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Home My WebLink About4740-zFOILM NO, '1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .)~a./~..~/~..~nO ....................................... Street Map No ..... ~ ............. Block No ........... ~ .......Lot No..X:~L .........)~B.t,.tl~t(~let..~,Ys .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................... ~.~. ....... 8 ............. , 19...~.0. pursuant to which Building Permit No...~.~..~0Z.. doted ........................ ;'~F' ...... ~ ............... , 19....~), was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ....... ~=l~r&te...o:~e..£a~tl~...&w~l;Llz~, ......................................................................................... The certificate is issued to ,..T-ouL~e...~a~teJct ............ 0~me~ ....................................................... (owner, lessee or ter~qt) of the aforesaid building, House # 1~1~ Building Inspector ..... FOIIM NO. ~ TO~VN 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) N9 ~?~0 Z Permission is hereby granted to: .......... ~.....JJ~lz~h....A~ ................................. .................... ~..~ ................................. to ............. lxaLl,~..mt~f, ttmt..f. Ja~e~...m..ea~t~.t~l...~;~.7,aaaJ ..................................... at premises located ot .......................................................................................................................... ................................................ llatt~tue~ ........... !!,~., .................................................................... pursuan~ to application dated ........................ ~ ......... ~ ............... , 19....~J and approved by the Building Inspector. ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , ]9 ........ Permit No ......................... Appfication No....~...2~..~.. ........ Disapproved a/~..~..~~ ...................... ;"(Building Inspector) 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, re at onsh p to adjo ning premises or public streets or areas, and giving a detailed description of layout of property 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 shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pe~roit pursuant to the Building Zone Ordinance of the Town of Southo d, Sulfa k 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, building code,,~3j~sing code, end regulations. '~" ($i~narure'~'-' or op~icant, or name, }'~'c~'~'~l;;;'r'~'~i'~'~')' ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, ger~eral contractor, electrician, plumber or builder. Name of owner of premises ~t ~ ~ c:~' I ................................................................................. If 9pplicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~, ~ 1. L:~cation of land_g_n which proposed work will be done. Map No.: ..................................... Lot No ' L/Street and Num'~bbe~r~.. P..~..{ .~..~.. ~.~.(~ ¢"E' .N.¢......~....~...~...'~" ............... .......... ~.~....77/...~..~.'.~iii'.~iii '/~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ,,/ c ' a. Existing use and occupancy ....................................................... .~ ....... . .......... b. Intended use and occupancy ~/~//~')~'/c' 3. Nature of work (check which app. licable): New Building..................~ Addition .................."-- Alteration .......... -'-~.~ ...... Repair ..;.-~.......~ ...... Removal -'--- Demolition .......... '"-.~ ..... Other Work (Describe)/~.~7..~..~..~..g'~.....~.~.."T"!..O.. ......... · 3b-o~-~-~ . ~ 4. Estimated Cost ......................................................... I'ee .......................................................................................... (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 c~rs ............................................................................................................................................. 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 a,lteretions or additions: Front .... ,~'~.t~t~;.....~.~.~,~.~..e.~.~:Rear ......... ~. .................. Depth .............. .,,~T~, .~ ........... Height ............................ Number of Stories ....... : ........................ 8. Dimensions of entire new construction: Front .............. ...~.....~.. ............. Rear ...... ..~......~... ............. Depth [ ~'' Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ..... .~...~.../. ........... Rear .......... .~.....~.../. ............... Depth ....../....~...?...../ ............. 10. Date of Purchase ~......~..~...~......~....~.~../...~.~.~.. ................ Name~ o[ Fo.~mer Owner ~.'...~...~...~..~..~.~..~..~...~.'...~.'.....~.....'~.....~....~..~ 11. Zone or use district in which premises ore situated .............. b........~.....-~...: ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ~..0. ..................................................... 13. Name of Owner of premises ~.~.u.!.5...~....~'....~...~...~.!~..~.5 ...... Address ~..~..~...~.~.~.c-.~...~..~.~....~.~..~.',~Phone No..~...~....~.~,.~..~....~.?. Name of Architect ...................................................... Address Phone No ..................... Name of Contractor ..~.~.?..~.~!.~......~..~...'~..~../.~.~...&'..~.. ........ Address .~Nji.~.:-..~.(..~.......~.q.q..~.,?~.~...n.~hone No~ .'~..T...~...~...~..-~ 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. ~'~ ~ ~ r! ~>o STATE OF N~~ I~. COUNty oF ~ ~.~ ~ _ . . ....................... ~...,'; ........ : .................................... Demg au~y sworn, d~oses and says t~t he is the applicant (Name of individual signing applica~ above named. He is the ......................................................................................................................................................... (Contractor, 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 and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and the~ the work ~ill be performed in the manner set fo~h in the applicoti~ fil~ therewit~ Swam to bef~me this ~ ~ ................ .......................... ........... ........ ............ ............................. ~TARY pUBLiC, State of New . 52-3233120 Sulf0Jk County ~ ~ ~rch 30, 19~