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Home My WebLink About4738-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ~ 11,0~3 Date 6ept 28 l~...~JO THIS CERTIFIES that the building located at .....~.~-.~........~......~...~.....~..~ .................. Street Map No.......X~..., ......... .... Block No. ~ ................. Lot No.~... ....... .~...?....~....l~...f..?...~.........~..e..~..?. ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. ~ ......... ..~. ............. , 19...~... pursuant to which Building Permit No ..... .JJ'.~.~J~ dated ............................ J~. ....... ~J .......... , 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 ........ The certificate is issued to ...~Jl~.../~J~JlJJ~l~.~ ........................ ~Jt~. ........................................... (owner, lessee or tenant) of the aforesaid building. Building Inlpector FORM NO. 9 TOWN OP 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.° 4738 Z ~e ............................. ~ ........ 'e ....... , ,v...{,e Permission is hereby granted to: to ........... .~,,~1,¢...~ ~.~ ~... l~u,13,~U,~ .................................................................................... at premises located at ................................ ~/,~....~]dlJ,..Jilll~...~B{l~ ........................................... ............................................................. {lev ..{{~'~'e3Jl ........................................................................ pursuar,t to application dated ................................ {~ .......8 .......... , 19.....~0 and approved by the Building Inspector. Fee $..~,i[~ ............ ~OWN OF $OuTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... , ^ raved" Perm,t No. Applicotion No /--~'~ ~ ~ Disapproved a/c ... (Bull~ APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot pi.an showing location of lot and of buildings on premises, relationship to adjoining premises or pub c streets or areas, and giving a detailed description of layout of praperty must be drawn 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 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 On:linance 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,~uilding code~J~ousin~code, ond regulations. /~nature of applicant, or name, if a corporation) ~,~Address of applicant)' / State whethe~applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..................... ~ ...... ~ ........................ . .................................... If applic~t~is a corpor, at~ign,~ of ~~,dl~icer. ............ (Name and title of corporate officer) 1. Location of land on which proposed work will begone. Map No.: ..................................... ;. Lot No.: ....................... Street ~ N_um~.~..~~....~.~... .............. ~.~i~.~-...~.~,~,.~.~.~ ............. 2. State existi.ng uSeand occupancy of premi;~and intended use agcL, occupancy of proposed construction: o. Existing use and occupancy ............ ~~i ......... i ........................................ b. Intended use and occupancy .................... ~-~.....~ ....................... 3. Nature of work (check which applicable): New Building J Addition Alteration Repair .................. R_q~noval .................. Demolition ............. :.... Other Work (Describe) ........................................ 4. Estimated Cost ...........~.~...~..~.~J~ .......................... 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 ............................ 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 ....... ~...../'~....~. ........ Depth ..../.~...../. .......... .2/ Height .....~. ............ Number of Stories ....... ./.. ........................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name ~,For, mer Owner ........................................................ 11. Zone or use district in which premises are situated ............ /~~ ..................................................... 12. Does proposed construction vioJqte o~ny ~oning la,w, ordinance or regulatic~D? .......... ~ .......................................... 13. Name of Owner of premises ~~"'' ~" / ........ Address ..,~..~~.~..~ Phone~ -' No Name of Architect '"~'"'"'~;>,7~""~>~ ...... Address ....~ .................. ~,.~ .........Phone No ..................... Na me of Cant ractor~ .~.~.~. ~~Add ress ~ ~ j~..~.r 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. ~ . STATE O~ NDv'~ Y(~PnK,~ IL tee '--'------ ......... ................................. being (Name of individual signing application) / ~' '/~/_~ ~ ~ above named. He is the ................................................... ~ ............................. : ............................................. (Contractor, agar, comorate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are tr~ to the b~t of his knowl~ge and belief; and that the work will ~ performed in the manner set fo~h in the applicati~ filed ther~ith. Swam to before me this I .~ __ ~, ,~_ . /. ], ...~m...~..~..~~~ ........... ~ ................. Nota~ Public, ~.~~Coun~ {Signa~re of applicant) ~NN~ ~O~ ~o~n~ Public in ~ of New Yor~ ~o, 5~-7057150 ~es~din~ in Suffolk Ooun~