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Home My WebLink About4980-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..J~Jk~ltJJl~.,J~tJ, .................................... Street Map No...31:J~ ............ Block No...J~l~ ........... Lot No..JlJ3J.......JJ~Jtjl~F.~....J/*]Je ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ i ....................... JJ~tJ~ ......... ~J ............... , 19.~... pursuant to which Building Permit No.....~.J~.... dated ........................ ~ ..........J ............ , 19..~).., was issued, and conforms to oil of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ The certificate is issued to ....~.~.~ak~ ............... I~ ................................................................ (owner, lessee or tenant) of the aforesaid building. Building Inspectlr FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) : N? 4980 z Permission is hereby grented to: .............. ...~...~..~.~.:~...~1~.~... premises I~eted ot ............................................................................................................................ ................................................ ~ ............ ~n~ofl: ........ ~.x,: ......................................................... ~ ~ $~ 19..~., an~ opprov~ by the pursu~¢ to opplJcafion dated ................................... ~ .......... ~ .., Building Inspector.~ Building Inspector 'TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No .... ~ ..... Disapproved a/c .............................................................................................. APPLIGATION FOR BUILDING PIKMrT ~'~ ~,~ Oct, .. O.: ................... .............................. , ,,..?...O... 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 location of lot and of bu.ildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout at praperty must be drawn on the diagram which is part of this 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 i~pection 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 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 alterat, ions, or for removal or demollt, ion, al herein described. The applicant agrees to comply with all applicable laws, or~n/~nj:es, 'building .code, ~ous,~c~,.and ~. ..... ............................... State whether ap II~p~is own,er, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................... ............................................................................................................................ Name of owner of premises ...... ~ .................... ('~ ' .....'~.....~...J~r~,,~.--~,~-- ................................................................................ If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) Location of land on,,~,ir.h proposed.,work will I~done. Map No.: ........................................ Lot No.: ....................... Street and Number'~..~(~'~.1.I~.~.~,,...1,~,~...~.,II ...... 2..~..~,.~,.~l~...i.~(~.,r. ........................... 7~ I- ~'~ .5~ 3Wunlclpallty ~ State existing use a,nd occupancy Ofrg~remlse,i and intended use and occupancy of proposed construction: o. Existing use and occupancy ...... ,,~.~-~,{..~,]~ .......................... ........................................................... b. Intended use and occupanc?', ................................................................................................................................ 3. Nature of work (check which applicable): New Building ~ ................. Addition ...~... Alteration .................. Repair ............... ~ Removal .................. Demolition .................. ~l~er Work (Describe) .~...~...~.. ............ 4. Estimated Cost ....... ~/.~.,....~.. ........................... Fee ...... T....~..t ..f~....~... ................... .?.~ ............................. (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units ............... ~ ...........~Number of dwelling units on each floor ......."~. ................... If g aroge, number of cars ......... 6. If business, commercial or mixed oc..cupancy~ specj,~ nature and extent of.each type of use .......'~.., .................. 7. D,mensions of existing structures, If any. Front '""-'~·'/7"" ............ Rear ...... ~..~.. ......... , ...... Depth .......~. ........ Height ........ /...~.......".. Number of Stories ........ ~. ................................... , ................................................ a-- .............. Dzmenslons 0f/sa~n~e structure with alterations or additions: Front ....... ~.../~. ................... Rear ....~...~... ........... Depth ......... .~..1~ .............. Heiaht .... ~...~.. ' ..... ' '/ '" · · . ........ ~Lumoer aT '~rorles ......... /,, .................... 8. Dimensions of entire new construction: Front ....... ~,..~.. .................... Rear ....~.~.. ......... Depth ....~...~.. .............. Height .....J....b. ......... Number of Stories .... ../. .......... 9. Size of lot: Front ..... I..J~..~... ........... Rear ~.~.~... ..... De;;~ iiiii?.i~.~.'.i~.'~...iiiiiiiii'i ...................................... 10. Date of Purchase ........................................................ ~jme of .Former Owner ........................................................ ] 1. Zone or use district In which premlsee are situated .....~.Cnd~:~../.~J~.~/j~.....j~...~. .................................................. 12. Does proposed construction violate anl~onlng law, ordinance or reaulatlon? ......... ~.~...~ ...................................... 13. Name of Owner of premlsel ."~.~.~l~.~.~.J~.lm~.,,...Addrell ..~.~..~...~..,t ............................. Phone No.~....~...'J..~.'~ Name of Architect .................... ~ ............................. ,~clress .~ ........i ............................. phone No ..................... Name of Contractor..~..t...~..~....~.: .~-:....~ ...........Address ......~ .............................. Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex ?tng or prapo~ed, and Indicate all Mt-back dimensions from property lines. Give street and block number or descrlptson according to deed, and show street nameJ and Indicate whether interior or comer lot, STATE OF NEW ~J~RJf~ #/, j,$,~, COUNt. OF ..~....~...~ .... ...... ~lng duly ~rn, d~ and ~a~ t~ he I~ the applicant (Name of Individual ~lgnlng appll~atl~) a~ve name. He Ii the .............................. ~ ...................... .~. ....................................... (~ntmemr, ~t, co~ officer, ~.) file ..... o, ..... ................ _ O N.taw ~hll. ~ ~ ~ ~~')'~1,,- - ~ ......... ,'"~ .................... ..-., ...... ,~.,~.~.,.~.~,~,~.~.~ ~n~ (Slgna~m of applicant) ~ ELIZABETH ANN ~EVILLE ~ ~ ri ' NOTARY PUBLIC, State of New Y~ No. 52-8~25850, Suffolk Term ~p~s M~ch 30, 1~