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Home My WebLink About4676-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF ocCUpANCY N . ~.~9~.~. ................ Date .......... ~ ................ ~O.~l.~ ........ ~ ....... , 19...~.0. THIS CERTIFIES that the building located at ....~e.t,e~..~e~.k..~.....(.p~'.t) ................ Street Map No....,~C .............Block No .....X~ ............ Lot No.~'~j~ .......(~.~ ......... ~,~.~ ................... conforms substantially to the Application for Building Permit iheretofore filed in this office dated .................................... A~r~l ....... {) ........ , 19..~). pursuant to which Building Permit No. dated ............................... A~:t~], ........ 8'"' 19...?~, was issued, dnd conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .......... Pr:~v~%~"one'"fa~4]:~""ctwe't'}i~g ....................................................................................... The certificate is issued to 'i~l~"~J"~Tal'lk ............ ~eI~"i'"'; ........................ : .............................. [owner, ~essee or tenont) of the aforesaid building. House # 2360 Pvt Rd # 13 Building nspe~or FOR~I NO. 2 TOWN OF SOUTHOLD 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? 4676 Z Permission is hereby granted to: Pe.t;e~...~e,ak.. A/C ..~,~,j~..I,, .. ~X~ ............ ......... e.l.~ ..Wes~ i.....i~.,r'~.,~ ....... ; ................. to ........... .B~:%'lL~.'~'"ad~ii~ci~¥'~r~"arr'~i:s't l~"~l'in'g ........................................... at premises located at .............. ~...~...e~.~..~..~..~......~.`~`.~.`~...~.?.~..~...~`.V.`~.~`~.~...~...~..~.~. ............................... .................................................... Orien%~--.it~.~.~- ............................................................................... pursuan¢ to application dated ................................. Apri'2 ......... ~..., 19...~/0., and approved by the Building Inspector. Fee $......~.>0{1 ......... TOWN OF SOUTHOLD ~(~/~/' O,'/'~ 4~*'~ '~. BUILDING DEPARTMENT ~_(.~.~ ~ ~, TOWN CLERK'S OFFICE ~ SOUI'HOLD, N. Y.- Examined ............................. , 19 ., ., Approved ........................................ , 19 ........ Permit No ............................. ~lr ~r Application No....;..~.~....~...?. ........ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. 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 a Certificate of Occupancy sholl 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,.~e,~2 regulations' (S'gnature of applicant, or nafhe, if a corporation) ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..................... ~./,, ........................................................................................................................ If applicant is a corporate, signature of duly authorized officer. ~-u, (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........ ~. ........ ..~... ........... Lot No.: ...../~.......~.. .......... ~ ~ ~ ~ ~ u ~/D ~ ~ .~ Munici~li~ ~ 2. State exi~ing u~ and ~cu~n~ of p~mi~s and intended use and ~cu~ncy of pr~ constmcti~: ~ .................. ....... ................ : .................. 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 filing this application) 5. If dwelling, number of dwelling units ....~....Z...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 .................... ~ ....... Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... ./...~'...'.....~T. ............ Rear ...... ../....~..~..z.~. ....... Depth .../...~...~.~. ...... Height .................... Number of Stories 9. Size of lot: Front ~..c~......~ ...... Rear .................................... Depth ................................ 10. Date of Purchase ...................... Name of Former Owner ............................................ 1 ]. Zone or use district in which premises are situated ............... ~ ......... ~.; ........................................................ 12. Does proposed construction vi~t_e any zoning Jaw, ordinance or reauJatign~ ../r~'J......(?. ........................................ J3. Name of Owner of premises ~.../'./....~....~.'....' .~....~...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 ................................ /..~.1-~....~....'~.....¥ .......................... being duly sworn, deposes and says that he is the ooolicant (Name of' ind~idual signing applic~tion) named He s the ~ C~ . (Contractor, agent, corporate officer, etc.) owner or owners, and is duly authorized to perform or have performed the said work and to make and file >lication; that all statements contained in this application ore true to the best of his knowledge and belief; end work will be performed in the manner set forth in the application filed th.e~with. - before me this _ of ......... , ,,.....,. ~ ~71.% =1.~'~1'1, ! I,..=. i I._ .:~1 ....~ ............. ,...{....~.~....~....td,'_,'_,'_,'_~g.~: .......................... ~~H~A~;.'.,~ ..... Countyy..~.~ (Signature of appllc~f~t) NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk Count~ ~'~rm Expires March 30, 19~.~*