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Home My WebLink About3394-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the bu,lding located at ...J...~..c..~...s...o..n.....S.~,.~.,e..e...~, .................................. Street Mop No ...................... Block No ...................... Lot No ...N..e..~.,...S...~.~.[,o.~..k.,.....L..~,,Z.....~.,...N..e.~....~.9:g~..,. conform~ substantially to the Application for Building Permit heretofore filed in this office dated ........................ ....~...,.~,.c.,.h. ..... ~.3....~ .................. , 19,,6,.7.... pursuant to which Building Permit No.~..3...~.,4....Z.... dated l~laz'ch '13, 19 G7 , was ~ssued, and conforms to all of the requirements of the apphcable provisions of the Iow, The occupancy for which this cerhficate is issued is ........ ........... R~..t..v...a..c..e.....o...q.e.... ~...~..~..z. ~,.....c~....e..z...z. ~ .n.~ ................................................................................. The certificate is issued to ........P..~.,.u..~.,,..G..e..,~..h..9..~..~,...,..c~....~..e..~.. ................................................................ (owner, lessee or tenant) of the aforesaid building. Building Inspector / FO]R,~ NO. :~ TOWN OF $OUTHOLD 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? 339 Z Permission is hereby granted to: C.o.r~Ar~..~t~e.~v~t2,....A/;..~.,Al..~g~.4 at premises located at ......~...~...~.~.~ .~.~.~..~....~..~. ..................................................................................... ............................................. lle~r..l~o]J~...]~.o Y. .......................................................................... pursuan¢ to application dated ..................... .~I~ ........... ~,~ ......... , 19.67..., and approved by the Building Inspector. Fee $. ~,,~00. ............. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ..... ....... Approved ........................................ , !9 ........ Permit No ................................. Application No ........................... APPLICATION FOR BUILDING PERMIT Do,e ........................... , INSTRUCTIONS o. Th~s application must be completely fdled in by typewriter or in ink and submitted in duplicate to the Buildins Inspector. b. Plot plan showing Iocotlon of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and g~wng a detailed descnption of layout of propertymust be drawn on the diagram which is port 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 Budding Inspector wdl issue o Building Permit to the applicant. SucJ 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 port ICor any purpose whatever until a Certificate of Occupancy, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with oil opphcab[e laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, orchltect, engineer, general contractor, electrician, plumber or builder Home of owner of premises .................... ~.....~~..~.,. ................................................................................ If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Locat on of and on wh ch proposed work w be done Map_No' .....~ ................................. Lot No' . ............ ........ ................................... Mumc Ldaflty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................. b. Intended use and occupancy ~ 3. Nature of work (check which applicable): New Budding .................. Addition f Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4 Estimated Cost ...........~.~...,.~,~, .f~.. :...~... ..................... Fee (to be prod on filing this application) 5 If dwelhng, 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. D~mensions of ex~sting structures, if any: Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ · _ ~.s; - "~", - -~,'~,~r,~-' 8. D~mensions of entire new construction: Front ..~. ...... .,~ ............ t<ear '3'~' ..................... Uepth ..,z.]..m..(..~¢ .... Height ........ ~.~..: ............ Number of Stor~es ......... ./.2 .......... 9. Size of lot: Front ............................ Rear ............................ Depth ................................ 10 Date of Purchase ........................................................ Name of Former Owner ...................................................... 11. Zone or use district in which premises are situated ................................. ~.. ........................................................ 12. Does proposed construction wolate any zoning law, ordinance or regulation? ....... ~ ..................................... 13. Name of Owner of premises .",~....~.~(-~...Address ............................................ Phone No ................... Name of Contractor ~'~',~4.:.~..,#...~4~...Address~ ' w'/.~~....~,'.?~.,.~.~. Phone 1~.:..~..-~.~...~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dime. nsions fro property lines. Give street and block numbers or description according to deed, and show street names and indica whether interior or corner lot. STATE OF NEW YORK, ~ q q COU NT~ OF ................; ............... ~ ........................................................... _ ................................ be ng duly sworn, deposes and soys that he is the oppllc (Name of individual s~gmng application) above named. He is the ...................................................... J_-zO~..~~.. ................................................................ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to per~orm or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and bel and that the work w~ll be performed in the manner set forth in the application filed therewith. Sworn to before me this / ............. ....... o, ..... .............. , - ........ ~rm~',"~ ..... ~:r;~"~- .................................................. Nota~ Public, C.K.J.~.....~.,..~Coun~r~y ~¢u~u~' ~(~ ' ~i~g~ture of applicant) ~ Term Expires