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Home My WebLink About3610-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~ .3.0.4.3 .... Date ......... THIS CERTIFIES that the building located at Wear. Cove. l~oad ........... Street ~ Block No ............. Lot No. CUgCh~g~e.,..~, ~.,..N~...~ .... Map No. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~Bg,..~! ......... 19.67. pursuant to which Building Permit No.~. ~6~0. dated .... Se~2~ ~ .......... , 19.~7., 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 ... ~lFa~e. ~n~. ~F ~ lag .................................... The certificate is issued to ................. ~h~. ~-..~OhnS~ ................... (own~, lesse~or tenant) of the aforesaid building. Suffolk County Department of Health Approval ................................... ........... FORi~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3610 Z · Permission is hereby granted to: .............. ~ ... L.... ~.o.~.e. ................................ .............. ~o..~...~w......'. ........ ~ ................ at premises located at .~O.~...~..~.l).....,JJ~l'L~O..~T~'~e~...Jg~JJ3.~ll~l~..]~a'~l'a~..~.O:~Tt~i ................ ................................ .~J~.....~le.a~...~'~e...~aar3.~. ....... C, ut~%otE~.e~..F~,~,, .................................... pursuance to application dated .............................. A13~ ......... ~ ........ , i9..~., qnd approved by the Building Inspector. Fee $~.,.?..9. .............. FORi~ NO. 1 TOWN O~: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S SOUTHOLD, N. Y. Approved ............................ !..! ........ , 19....~.!.. Permit No ............................. Disapproved a/c ....... ,~,.~ .................. .~ ............. ~ ........................ ......................... ....... APPLICATION FOR BUILDING PERMIT °ate ......................... ............... , ..... 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 lac~tion of lot and of buildings on premises, relationship to ad oining pr?mises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which ~s 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 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 buJldlng 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. / ~ ........ ,~ ...................,~r~ ............................ (Sigr~at~e of i~pp~lcal~t, or name, it a corporation) ................. '~' ...... ~.!~.,..Z/.:.:~.~.~.?.~ ...... ~..., ........... ?/.f!..~..~,. .... ~ ~ T' / ~ ~,,~ i~: ~ ~,r ~ (Address 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, signature of duly authorized officer. (Name and title of corporate officer) · . 1. Location of land on wh,ch proposed work wtll be don~:Map No.: >~z...:.~.~ ...... ::~. k~t No.: .............. Street and Number ~ ~U¢-~ G'¢~ ................................................................................................... ~'.~.~::.s~ ............................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propos~ construction: , ,, ....... (.. ..... ..................................................................... b. Intended uso ond occupancy ................................................................................................................................. 3. Natire of work (check which applicable): New Building .................. Addition ...... ~x .........Alteration Repcr .................. Removal ....#. ............. Demolition .................. Off;~r Work (Describe) 4. Estimated Cost ......................... '..~,0.~ ........................ Fee ' , / (to be paid on filing this application) , d 5. If d~elling, number of dwelling units ............................ Number of dwelling units on each floor If gbrage, number of cars 6. iF ~usiness, commercial or mixed occupancy, specify nature and extent o¢ each type of use 7. Di~ensionsofe~istingstructures, if any: Front ................ ~..~... Rear ....... ~/.~....~ .............Depth ~ Height ........... ~'. ........... Number of Stories .................... ~. ............................... ~....; .......................................... ~ ..... Dim ~nsions of same structure with alterations or additions: Front ............ ~..~ .................Rear ~- ) Del 'h .......... ~. .................Height ............................Number of Stories ........... t: ................... 8. Din ~nsions of entire new construction: Front .................. /.~ ............. Rear ...........Z.~ ............ Depth ~ ~ Height ............ ~.... Number of Stories / 9. Size of lot: Front ........... ~.9. ........... ReQr ..............~ ............. Depth ............ ~.Z~ ............ ~ 10. Dat~ of P hose .......................... ~ .......................... Name o o met Owner .................. ~.(. .................. ) ....... 1 1. Zone or use district in which premises are situated " 12. Doe~ proposed construction violate any zoning law ordinance or regulation? Na~e of Architect ...................................................... Address ............................................ Phone No. Na~e of Contractor .................................................... Address ............................................ Phone No. J PLOT DIAGRAM [_ocat~ 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 acc~i~to deed, and show street names and whether in~erior or corner Jot. ~ of said o~ this applJ~ that the ~ Sworn to [ ' ~ ...... day of /~ ~'' , 19. ~.. Notary Pu~)lic, . ........................................................... County / STATE OR, NEW YORK COUNTY,~IOF .................. ................. ' .................................... ; .......................................... Demg duly sworn, deposes and says that he is the app[i¢ ](Name of individual signing application) above nerved. He is the (Contractor, agent, corporate officer, etc.) ,nar or owners, and is duly authorized to perform or have performed the said work and to make and :arian; that ail statements contained in this application are true to the best of his knowledge and belief; 3rk will be performed in the manner set forth in the application flied therewith. afore me this )licant)