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Home My WebLink About4773-zFOI~/[ NO. 4 TOWN OF SOUTHOLDI BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY No.[..3.~6.~ .............. Date ............................. ~eDt .......22....., 19...~.O THIS CERTIFIES that the building located ct '"'~OI~.J~S...~d. ........................................Street Map No. ~ ................ Block No .....:~ ............. Lot No. ~ ....... 0~:~11~'""~'~'¥'~' ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................... ~:J~y ............ 2~' ...... , 19.~0.. pursuant to which Building Permit No. dated .......................... :.~f~ .......... ~ ......... , 19..rj~)., was issued, ~nd conforms to oil of the requirements of the applicable provisions of the law. The occupancy for wl~ich this certificate is issued is ........ ........... · ~r:[~w~ce...ac.c e..~ s ,~ry...bu:[ [~il~g ..(.~t e~a~e...shed.) .................................................... The certificate is issued to F.z'~...~-g~:~a...JJ* ........... ;..l~ ....................... : .............................. towner, mssee or tenat~t} of the aforesaid building. ~ouse # 1300 Building Inspector TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~n' (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4773 Z Permission is hereby granted to: at premJses located at ............. ~ll3G~l~..[t~Ml~ ................................................................................... ................................................................... ttr~mtt,'.-"ir~¥'~ ................................................................. pursuant to applicQtion dated .............................. ~r.....~. ............ , 19...~(X, and approved by the Building Inspector. ~ Building t~specto~'~r~"/ FOB, M NO. 1 ~ ~OWN OF SOUTHOLD BUILDING DEPARTMENY TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............. ~ ......... 2 ........ , Approved ........................... ~..'. .......... , 19 ti Permit No. J~ '~ '~ ~ Disapproved a/c ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date "i ................ ~...~..~.....~.....Z .............. , 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, relaf~ionship to mdjoining 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 sept on the premises available for inspection throughout the progr~ess of the work. e. No building shall be occupied or used in whole or in part for any p~rpose whatever until a Certificate of Occupancy sha~l hove 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 Regula~tibns, 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, bj~ilding c9de and regulations. ...... ........ ~ ~/ (Address of applicant) ........ State wheth/~plicant~ owner, lessee, agent, architect, engineer, genera? 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) 1. Location of land on which proposed work win be done. Map No.: ........................................Lot No.: ........................ Street and c~' ~,,,~ 7- Number .... ...... .......... ............... ............ ...................................... ,/~ ~2~2/ Municipality 2. State existing use and occupancy of premises and intended use on~d occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ............... ~-ff., ..~...l ............ ~...~.~/g ~..~ .C ................................................... 3. Nature of work (check which applicable): New Building ......... ~.~'.(i.i.. Addition ..................Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................... ff.....~.~. ............................. 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 ................................ / .................. Depth ,..../.,..~, ............. 8. Dimensions of entire new construction: Front ................ ./.~.. ............. Rear. Height ...... ~...~. ....... Number of Stories ...................................................................................................................... 9. Size of lot: Front .......... ~...~...~.. ...... Rear ..... ~...~,..o.. ................... Depth ...... ~..'~. 10. Date of Purchase .......... /~...~..~......~/....,..~..~....~...~Z ........ Name of Former Owner .....~./'~..,~rt.¢ .~...~/......~.~.{..~..C~,~ .... 11. ~one or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises "" "~'/~"~'"/'<'""/~"'e'~''~'''~''/t'Address''- , ,~ A .....~....~...o...~../.~...., ./..~..~..~' "~' ......... 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 indicate whether interior or corner Jot. STATE OF NEW YORK, COUNTY OF ................................ (Naif i~tv~ua[ si~}ng opplicati~) / -- ~~/ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to per~orm or nave performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; ~nd that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ '~, uz-~lz~850 St o