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Home My WebLink About5076-zlh'OP.,,,l~l NO. 4 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES thot the building located at ........ S~.S.....[~/a~..B. oad ............................ Street Map No. ~ ................ Block No :3~ .................. Lot No .... ~ ....... .(~g~O~l~fL....~.~.~.~. ................. conforms substantially to the Apphcation for Budd,ng Permit heretofore filed in thru off,ce dated .................................... ~D,~%...~t ......... , 19..~.0.. pursuant to which Budding Permit No...~0.~.~..... dated ............................. 3[O.~. ......... ..~0...., 19...~.0., was ~ssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ...... ~ts.~e~..~cc.e~.orY...~l~lg~ .................................................................................................. The certificate is issued to ..... ~[~..~....~..~.O.~..~.q..~. .......... ..~_..~..e..~.8. ................................................. (owner, lessee or tenant) of the aforesaid build,rig ~touse ~ 36660 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5076 Z Permission is hereby granted to: ............. ~ ........... ~.!..~.~..z...~...Y...5 ............... at premises located at ............................................................. -?-.--~.-./.,.~.- ......... ~.~.. -~--./~- ..................... .................................................................................................... ~..~..~..(...~.~..~.~.~ ................ pursu(m,t to application dated ................................. ..~,...-~,..,-.,..J~.-~.,.~.,.., Building Inspector. Fee $ ........................ ~ 19Z.,~.., and approved by the Building Inspector Cr~ TOWN OF SOUTHOLD [-,~ .~q~q~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........ ~ro~ed ........... ~'"~ ~o ~.~,, ~o. ~o ~ ~ z ~iM~p~ed o/c ....................................... : .......................... ......... ............ .................. ....................................... {Suildin~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~ o. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premir, e$ or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of thio 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 whale 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 pumuont 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, os herein de,crlbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ...... : ...................... ( g ;.apllca~, o~4~me, tf a corT~ratlon)" (Address of oapllcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. /I'I I D [~ L E, ¥ Name of owner of premises .................................................. ~ ............................ ..~. ............................................................. ~'~ If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) I. Location of land on which proposed work will be done. ,V, ap No.: ........................................ Lot No.: ....................... Street and Number .................................. ,,~,,/q,,(,,~,,......_'~,,,.,,D, ....................... .,~,..,,~,.?~.,.,~,,.,.J'/.~.,,~,,.~.L'.'~, ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propoeed construction: · u n -~i'//~ / ~ £_~ -f:~'/='£ o. Existing use and acc pa cy ................................................................................... ~ ................................... ,~ ...... b. ntended -se and occu~,on-c ................ ..~...~....'~..-~. ~/, .."~...,,~.. /t ,~Z~ ..~....~..~...I..~/. .... ~i.~.~.~.~~' 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. _Or/her Work (Describe) ..................................... 4. Estimated Cost ..................... c~..u.......~.. ..................... Fee ..... .~. ................................................................................. (to be paid on fi~ing this application) 5. 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 ............................ 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 ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................ ./......~:.. .......... Rear ............................ Depth ...../...~... ............ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........... ,/,..~.~. ...... Rear .................................... Depth ................................ 10. Date of Purchase ............................ ./...?....'~.....~....?~.. ........ Name of Former Owner ...~.?~....~./...~...~.L.':.~.~..&~.. ........... 11. Zone or use district in which premises are situated ........................ ~ .......................................................... or regulation? .......................................................... 12. Does proposed construction violate any zoning law, ordinance ~ ................... Pho,, 13. Name of Owner of premises ..../~../...D~....~.:..Y...~.......fl.~.~...T'.l..Addres, " , ..:~, ~eu ~Ay ^¢" Name of Architect ...................... .../. ......................... Address ............................................ Phone No Name of ~'nnf,n~tn, ~'4/~/ /"'- A~.t~=e~ ~ 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~?,~. t-i. ~ ....... (Name of individual signing application) duly sworn, deposes and says that he is the applicant (Contractor, agent, comorate~fficer, ~c.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work a~ to ~ke ~d file this application; that all statements contained in this application are tree to the best of his knowledge and ~lief; and that the work will be performed in the manner set fo~h in the application filed ther~ith. Swam to ~fore me this Term Expires ~rch 30,