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Home My WebLink About4765-zFO~,M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..j~lt~,..jJ~jl~..0~'..:lt/~..6t,~..~t~ ............ Street Map No. JJ3J; ................. Block No ......~ ...........Lot No ..... ~1[ ....... J~,I~III. e~J:IOZ'.J; ....... JLl[a~'.e. ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. .[v~Jt ....... .1.~ ............ , 19.~(~.. pursuant to which Building Permit No...~.~.~..~.... dated ...................... J~. ......... ~.i~ ........... , 19..'~.0.., was issued, and conforms to oil of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ............. l~£~a.te..&eceaao~...(ator~ge)...huilding ............................................................. The certificate is issued to ..Jl/~J~,~,~i..~J~&!jl~ ..........(~tt~. ......... (owner, lessee or tenant) of the aforesaid building. FOI~M NO. ~- TOWN 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) 4765 Z Permission is hereby granted to: ............... .tS. ......... ~18~ ........................................ to ............... tmJ-l~.~..~m~e~m~...l;~t,c~e ~.. buA~ ............................................... at premises located at ................... ~t..B. eO.,~.~',~..i~....6t~..~ .......................................... ...................................... ~l~'lmael~ ~I,~:~ .......................................................... pursucu~' to application dated .................................. ..~ ....... .1.e. ...... , 19...~.~, and approved by the Building Inspector. ,Cee $ ........................ Building Inspector App~',OTZD .AS NOTED ' 765-{nc'~ 9 ,*~ "-") '! P?A FOR THE 1. FOU~._,~¥m,~~ . T~VO REQUIRED FO~ ~t~t :-': CO~',c~TE ~ ~ ~ * PLUMBING 2. ROU~'~ -R,%,~.~: ':~ 3. INSULF ~F], ~ ~' ""~ MuST 4. FINAL. CO, ~S~ ,,'~ .... oN BE C~k~'~] ?~ FOR C. O. c~,cm~' ~Z!~-~. ?/ALL ALL ,-' ' THE RE~ '~E'*Zh''TS OF THE N.Y. ~ATE CCNcZRUCTION & ENERGY Co~ES. ~,.~ R~SpOF]?DL.E FOR D~IGN OR CONSTRUCTION ERRORS. IvDB~ NO. I TOWN OF soUTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. I ~ 19....!..~, Permit No ........................... Approved ........................................ . Disapproved a/c ....................................................... ~ ~or) APPLICATION FOR BUILDING PERMIT ...... .......................... .... Date INSTRUCTIONS a. This application must be completely filled In by typewriter or in ink und submitted in duplicate to the Buildingc~ 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 drawn on the diagram wl'~ch le part of thle application. c. The work covered by this application may not be commenced before issuance of Building Perrolt. d. Upon approval of this application, the Building Inspector will Issue a I~'ulldl'ng 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 Occupancyb~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pureuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~, Ordnances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cod~e, and regulations, (Signature cf/appllc~l~t, or name, If a cd'rporatlon) / /£ ~ ~ ~ ~ //.--/~ ~ - , , (Ac~ess of applicant) / State whether applicant Is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar builder. ................................................................ .Q.~..~.~,.~.. ........................................................................................................... Nam, of o~n.r of pr,m,,,, ....... ~.~.A~..~.~. ...... ~.:....~.~.,.~. ........................................................................ applicant Is a corporate, signature of duly authorized officer. If (Name and title 'of corporate officer) 1. Location of land on whlc~oro, posed work will be done, Map N~o,: ................ :~ ...................... Lot No.: ........................ st,,, and N,mbe, ..... ~.!.~.~.F..¢....~.~,.....~..~...~.~]~ .......... ~~ ~. ~....F.. .................. Municipality ........ 2. State existing use and occupancy of premises and Intended use and occupancy of propos~.J construction: a. Existing use and occupancy ~.. ~....~...~, ..................................... b. Intended use and occupan:', . ........ ~..~...~. ...... ~...~...~..~...~ ............................................................................... 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 fi!lng 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. D mens OhS 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 ........ ~ / Height ...... ~.. ........... Number of Stories ............................................................................ 9. Size of lot: Front ....... .Z'..~. ............_~Rear ...... .~'.~.~. ..................... Depth ..... ~.~....~.. ................ 10. Date of Purchase ......'~.~r....~..~.~...~. .................... Nome of Former Owner ...~..~.~../~...../~...~.~.~.~.. 11. Zone or use district in which~prernises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... .~...9. ............................................... 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ 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 indical'e whether interior or corner lot. STATE OF NDvV~.YORK, tee L~ Ft'r~_r- COUNTY OF ...~~...~'~' ........................................................ :..~.~..;.~...z.~ ................ being duly sworn, d~oses and says t~t he is the applicant (Name of individual signing application) above name. He is the ................................................................................................ ~ ........................................................ (Contractor, agar, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke ~d file this application; that all statements contained in this application are true to the ~f~tE~6~F~dge and belief; and that the work will be performed in the manner set fo~h in the applicati~ filed therewith. Swom to ~fore me this ........ ....... o, ...... ...................... , N~ARY~DLIC, State of New York No.30-5428400 ~ualified in Nassau Coun~ ~m ~r~ ~rch 30, 19~