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Home My WebLink About4616-zFOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~J'.~.....~,..~D.~,~ .................................. Street Map No,:~ .................. Block No ...... ~ ............ Lot No ....:~.....~.~..~.. ...... ..~..?~ ........................ conforms substantially to the Apphcation for Budding Permit heretofore filed in th~s office dated .................................... F~ ....... $.~. .......... , 19...~.0. pursuant to which Budding Perm,t No..~.~..1...~.. .... dated ............................ ~21D ....... .1.~. ....... , 19...~.0, was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is Jssued is ........ ..... B~ts$nass,..bmi3xt in~...C r.e s.te~-?ant.) ................................................................................. The certificate ~s issued to ...... ~olph;[~..f$.~3333~.~t3~& ......... .Q~D,f~. .................................................... (owner, lessee or tenot~t) of the aforesmd building House ~ 120~ Building InspeT ~0~ NO. 2 TOWN O~ SOfT,OLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 4616 Z Permission is hereby granted to: .............. ~.~.~.~ ....... :...~.,..~.~.~.~..~ .... ......... ~ ........ .~..~.~..'..~. ......... ~.~.~.~?~-~ ot premises located ot ............................................... .../~....~,.~,-~-,/- .............. ~,~---.-~--..~...--~.- ........................... .......................................................................... ~.~.....u...~...e......~. ..................................................... pursuan¢ to application dated-. ............................ i ..... ?....Z.......~....~.../.~., 19..-7....~, and opproved by the Bvilding Inspector. · Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~ ~/~~' Disapproved o/c ............... ~ ................................... (Building Inspector) APPLICATION FOR BUILDING PERMrI' Dote ........... /..7 .......................... , ,9...ZO... 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 drown 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 Jn 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 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 oil applicable laws, ordinances, buildina code, housing code, and regul ions. ~ignature offapplicon~z~r name, 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 ...~'....~ ........................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of lane on which proposed work will be done. Mop No.: ........................................ Lot No.: ........................ Street and N_~umber ....~.........~...~.... ................................... .~,,~ .................................... ~' -~ -- / /3 0~' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction; o. Existing use and occupancy-....,~...~4~:~'.~: ......................................................................................... b. Intended use and occupancy ............. ~.~ ......................... ' ....................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4· Estimated Cost ........... ~.?....~.~...'r~... ................................. 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 gature 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 addmons. Front ....... . .~... ....................... Rear ............................ Depth ..... ~....~...~.. .............. Height ............................ Number of Stories .~.......~.......~... ......... 8. Dimensions of entire new construction: Front .......... ~. ...................... Rear ...... /....O. ................ Depth ........................ Height ....~..../. ......... Number of Stories .............~ .................................................................................................... 9. Size of lot: Front .......~......~?...~.. ........ Rear ...... .~....~. ...................... Depth .......................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate a~y, zoning law, ordinance or re~ulation?,~ ........................................................... ,3. Name of Owner of premises__ .................... Phone Name of Architect ...... .~.~ ........................... .............. ........ 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~%~cl, and show street names and indicate whether interior or corner lot. 7~ STATE OF NEW YORK, tec ...................... ~.i......~..~...~.........~...c..~...~'~. ....................... being duJy sworn~ d~oses and says t~t he is the applicant ~ (Nam~ of indi~al signing application) ~ ~ ~~~ above named. He is the ............................................ ~~~ (~ntmctor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke end file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the applicati~' fil~ therewith. Swam to before me this ........................ day of ............................................ , 19 ........ Nota~ Public, . ........................................................... Coun~ (Signa~re of applicant)