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Home My WebLink About4960-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ....................... Zl+O.~.O .... Date ........... .............................. THIS CERTIFIES that the building located at ~/.S...P~l,l~le.i:~e~¢~..I~le, d. .......................... Street Map No...:Y~ ............... Block No~ ...;ET .............. Lot No. ,,,~, ....... SC~ll,~3.O~d.....~,~., ..................... conforms substantially to the Application for Bui[dipg Permit heretofore filed in this office dated ....................................... ,~e.l~t, ........ 1.~....., 19...~) pursuant to which Building Permit No...~..~...~...(~...... dated ......................... ~e~p.tx...1.~..&O¢.,6..,119.....~O was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ .......... ~.r~ate...one...£a~I~'...d~lin~ ...................................................................................... The certificate is issued to ..~.~,~J~..~.:[,e~'.ff~C[~' .......... .~.~r~.e.~ .................................................... (owner, lessee or tena.nt) of the aforesaid building. ltouse ~ 920 Building I~'~pector J[ FOEi~ 190. ~ 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), ,NV 4960 Z Dote ..... Permission is hereby ~]ranted to: i,' ' r at premises located at .~ ..................................................... I1~.~1,¢1, ......... ~.~.~ ...... :...-!: ................ ~ ........ ~ ............ : ................. p.rs.o~,~o opp,,co,,o, do,e~ ........................ a.~ ......... :;~..=!!..... '9-:,~. o.d ,P~rOV~ ,he Buildigg" I~spector. Fee $..~.(~ ............. TOWN OF ~OUTHOLD BUILDING DEPA~.TMENT TOWN (~LERK'S OFFIC! O APFLIGATION FOR BUILDING FERMI7 ~ .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in d~plicate to the Building Inspector. b. Plot plon showing location of lot and of buildings on premises, relationship to adjoining premiers or public streets or areas, and giving a detailed description of layout of pmparty must be drawn on the diagram which Is part of ~le application. c. The work covered by this application may not be commenced blfore issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purPose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ond other pppll¢oble Lawl, Ordinances .or Regulations, for the construction of buildings, additions or alterations, or for removal or de/nolltJ~n, al herltn d~crlbed. The applicant agrees to comply with all applicable laws, ordinance., building code, housl~ code, orl~regulatlon$. (Address of appllcafqt) State whether applicazxt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicon, t,411 a co~orote, slgnatu~ of duly ~thorJzed officer. (Name and title'of corPorate officer) ~ 1. Location of land on whlc].l.l.l.l.l.l.l.l.h.~rc~oosed work will b9 done. Map No.: .............. ~! ............. .~, ..... Lot No.: ...................... "I Street and Number ~...~....~~ ........... ~ .................................. ~'1'1~/~ ~,,~0 Municipality 2. State existing use and occupancy of premises and intended uss and occupancy of proposed comtructlon: a. Existing use and occupancy ...~ ............................................................................................... b. Intended use and occuponz, ..~ ................................................................................................ 3, Nature of work (check which applicable): New Building ~ ................ Addition ...... ~... Alteration ....... : ...... Repair .................. Removat ................. Demolition .................. Other Work (Describe) .................................... (to be poid afl fi~ing this application) 5. If dwelling, number of dwelling units ........ ~ .......... Number of dwelling units on ~ch fl~ ............................ If g~rage, number of c~ ........... ~...~ ................................................................................................. 6. If business, commercioI or mixed ~ncy, specJ~ ~ture a~ extent of ~h ~ of~ ............................ 7. Dimensions of existing s~ructums, if any: Front ............. ~..~.~ ......... R~r ................................ ~pth .................... Height ........................ Number of S~ori~ ................................................................................................................. D~mensions of same structure with alterations or additions: Front ....~.~ ..................... Rear.~ Depth ..~.~. ................... Height .... Z~ ............ Number of Stories ...~ ............. 8. Dbnensions of entire new construction: Front ....... ~y ..................Rear ..~ ............ D~th .J.~. .............. Height ...~..~ ........ Number of Stories .~ 10. Date of Purchase ........................................................Name of Fo~r ~ner ....................................................... 11. Zone or use district in which premises are situated ...~.~.: ........................................................................... ~2. Does proposed construct)On vi~te any zoning law, ordinance or r~ulation? .,~ ......................................... 13. Name of ~,er of prom se~'~ Add,ss /~'~~ ~Ph n Name of Architect ..... ~ ............... ~ ............. ~ .............. A~ress ....~ .................................. Phone No ..................... Nome of Contracto~..~~.A~ress~.~..~ne' ' No .................... PLOT DIAG~M ~ate clearly and di=tinctly oil buildings, whether existing or pr~os~, a~ indicate all set~ck dimensions from pro~ lines. Give street and bilk number or description accord~ to d~, ~d sh~ street nam~ and indicat'e whether ;nterior or corner Jot./O ~ STATE OF NEVV ~)R/~_//A tS.S COUNTY OE--~~ ......... ~ · ................... · ,~~...~ .................................. being duly sworn, deposes and says ,hot he is the applicant' (Name of individual signing q~plication) . - -- above named. He is the ....... : .......... ~~ ........ ................................ '~ ................................................ ~ ...... (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 file this application: that all statements contained in this application are true to the best of his knowledge and belief: and ti.ay the work will be performed in the manner set forth in the application filed therewith. Sworn to befOre me this .~ . .// ...... )..'~'~ ..... d~.ay of ~......~ ........ . 19.7~.. ?n.i _ :; (1.___ 9q __.' .... ...... Notor'/ Public,~..t.~...~9?.v.J[.~.~.... Coun~~ (Signature of applicant) ........... ~/ ELIZABETH ANN NEV~LE ~' ~# ' NOTARY PUBLIC, State of Now York .o. 52-8125850. Suffolk Cou~.J~ TerlTI ~Rires Morch 30,