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Home My WebLink About4736-zFOlt~l ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~.,~.~.~. ................ Date ...................... ..~..~J.~. ......... ~.~. ......... , 19.~..~... THIS CERTIFIES that the building located at ...~...J[OZ'.t~..JJl3~tL.(~.~.) ................ Street Map No.~o1~ljl~..&..j~. Block No ....................... Lot No..%~..&..JJ~..J6....l~'~Jl~l~.t ....... ~,¥~, conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. ~lJ~ ......... 6 ............. , 19..V0. pursuant to which Building Permit No.~.~ ..... dated ............................... ..~Jl' ....... ~ ........ , 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 ........ .............. l~,v~e..e~e..~.am~l.y..etwell~. .................................................................................. The certificate is issued to ...Ir~r~e~.j,l~..~J~l ............ ~/l~J'. ........................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector~ FORM NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE .KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4736 Z Permission is hereby granted to: e ,,Ii ,,IJt,,t,b...&...~,G~LX ~,~ ..~...,JJt3m Z.I~ Poz,~ldm at premises located ot ................ JJ~.....~ul)~'.t, JL.~d:i~.....J~.~/~) ..................................................... ......................................................... GJ, eealm,~t, ......... I1.'~.. .............................................................. pursuan¢ to application dated ..................... JJ~Jl'. ......... ~ ................... , 19...~.0., and approved by the Building Inspector. Building InspTor BUILDIHG DEPARTMENT ~TOWN CLERK'S OFFICE /~,L.~'~- c~ .~.~ ~...~... 19~ --THOLD, N, ,. , ~ A~ ........................................ , 19 ........ Pe~it No. ' .___ ...... ......................... , , ~. Thi, opplic~tion must be compl*t~ly filled in by ~ewrit~r or in ink ond ~ubmi~ted in duplic~t* b. ~lot plan showino I~t~on o{ lot and o{ buildihos on pr~l~, r~lotion~hip to odioininfl prem se, or nm*~, ~nd ~ivin~ ~ d*t~ilod description of Ioyout o~ Prop~ mu*t b~ drown on th~ di~oram which ~ ~ o{ thi~ oppliCotion. 'c. ~ work c~or~ by this ~pplication m~y not ~ commenced b~for~ i~nc~ o{ Buiidino ~rmlt. d. Upon opproval of thl~ opplicotion, th~ Buildln~ Inspector will i~ue ~ Bui~dln~ ~rmit tO th shall ~ k~pt on th~ promise~ ovoil~bl~ {or in~p*ction throughout th~ pr~r*s~ o{ th~ work. ~. ~o bu~ldln~ *~11 b~ occupied or used in whal~ or in part {or ~ny pu~o~e wh~t~v*r until a Ce~ificat~ shall have been granted by the BuiTding ~nspector. ' APPLI~TION IS HEREBY MADE to the Building De~rtment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Count, N~ York, and other applicable L~s, Ordi~nces or Regulations, for the construction of buildings additions or alterations, or for removal or demo t on, as herein descr bed. ~e applicant agrees to comply with all applicable laws, ordinances, building c~e, ho~ing code, ~d regulations. ...... ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder om of n rfr "//' N e ow e o p emises ...~..~ ........................ ~..~~.~ ............................................................ Ifhcant is a co orate s, nature ;dui auth -ed off,cer I~,,~ ~ ~ ~'~'~' app'/~l_ ~'-- rp _ , 'g aturej~l/duly authg/l~ed officer, j, fo (Name and title of corporate officer) .50UTHOt..O 1. Location of land on which, proposed work will be done..,Map No.: .................. ~ .................... Lot No. Street and NUmber ~~""~~.Z/~!..~.~) ~'~' ........ ~....~...i..'.~.... ilMuni~ipallty ..... 2. State existing use and occupancy of premises 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 ........ Alteration ~. ......... Repair .................. Removal ........;~..~... Demolition .................. Other Work (Describe) ........................................ · 4. Estimated Cost ........../' ................................................ Fee .......................................................................................... ,(to be paid on filing this application)x 5. If dwelling, number of dwelling units ..... .~..../. .......... Number of dwelling units on each floor ..~.......i ................. 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 some structure with alterations or additions: Front ....,.~..~.. ...................... Rear ..,,~...~... .................. Depth ...~. ................... Height .....~....~... ............ Number of Stories ...~ ............. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Nu~er o,f Stories ...................................................................................................................... 9. Size of lot: Front ...~J~.....~.~.... 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 gny zoning law, oj'cl_inance or regulation? ....~ ................................................ premises~....~.~ddress Nome of Architect .................................................... Address ............. ~ .............................. Phone No ..................... Name of Contractor~..r~..-.~-....._~.....Address ...~...'...;~ ............ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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. STATE OF NEW YORK, COUNTY OF ................................ ......... ~..~ ..................... being ~/'''~duly sworn, deposes and says that he is the applicanl (Name of individual Sj~ning app~liCati0n) above named. He is the ....~(~'~f/-,~~ ........................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicatiotn 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 therewith. Sw6m to before me this .... ~'/~.:~.........~ay of ......... .~. ~.~ ................, 19..~/.0 A'/). f ..................... Notary Public~/~.~. EL~I~Z~~.. County~Jj~ ~ (Signature o'f applicant) NOTARY PUBLIC. State of New York No. 52-8]25850. Suffolk Co~ ,Tji'rn ,Expires March ~0, 19,~J