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Home My WebLink About5004-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~eeten .D~'~.~ ............. Street Map No.. ~'~ ........ Block No... ~ ..... Lot Nox,~... S4~tho].d.. ~.,¥ · .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 0cgoBe~'..¶.~ 19. ?O pursuant to which Building Permit No..~.. dated ........... 00.~..]9 .... , 19. ~, 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 .. P. ri¥~.~e, olxe..family. ~.elli~g. The certificate is issued to...~.~_,,,~,.- .... ~,,,~--I~ -. ~ "i£v:. . ... ~w~e~l~r. ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · .Noir, ............................. UNDERWRITERS CERTIFICATE No.. I~.,R, ........................................... HOUSE NUMBER. ~O ....... Street ......t.oe~or~ D~ ................................. .::~,.(... !'¥. ~'~ ...... Building Inspector FOILM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISE', COMPLIz-FION OF THE WORK AUTHORIZED) UNTIL FULL N? 500 Z D~e ....................... 0e.tO~'. ......... .'19.., 19..'~/0.. Permission is hereby granted to: ...... :~Teel~l~e....i4n~ ..................... ~ ................ ........ It.'i,~..-...3-~ ....... .;.,~..~,,**,e ......... . ................ .......... til~ ....... ~,~,,.....~.1-300-.; ................ to ...l~ke .. at~e~&e~ ..& ..~.1~1..e4~-~o~ ..e~-.e~-s~.n$..~l~e~- .................... at premises located at ....... l,~e.t~el~.-~l~:.~..]L~e..~ ......... ~tie~& ....... 1~.]~ .......................... pursucm¢ to application dated ...................... 0~'~ ....... '~'~ .............. ;...., 19...~, and approved by the Building Inspector. ~Fee $'$~,0~ ............. .............................. .......... , 19 ........ Permit No ...... Application No ............................. Disapproved o~ ~ ....... ..~.~. / APPLICATION FOR BUILDING FIRMIT ..... ........................................... , f INSTRUCTIONS~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building~ Inspector. b. Plat plan showing location of lat and of bujldings on premises, relationship to adjoining pmmiees or public ~treets or areas, and giving a detailed description of layout of property must be drawn on the diagram whlch Il part of ~thJl appIIcation.~/ 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 port 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 punmant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other appllceble Lawl, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal o=Ldemoiltlon, al horlln described. The applicant agrees to comply with all applicabl, laws, ordin~h~l,l,,. (Signatura of applicant, or name, If a COll)oratlofl) ............ State whether applicant is owner, lessee, agent, architect, engineer, ger~eral contractor, electrician, plumber or builder. Name of owner of premises ...... .~..~.~..,~...~,~,....~I....~'....~...;~.~..C~.) ............................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) Locat*on of and on p, esed, wo%wi! _ be. on*. No.: ..................................... ....................... ~' ~n~cl~li~ ..... State exi~ing u, a~d ~cu~ncy of pmmisfl and int~use and ~cu~ncy of pW c~lm: a. ~isting uN a~ ~cupancy ....~...~.~..~~= ~ ............................................................................ b. Intend~ u~ and ~cupanc,~...:...~ .................................................................................................... 3. Nature of work (check which applicable): New Building ................. Addition ................ Alteration ............. Repair .................. ~Removol ..................Demolition .............. .~ Other Work (Describe) .................................. 4. Estimated Cost ..... ?...~...~....O.. ...................................... 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 s:ructures, if any: Fron~: ............................ Rear ................................ Depth ......... Height ....................... Number of Stories ............................................................................................ Dimensions of some structure with alterations or additions: Front .................................... Rear ......................... Depth ................................ Height ........................... Number of Stories .............. /. ................. I 8. Dimensions of entire new construction: Front ...... ..2...~.. ....................... Rear ....~....~. ................... Depth .../. .................... Height .................... NurSer of Stories .............................................................. ~ ....................................................... 9. Size of lot: Front ..... ~ ...............Rear ................................... Depth ...~,~..~....~. ............ ~ ...... 10. Date of Purchase ..../.~..~.. .......................................... Name of Former Owner ....~..('f..~....~. ..................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed co_,g~truction violate any zonino law, ordinance or regula~tion? ............................................................ 13. r~ame aT uwner or premises ........................................ ^aaress ..'. ...... · .......... .~....~.: ............... mane r~o.~e:T.r......-~..~.~... Name of Architect .................. ~ ................................. Address ............................................ Phone No .................... Nome of Contractor .....~... ......... A.~.../.[ .......... Address .....~..: ................... Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or pr. oposed, and indicate all set-back dimens!ons from property ines. Give street and block number or description according to deed, and show street names aha inaico~e whether interior or comer Jot. STATE OF NEW' YORK, . · ! lac COUNTY OF ..... ~.~.~;~'~...~ ~'~' .................................................................................................! being duly sworn, deposes and says t_hot he is the applicant (Name of individual sig,~' ~g app_lica/~o~ If)~ above nomed. He is the .......... ~-~ ........ ~. ........................................... ......................................................... (Contractor, ag~t, comorate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke ~d file this applicotion; teat all statements contained in this application ~re tree to the best of his knowledge and belief: and that the work will ~ performed in the manner set fo~h in the a~ation filed ther~it~ Swam to ~fore me ~is ~ _ '// ~ ~ · 19~ ......... ....... o, .................. . ........ ,