... Rear ..... ?.i?....~16. ......... Depth ...~.J~ .......... Hei~ght .................... Number of Stories ....... O1~ ......................................... !.i..! ................. 9. Size[of lot: Front ............................ Rear .................................... Depth ........... '~....~ ............... 10. Dat'e of Purchase ........................................................ Name of Forrner Owner' ........ 11 ' Zorle or use district in which premises are situotbd ...... 12. Doejs proposed construction violate any zoning law, ordinance or regulation? ..... No~e of Architect ............................................. ......... Address ........................... : ................ Phone No. No,ne o! Contractor ....... ~.O,~(~j)~..~ll; ......... .: ....... Address ................ .(}~'~Jil~00~.t, ...... Phone No. i PLOT DIAGRAM · Locatb dearly and distinctly all buildings, whether existing or proposed, and indicate oil setrbacF,, dimensions property lines. Give street and block number or description according to deed, and show street names and whether inlterior or corner lot. ilicant) Sworn to efore me this ............. · ~ ......... day o~ ....................... Notary Pc bhc, 2.....~ ........... ,...~......::..,~Z/,~.~ ( MILDRED CIIp ~RY ~UBLI~ Si A MAN ~Om ' ' 52'061810 at~ at ~Vew m~ss~on EX~r~eO ~uilol/( (Signotu STATE oF, NEW ~)J~f,,,. } c ~ COUNTY i OF .... .~....~...~..Y.~ ........... ~' °'~' ............................. .~.l~.~]~..~..~j~j~ ........................................ being duly sworn, deposes and ~ay~' that he is the appli< (Name of individual signing app ication) abow,~ nar~ed. He is the ............... .g..O..~.~.~1,.O..~.~. ............ '. (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or hove performed the said wo~k and to make and this oppligation; that all statements contained in this application are true to the best of his knowledge and belief; that the Work will be performed in the manner set forth in the application filed therewith·