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Home My WebLink About4700-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.~-.~8~O ................. Date ........................... ~T~ .........2J,....., 19...~.O THIS CERTIFIES that the building located at ..~/.~.....~p~]~..T~ ............................... Street Map No ...... ~ ............ Block No. "'~g~l: ............. Lot No. ~ ...... ~O~I.~'~O~.~'""N'~'¥'& ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................................ ~1~.1......22 19...r~ pursuant to which Building Permit No. dated .................... ~'pl'~'~' ......... ~P ......... , 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 ........ ................ P~'~,vete.. ~w'~t~,~n~ "pe~'"'"('aece s-aor]~") ................................................................ The certificote is issued to .......Dl'..~a*l'l'~..l{e~. *l~sa.l~l..*; .......... {)tl~ ............................................ [owner, ~essee or teno~t) of the aforesaid building. House ~ 31~ Building Inspecto~ FORM NO. e TOWN O~ SOUTHOLD BUILDINg DEPARTMEI~r TOWN CLERK'S OFFICE SOUTHOLD, iq. y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK' AUTHORIZED) N? 4700 Z pursuant, to application dated ........................ dLpZ'~ ....... ~ .......... ~ 19..~., and approved by the Building Inspector. 765-18~2 BUILDING DEPT. INSPECTION [ ] FOUNDATION XST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ]~ULATION [ ] FRAMING REMARKS: ~ DATE 765-18112 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION NO. I 'IX~4'N OF SOu'r~D BUILDING DIiPA~,TMENT TOWN CLERK~ ~OUTHOLD, N. Y. Examined ~ '~"%'~ 19.Z..0.. Approved ........................................ , 19 ........ Permit No.--~... Disapproved a/c · ~....-...~..........~_ .... (Building Ir~pector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ¢. 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 drown 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 progrr~s of the work. e. No building shall be occupied or used in whole or in pm9 for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building~:)el~artm~¥-~or the issuance of a Building Perm t pursuant to the ~Buildln.g' Zone. Oral_notice of the Town ..~ .Southold,..Sbf~olk C. oun~, Ne~ York, and other applicable Laws, Ordinances or ~.egu at?ns, tar the ~:~l~truction of buddings, add,t,ons or altetet~ans,. ~or for removal or dernoliti~n~, as herein described. ~ne applicant agrees to comply with all applicable laws, 0.rdiqances, b~llding code, housing code, and regulations. ............................................ fU !A~ress ~e~ applican~ Sta~hether applicant i,s owner, lessee, agent, architect, engineer, general contractor, electrician, plumbe~; or bu der. Nome o{ owner o~ premL~s ........................ } ................................................. If applicant is a corporate, signature of duly authorized officer. '(Name and title of corporate officer) 1. Location of andan which proper, ed work will No.:. . Lot No.: .............. .......... Street ond Number .......... :.~~¢_ ................................ : ................................. : ................ Municipall~ ........... 2. State existing use and occupancy of p_re,mises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~ .................................................................................. b. Intended use and occupancy ....~.....~....~ ................................................... '..'"'"" 3. Nature of work (check which applicable): New Building .................. Addition .................. ,~ - ~'_~AIt, eroti°n, ...../~, ....... Repair .................. Removal. ................. Demolition .................. Other Work (Describe)-,k~:~:~/..~....~. 4. ~timeted Cost ........... ~.:.'.~.:.'..~ ..................... : ......... f. ....................................................... ....../.. ............... (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 ............................ 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 .................................... Rear ............................ E~epth ........................ Height ..................... Number of Stories ................................................................................................. 9. Size of tot: Front ......... /~..¢~.. .......... Rear ....... ~..,~-***(~.. ................ Depth ..... ~.,~.~. .................. ]0. Dete of Purchase ........................................................Nome of Former Owner ........................................................ ! ]. Zone or use district in which premises ore situated ..................................................................................................... 12. ~Does proposed construction violate any'zoningJ[/)/~ ' law, o rd i no nce or~zu, ~,n;~...: ................................................ 13. Name of Owner of premises ~'....,f~E~.Z~wa~_...Address .~ ................. Phone No Name of Architect ............. : ...................................... t.Address ............................................ Phone No ..................... Name of Contractor ~11~... ~w~/.Address ~~....~.;.~:' Phone No. ~...3.. ~ .~ .~..,.,~...~.. 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 comer lot. S-"^T~ OF N~,,,~o~, , 'ss couNw OF.-~.....~ ". ................. /-'~-.~....~)'~.x~eing duly swam, deposes and says that he is the applicant (Name of indfvidual sign~~ _~ ~ ~bovo nome& He i* the ............... ~ .................................... ..................................................................... · ~(~ntmc~r, agent, co~orote officer, etc.) of said owner or owners, and is duly adtho~t~,perfqr~ o[ have performed the said work and to ~e ~d file this application; that all statements contained in this application am tree to the best of his knowl~ge and belief; and that the work will be performe~ in the ~anner ~t fo~h in the ~plic~i~fil~ therewith. S~m t~b~me this /__ / ......... . ~ ~ ~-~. ~ ~ ~'~ . _ '---~'~~.~-~..~:..? .......................... ~~--~.~/~.~.~~. ~ounw ~ t31gna~ure o~ apron) ~mm~,~on Expires ~. 3~ ~ ~ ' ,