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Home My WebLink About4959-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .~....~1~1'...&?.e ................. Street Map No~.~5.e..~.~rl]~l~ No ........... Lot No. ~. .... .~..O[i..~...~.4...N.,.]~? .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .~. P.~...~.., 19. ?.0. pursuant to which Building Permit No.~.~'~... dated ........... 8~lM;....1.~., 19.7.(~, 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 ...~.~.?.a.t.e...on.e..f..a~..~.Y...5..~.l..1.~. ~ ....................................... The certificate is issued to Ilex*be~t B~ox.e Ow~ex. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I~,R · UNDERWRITERS CERTIFICATE No... I~,R, HOUSE NUMBER .... ~$0. ..... Street .....~[~.1~. .~$ .................................. .~.:. ~ ...f ..... t Building Inspector FOF,~ 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) Permission is hereby granted to: to ........ ~at).~.. em, e(J~.~iea.- el~.. e~m~ .:e~ .~ .............. ~ ....................................... at premises Io~ated at ........... y-J~j~t ................... J~ii~'~":' ...................................... .......................................... ¢ea~-~rt, ve..(~r+l~ ~ ..... ~*~ ................................ i pursuant to application dated ............................ 'Jilt ......... :~':i""" ig'"YeF and approved by the Building Inspector. ,Fee $. ~..*.,~. ............. Building I:hsP~ec~6~r '~ ~N OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥. Examined ...... Approved t( el 19....c..~.. Permit No..~...~....~.....~..~ Disapproved a/c .............................................................................................. APPL, T,O. FO. BU,'DING Bto ....................... .......... . INSTRUCTIONS a. 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 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 thie application. c. The work covered by this appl:cat:on may not be commenced before ssuance of Build ng Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. S~ch 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 Certff*cate of Occupancy shall have been gr~lnted 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, bu!lding code, housing code, and regulations. (Signature cf applicant, or name, if a corporation) State whether applicant is owner~ lessee, agent, architect, engineer, general contractor, electrician, plumber o~ builder. 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.: .~..~.~ot No.: ~ ................. Street and Number .~/~.....~..~..~....~...r..~.~.~'~. ~/'"~[~i~'i"p~'li~' ...................................... 2. State exi~ing u~ a~d ~cu~ncy of promises and intended use and occupancy of prop~ constmcti~: Existing use and occupancy ................................................................................................................................... ~ Intended use and occupancy, .... .~..~/..~. ......~. ................................................... , 11. 12. 13. 3. Nature of work (check which applicable): New Building .................. Addition ..~. .......... Alteration ............... Repair ................. .~.Removal ;g ............... Demolition ................. .~.Other Work (Describe) ...................... · (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ....................~ii: .... If garage~ number of cars ........................................................................................................................................ i .... 6. If business, commercial or mixed occupancy~ specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ....... r~ ................... Rear ................................ Depth .................... Height ........................ Number of Stories .................. ~ .............................................................................................. ~nsions of same structure with alterations or additions: Front .................................... Rear ............................ , ~.pt-h ............................ ;... Heig_ht ............................ Nuj~n. ber of Stories ............................ 8.//Dimensions of entire new construction Front ...... ~.,7..~.7... Rear .......... Depth 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ Name of Owner of premises/ff~/~.~..~....~..~Acldress ..~:J~-,~...~f;/.~...~..v .......... Phone No ..................... Name of Architect ..................................................... Address Nome of Contractor r Address .......... ....... ~ ...................... ~~- Phone No ..................... PLOT DIAGRAM locate clearly and distinctly a I bus d ngs, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and blbck number or description according to deed, and show street names and indicat'e whether interior or corner lot. STATE OF NEV~Y.I:~,~.,~,~,'" " ~:~"'~'~ ~ ¥'E"' ................. ','~'.'~?~:..:.....:....:-.~..;..:...:......- " ........... being duly sworn, deposes and says that he s the applicar~t trqame at Inmvlaum s~gnlng appllcation~ #, _ above named. He is the ..................~..'.~....~'/~.......~.~:~....~ ..' ..... of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .................... " ..................... '" ........ x / t. /t Notary Public, . ....................... t- ..... """:'}'""~""~ .............................. ............................. ~,gunq, - ($1gTtur~ of applicant)