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Home My WebLink About4987-zFOF~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF' OCCUPANCY THIS CERTIFIES that the building located at ...~&~(1~'9~3~- ~.(~.I~ ............................. Street Map No......3[::[~.. ............ Block No..~ .............. Lot No. ~ Ileal' I~1~fo~11; N,¥e conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... ~.~l).t ....... ~l ....... , 19.?.~... pursuant to which Building Permit No...~8.~... dated ........................... .0~.~; .......... ~ ......... , 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 ........ ............. ,~,~v~te...£ at, o~.~se)...~.g.e. ~ s~...~..butld..~...~ .......................................................... The certificate is issued to .....l/~L~]~,l~,l...tlle~r~,~1 ............ .0~D,~.~ ...................................................... (owner, lessee or tenant) of the aforesaid building. Bouse ~ 3120 FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT. TOWN CLERK'S OFFICE -SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT 6N THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL Permission is hereby granted to: to Building Inspector, .Fee $..~.~' .................. at premises located at ................. .(~4~t~J~,...~l~iJ4j ....... :'. ...... ,~ ................. ~ ....................................... pursuan4' to application dined ...... ~.....~. ~..., 19.~., and Opprov~ by the ' / I~)WN OF soUTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOU), N. Y. Approved L ~ ~? ~~/~c ~ 7 ~ Disapprovecl a/c .............................................................................................. ^pp, ,,an No ..... ........ APPLICATION FOR BUILDING PERMIT Date ' ~ ........................... ........ INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Bui'dina~'T Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre t or areas, and giving a detailed description of layout of property 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 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 pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicab · 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, building code, housing code, and regulations. tSignature cf applicant, or q6me, if a corporation) ......................................... (Add~ress of applk~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... __ ............ T ........... r ...................................................................................................... If 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.: ........................................ Lot No.' .............. Street and Number ...... ......... ..~.....~....~....~.....~.. ............... ./..~..~.~~. ............ 2. State existing use a,nd occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................. : ................................................ b. Intended use and occupanc.. ....... /~.~.~... ..................................................................................... 3. Nature of work (check which applicable): New Building ~ ................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on fi!lng 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 st'ructures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories de///~ ~/ 8. Dimensions of entire new construction: Front ...... ~../. ......................... ' ........ ~ ..................... Rear ...7.. ...................... Depth ........................ Height .....~.(~-.~.~ Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ...................................................................................... 12. Does pr,0posed construction violate any zoning law, ordinance or regulation.;) ............................................................ 13. Name/of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indica~'e whether interior or corner lot. STATE OF NEW YORK, tee COUNTY OF ................................ .f "'~' .............................................................. ~ .................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this o, ............................................ Notary Public, . ........................................................... County (Signature of applicant)