The URL can be used to link to this page

Home My WebLink About4674-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..7....~.001 ............. Date ........... i' ............ ~'t ....... ~8 .......... , 19..~0. THIS CERTIFIES that the building located at ..... ~Jld.~/tl~.;J~J~t~-..~ ............................... Street Map No....~[~ .............. Block No .......~ ........... Lot No ..... .~. ...... .l~ee~i¢. .........1¢.~., ............... conforms substantially to the Application for Building Permit ~.heretofore filed in this office dated ................................... ~j~j)~..'J.,~. .......... .~. ...... , 19..~).. pursuant to which Building Permit No.....~.6~.J:.~~,. dated .............................. ~'.'1..'1,......~, ...... , 19..~0., was issued, alnd conforms to all of the requirements of the applicable provisions of the law, The occupancy for which this certificate is issued is ........ ...... ~riva'%e'"on~"~am~' ~y" d~e'~J.~tg .......................................................................................... The certificote is issued to ............ I{.o~I'd...~tzer~be~'~."i....~nel,.; ....... '..~ .............................. ~owner, essee or of the aforesaid building. House # Building Inspecl~r TOWN OF SOUTHOf. D 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) N? 4674 Permission is hereby granted to: ~ .~'~ ~:~'~'~/ .... ...... ~ ...... .~.~;;.~ ;~ ~ .......................... Building Inspector APPLICATION FOR BUILDING PERMrI' ...... .............................. INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port 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 o 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 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. .............................................. (Signature of applicant, or nome, if a corporation) . (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................... · ........................................................................................................ Name of owner of premises .~.,~. X~./L~,~. ,e:O. ~........ ~...~.~ ~...,,~......~..~,~.. If ~licant is a co~e, signature of duly authoriz~ officer. (Name and title of co~orate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and ~g~l~Tb_er..-/.~...~.../.~..~........./~'.. ~....~..~..~'.~. ......... ...~.~.;~. ~ ~ O ~ .~ .............. Mu~i~:ip~'li~/' ...................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~..~...,~Z~...,~...~.,~..~;3r ./.~..~..~.~...!~;.. ......... b. Intended use and occupancy ..... ..~.A<'.~f,~,~.~.....~....,/~..~.~.../~:...~.. ............................. Nature of work (check which applicable): New Building .................. Addition ..... ~ ........ Alteration Repair ................. .,,J~,emoval .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .........~.....~.~ ....................................... Fee .......................................................................................... (to be paid on filing 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 structures, if any: Front ........Z:.....~..! ............. Rear ......... ..~....~. ................ Depth .~.'.~. ......... ~ /~- Height ...../.~...~. ......... Number of Stories .................. '~. ............................................................................................ Dimensions of same structure with alterations or additions: Front ....... ~'..~...,.~. ................. Rear ....~./..~.~..' .............. Depth ....... ~',~,..¢../.(2...~ ........ Height ......./.~.~...~. ............ Number of Stories ............/....~.z~.. ............. , . . 8. Dimensions of entire new construction: Front ..... ~..'~...;Z ................... Rear ...~.~'.....~.. .............. Depth ....................... Height ....... .~.. ......... Number of Stories ................. ~/ ................................................................................................... 9. Size of lot: Front ..... /..~...~.. ......... Rear ...... ./...4~.....?. ................... Depth ...... ~..'?..6.....~.. ............ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... ~..~..~..-----------------~<..~./k'.;.,.~-c~. ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... .../~..?. .......................................... 13. Name of Owner of premise~...'.,~.*.')..."~'.~_,,~.~.~..~...~...~.....Address ~.~.~../~../~/. .................... Phone Name of Architect ...................................................... Address ................ Phone No ..................... Name of Contractor ..~.:..~.//..~,~z~., .......................... Address ......................... Phone N .o~.~.~...Z~,../.~..~ 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 d~d., and.s~how..~t~et, names and indicate whether interior or corner lot. ~,o~.~c:, )':~,,~,-/ STA]-E OF NEW YORK, ~.~e I COUNTY OF ................................ .................................. ~ ....... ~.~.~.~.~.~.~.{~.L ....................... being duly sworn, d~oses 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 m~ke and file this oppJkation; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed ~erewith. Sworn to before me this ................ ........... A~Y pUBI.IC, State of New York ~OT