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Home My WebLink About729-ZFOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Z 624 ~T~ne ~.4 60 No ......................... [~te ........................................................ , 19 ........ THIS CERTIFIES that the building located at ...II...~......~..~....~..~?.....~..~...i~......~..~.....~..~`...?..~...?~..~....~..~.~.~.?1....~.?....~Sttreet Map No ......................... Block No ......................... Lot No ................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ~ 22 19..~., pursu.ant to which Building Permit No. Z ~e 23 d~t~d ...................................................... 19 ........ , w~s issued, ~nd conforms to ~11 of of t~ ~ppl~c~le provisions of the I~w. ~e occupancy ~or which this certificate is issued is ................ This ce~ificate is issued to ~O~ DZOllOI~ (owner, lessee or tenant) of the aforesaid building. FO~M NO. 2 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.° 729. Z Date ..................................... Jg~e..2~ ....... 19... Permission is hereby granted to: ....... (~est,)....~r. ee,,pert,...Jl.! ........................... to ........ mte~t,. ~x'~hez:lr..b~kl~t,~li~e .. ~.~.e..~¢~1.( e.~.g.~g~ ..~..~ ) ~ ~ .................................. ot premises located ot ..lli~.e~.d~.~a.~.,~l~e~...&rsl~m~qae~ ...................................................... ......................................................... (.~,~t,)...~....~.~.: .......................................................... pursuant to opplicotion doted .................................... J'~Je.22, ............. 19...~1., ond approved by the Building Inspector Fee $..].O.(X) ............ Building Inspector FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exom ned ............ Approved ........................ !: ......... ?...19...Z!..Permit No......~.....i?...~.? ........ Disapproved o/c ........~¢~..~ .~,.~..? .................................. ~ .................... .......... ................... (Building Inspector) t 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 port of this location. 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 Deportment for the issuonoe of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or o Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ aamp~ ,;~a ~ ~: ra° fc c; r;c rm~:;:':i'~f"~'~; ' '~'~':~, ~'~Z:~.''': ...................................................................................... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number .../~.Z...~...,--~-~4 ~j~c~ .... /~-)~ ~,, .~ ...~...?.._~,~_..~...,~/~- /1/~, Municipali~ 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...~.~.~..,....&~.:~.....~.~.~.J .............. 3. Nature of work (check which applicable): New Building ....... ~ ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .............................................................. Fee ../0...?...~°... ................................. i ....................................... (to be paid on filing this application) §. If dwelling, 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:~u~.-~,~.~: ..... 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height ........................... KJ~umb~r o£ Stories .,.~......t..,.~ ............... 8. Dimensions of entire new construction: Front .......... /..~ ........... Rear ......... ~..~. ............ Depth ............................ Height ............................ Number of Stories ..O..~'.¥....~::~... ............. 9. Size of lot: Front ........~.......~.....'~.~. ...... Rear ..... .~....:~:.~.. ............ Depth .../..~..-~..D..../.~.--T. ....... 10. Date of Purchase ...................................... Name of Former Owner ........................................................ !1. Zone or use district in which premises are situated ........................................................................................... 12. Does proposed construction violate~any zoning law, ordinance or regulation? ...... ~....O. ..................................... 13. Name of Owner of prem~ses...~.:..~.....~...':~-...:z' ~' ........... ' Address ............................................ Phone NO .................... Name of Architect ............ 'J .............................. Address ............................................ Phone NO ..................... Name of Contractor....~./.".~z:.~...~ ....................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set,back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~YOI~I~ /),~ ) S S COUNTY OF ..~..~-....) ' .... ~/~,,~.~O...........~...~ ....... being duly sworn, deposes and says that h~ is the applicant ................ i'l~ame j~'in~vi~ual signing application) above named. He is the ................ ~.~ .................................................................... ~'": ........................................ (Contractor, agent, corlSorate off car, e of said owner or owners, and is duly authorized to perform or have performed the said work and to mal~ and file this application; that all statements contained in this application are ~e to the best of-his knowledge and b~lief; and that the work will be performed in the manner set forth in the app'lC.~ation ~iled t,h~eK~with. Sworn to before me this ~ ~'~ ' f ~ 19 ~'~ ~Signature of applicant) ........................ · ............ JUDITH T. BOKE~ Notary Public, · , ,~ iH:' County