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Home My WebLink About3666-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~I.~.(j..~.~.~,~J~..~I~I~.3C~V,~. ................ Street Map No..C...a.~..t,..a,.~.n. ..... Block No...~.5. ................ Lot No...3,1~.6..[~l~.~t~...~.~!Y/...~.q.~ ............. conforms substantially to the Application f~r Building Permit heretofore filed in this office dated .................. ..O~....t,...O..~..e..~...~.6..~. ...................... , 19..~..?.,. pursuant to which Building Permit No..~.6~.~ dated ....... .O..c.~.O..~...e.~...~.~.~ ..................... , 19...6..~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ..... ~..~iw..t..e.....o...n..e....~...~..~..Z.y...~....e.~..~.u~ ~. The certificate is issued to ....~..~..~..~..e..~.....~..~.~..~..y....[.o~.~,,e..~..,) .................................................................. (owner, lessee or tenant) of the aforeso, id building. F01~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPTfON THE PREMISES UNTIL FULL COMPLETION OF THE :WORK AUTHORIZED) · Permission is ,hereby granted to: · ~. , ,, ......... ;~.....~e~,.,~,~'~ ............................... ... .......... ,,i~e~,:p~e.......7. .................. ~ ............... ..... at premises located at " ~ ~ ' ...................... ~-.~t~..~..~,ve ......... ~,..Ct,~t~o~. ................................................................... pursuar{~' tO application dated ... ............... ::..-..~t,...,.~ ................. , 19.1~2., and approved by the Building InsPector. £ee $.~,.~0 .............. Building Inspector FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OF~:ICE SOUTHOLD, N. Y. Examined ......... 19.. Approved ........................................ , Permit No ...... App,cot,on ............. Disapproved a/c .................... ~ ................... ~. ..................................... .................... ............................................ (Building Itpector) 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 premiees 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 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. ,m ..... (Signature of applicant, or name, if a corpora~n) ...... ........ ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ~.. ?..../...~(~:.~..c ]. ~..c~../ ~ ~ ..................................................................................................................................................... Name of owner of premises ,. r~...~.f~...~..--..~.. ...... ~..~..(.~.,~...~.. ........................................................................................... If opplicant,-f-s)a corporate, signature o,f duly ou. t4jgorized,offLger. ................ ....... 1. Location of land onwhichproposedworkwillbedone. Map No.:...~....~....~...~..l~:it}~/.~'~C.. ½.'/.. Lot No.: ..... ~'...~.//..: .......... Street and Number ....... ./..~../~ .......... ...~...~..'..~..Ct~.L~r ............. ~..~..I.j)~.......J?.~ ........ ~..~....~;.-.~.../..~.~.(¥.~?./. ........... /.'(.:.~..... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy ................ .h. ......... ~,.,:~......= ....................................................................................... b. Intended use and occupancy ............... l~ ..~. ?.: {.. ~ ..(..~C-./..~..... ~...A ~ .~....~... ...................................................... 3. Nafure of work (check which applicable): New Building .................. Addition .................. Alteration Rep,,air .................. Removal .................. Demolition .................. Other Work (Describe) ! (to be paid on filing this application) 5. If cJwelling, number of dwelling units ............................ Number of dwelling units on each floor If ~arage, number of cars 6. If l~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dir~ensions of existing structures, if any: Front ....... .~..~.. ............. Rear .......~..~. .................... Depth .....Z~. ....... Height .............. Number of Stories ................ Din~ensions of same structure with alterations or additions: Front ............. ..'~....~.. ...... .... Rear ......... 8. Di4ensions of entire new construction: Front ............. .~..../ ................. Rear ............. .~..[. ........ Depth ...... .~.~ ...... Hei'~ht ........ ./..,~. ...... Number of Stories 9. Size of lot: Front ............. ./..~.0....! ..... Rear .......... /~ r Depth ! ~L~ r 10. Dat~e o1: Purchase ........................................................ Name of Former Owner 1 1. Zor~e or use district in which premises ore situated Do!s proposed construction violate any zon~g law, ordinance or regulation.;) .................... ..~...o. .......................... Name of Architect ...................................................... Address ............................................ ,Phone No. Locat property I whetherin PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fi nas. Give street and block number or description according to deed, and show street names and indic :erior or corner lot. STATE Of~ NEW~ COUNTY J OF S.S. ':(Name of individual s~gning above named. He is the g duly sworn, deposes and says that he is the applk (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and :arian; that all statements conta,ined in this application are true to the best of his knowledge and belief; ark will be performed in the manner set forth in the application this appli that the v Sworn to I Notary P~ ...~re me this ,,,_/~:/ ..... day of ............. ~.~....., 19.~.7. NOTARY PUBLIC, Sla[e o~ New York NO. 52-3233120 Suffolk County therewith. (Signature o