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Home My WebLink About4961-zI~P--M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.~...J~0~ .............. Dote ........................ Jlep, t ...... ~/~ .......... , 19...~. THIS CERTIFIES that the building located at ..J)l~..,~l~.~)~.m ............................... Street Map No...313~ .............. Block No....31~ ............. Lot No ..... 31~....J~t:Lt~l~[ ....... J~m'J'.~ ............... conforms substantially to the Application for Building Permit heretofore filed in this office ..................................... ~nJ~J~r ......... ~J6'"', 19'~0.. pursuant to which Building Permit No.J~J~,ii.. dated .............................. ~p.t, .......... '~6., 19..~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .... l~i~a re.. aeeeeee~.. ~.o~e~ele )..~t.).4 laI ....................................................................... The certificate is issued to ..~J~i~...gJll~r~ ............. .(~lg~fll~. ............................................................. (owner, lessee or ter~t) of the aforesaid building. ao oe f 19t+ Building Inspector TOWN OF S0U~rHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N/. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) , UNTIL FULL Permission is hereby granted to: .................. v~.~ ...................... ~; ................ to ............. tm,rjr.. ~.. ~ee a,~oz~..btO,:l,~it ............... ~ ....... ; .......... .,..; ......... : .................... ............................................................. ...~......~,,~, ......... ~.,~ ........ , ........................................ pursuan¢ to application dated .................... ~.~...;,~l~jtl i,.,-, ,19...~' and approved bY the ~ Building Inspector. Fee $ ,,.-~':*.00 .......... r ~ BudSmg lfOB~ NO. I TO~Y~ OF soUTHoLD BUILDING DEPXRT~IN? TOWN C:LEItK'S OFFI¢! SOUTHOt. D, H. Y. ~omined ..................... , 19 ........ Approved ........................................ , 19 ........ Permit No. ~ ~' / ~ Application No....'.~...~....~.~ .......... )%4 Disapproved a/c .............................................. (Bulldi~ APPLICATION FOR BUILDING PERMIT Date .................. ~- ~' ~../...~....' ................ , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink end submitted in duplicate to the Building Inspector. b. Plot plan showing Io~ation of, lot and o~building~ on,prem(ses, relationship to adjoining pmmiees or public streets'or areas, ahd~l~-a'd~il~d ~e~c~,iPtiqn of ]~t 0f~rc) must be drawn on the dl ram which is ri' of thi~a Icatlon c. The Work cOvered by this application may not be commenced bafore issuance of Building Permit. d. Upon approval of this opplication, 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 Bud ng Perm t pureuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York and other applicable Laws, Ord nonces or Regulations, for the construction o.f buildings, additions or alterations or for removal or demo t on, as here n de~rlbed. The apPlicant agrees to comply w~th all applicab · aws, ordinances, building code, housing code, and regulations. nome, ~ (Signature of applicant, o ~orperatlon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. 1. Location of land on Which proposed work will be done. J~Aap 2. State existing use. and OCcupancy of premises and intended use and occupancy of proposed construction: a. Existing use am:l occupancy ................................................................................................... 3. Nature of work (check which applicable): New Building ?....~... ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ~ /.~¢>, ~) O. . . Fee ~ ' ~ (to be paid on fi!ing this application) 5. If dwelling, number of' dwelling units .......... ~ ....... Number of dwelling units on each flqor .......... ~ .. 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 ............... L-~.. ............... Rear ~ Depth ......................... ~ ...... Height ............................ Number of Stories ................................ I I / 8. Dimensions of entire new constru.ction: Front ...~.~.. .......................... Rear ...... Z~. ............... Depth ..... ~.. ................ Height ....~.../. ........ Number of Stories ~ 9. Size of lot: Front ....................... Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner .............................................. 11. Zone or use district in whicll premises ares tuated .~..~i.~; ................. 12. Does proposed construction violate any zoning law, ordinance or regulation? "t/t. X3 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all 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. I 3-4 De COUNTY OF .~s~'~,~..........f~'~' ..................... ~~..~.....being duly sworn, d~es and soys t~t he is the applicant (N 3me ~f {ndividual signing a~licati~ above n~med. He is the ......................... ~ ~ ....... ................................. (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to pe~orm or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this application are tree to the ~st of his knowl~ge and belief; and tha~ the work will be performed in the manner set fo~h in the opplicati~ fil~ ther~ith. Swam to be~e me this .................· o, ........ ........ ~.~ ...... ~....~ . ........................................................... ..................