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Home My WebLink About3637-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z. 29:!6 ..... Date ............ 0e~:Qbe~...27..., 19.67. THIS CERTIFIES that the building !ocated at I~a~ .Ave ................... Street Map No. ~a:.:~aU .F~ No ............ Lot ~o. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Sep~ ... ~., 19. ~ pursuant to which Building Permit No.. ~3~' dated Se~2 ~ 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~):;~ .q~..f~,l.3. y. ~1~3.~ $~g .................................. The certificate is issued to . .. Ala~ .~o~[~ge~. ........ Ow~e~ .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .............. ~...~? .............. .FOE.V[ NO. ~ 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? 3637 Permission is hereby granted to: ' , ........... ~...~,~,.~o~.q;~,..':-------- .................... ; ........ to .~-~:.~n..~,~a~L~,,,~.~.~eL.~ter~,~.~.~;~,.'~'..e,~O~.a~ ........ at premises Iocated~t .' ,~.~..~.. '~,~'.,0., i"..~,~,~,~.~,t~ ..~.~ . ' ..... .............. , ...... -- ---.........~...~.~......;....~..~.~:----.~..,.~.;. ................. :: ................................................. pUrsua~¢ tO application dated ............;..~ ........... .~.~.~..~...~,i...~.~. ........ ;.., 19..~.~..,, and approved by the' Building Inspector. Build'rig Inspector L / FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c '"'~~i ......... ......................... ................................ APPLICATION FOR BUILDING PERMIT Date ...~.~..'~...~~ ........... , 19...~?, ..~.... 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 nat be commenced before issua,nce 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 hove 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 of applicant, ~ame, if a corporation) ~(/~ddress of al~'plicant~v/ State whether applicant is owner, lessee, agent, architect, engi'neer, 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 which proposed work will be done..Map No.: ././.../....~'.....:'. ........... Lot No.//~...'.~...'.~..../...~..~... Street and Number ..... ./..~...~.....~~:...:~ ......................... ~.~.~ ................................. Mu~cipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............................................. t ! b. lntended use ond oecuponcy ................................................................................................................................. 4. 5. 6. 10. 11. 12. 13, Local property whether NatJ~re of work (check which applicable): New Building .................. Addition .....~.......... Alteration L Repj:ir .................. R~)val ..................Demolition .................. ~'. ~W.o r k (Describe) EstirLnated Cost ......... . .'~....~..~..-"~.....~... !. ............................... Fee ........ ~ (to be paid on filing this application) If dwelling, number of dwelling units ......... i~....' ............. Number of dwelling units on each floor If gj~rage, number of cars IF t usiness commercial or mixed occupancy, specify nature and extent of each type of use " ' Dirt ensions of existing structures, if any: Front ............ .~,.~.. .......... Rear .... ../',~..~. ....................... Depth Hei, lht ..~..~. .........Number of Stories .......... ./..../.~.'..~... Din' ensions of same structure with alterations or additions: Front .................................... Rear DeI ~h ....... ~..~..~.~. ................ Height ..... ~....~... .......... NUmber of Stories ........ /..Z.../-::C~... ......... Dirt ensions of entire new construction: Front ...../...~'. .......................... Rear ..../...~.. .................. Depth Hei!lht ..../.~....~. ........ Number of Stories Size of lot: Front ..... /...~..~...~. ............. Rear ........ ~...~.,.~ ................... Depth .~.....~...~..~..'T..~.~.~..' Dot, of Purchase ..~...~....~...~..~..~....~. ..............Name of Former Zon or use district in which premises are situated ...... % ............... " Doei proposed construction violate any zoning d n Na~e of Owner of premises . 4Y~.~-.'~...Address .. .~. ~ ... Phone No. Na: le of Architect ....................................................'~t~[~-,~, ~-~ Address iii~i'.iiiiii Phone No..~3. No, ,e of Contractor .~.~.~,.....,~,,.~.,..-.......¢.........Address Phone No. PLOT DIAGRAM ~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions *es. Give street and block number or description according to deed, and show street names and indic erior or corner lot. /00 ' "- STATE OF NEW YORK, ~¢¢ COUNTY,OF ..: ............................. ~ ........................................................ i ........................................ being duly sworn, depose~s and says that he is lhe above nar of said ay this applk that the w Sworn to lc Notary Public. Name of individual signing applic,,a:tio~) ed. He is the ....................... (Contractor, agent, corporate officer, etc.) net or owners, and is duly authorized to perform or have performed the said work and to make and orion; that all statements contained in this application are true to the best of his knowledge and belief; }rk will be performed in the manner set forth in the application filed therewith. afore me this of New York ',-0618]00 Sulf~[k County I]oram~sslm} Expires March 30, 19 ~_ (Signature of applicant)