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Home My WebLink About4664-zFOBM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE: OF OCCUPANCY THIS CERTIFIES that the building located at ..... ]~&,¥~..T~ ........................................ Street Map No ...... ,2~ ........... Block No. ~ ............... Lot No~]~, ...... ~tog. t,,h~14 ......... ]~e~,e ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................... ~IAF~ ......... ~0......, 19..'~(~. pursuant to which Building Permit No.~l:~e ..... dated ....................... ~4,~' ......... .~0 .......... , 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 ........ .............. ~tvata..mm.. t'matl~..d~m].~. ................................................................................. The certificate is issued to .G~OI*~ILJJ~I2]f. ll .......... ~ ................................................................. (owner, lessee or tenant) of the aforesaid building. Go~ ds 160 Building Inspector/ F~RM N~o 2 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) N? 4664 Z Permission is hereby granted to: ......... ~Pi,.. · · .il,~ ~...l~,ee& .................................. to ........... ,J~3~.. m.. mM$.t.l.m%., mi.. an..ezJ. ,..tt~$.. ~w~l ~ ........................................... at premises located at .................... ~O1~.O].t1. ......... N'~¥¥ ................................................................. pursua:n~ to application doted ......................... J~.~O1~ ......... .~ ....... , 19..~)., and approved by the Building Inspector. £ee $...j.;~ ........... Building Inspector BUILDING DEPARTMENT ~/.,.~ ,~,~' //~.T' #.*/~ TOWN CLERK'S OFFICE, , ~ ¥ ~ ~ ~.~. ~ ~ ~. ~D, N. Y. ~/~/~' ~ ~ ~'~ ~amin~ ............ ~..~ ........ , 19.~. ~l'~/?a ' / .Ac l,=tio~No ~ ~ ~ .......................... '.>. ........... , ..................... Di~ppraved a/c ..................................................... 0"/~/~ · ~ ................................................. ........................ APPLICATION FOR BUILDING PERMIT 9~ 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, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port 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 b~ kept on the premises available for inspection throughout the progress of the work. 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. APPLIC^TION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town c~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alt~r removal or demolition, as herein described The applicant agrees to comply with oil applicable lows, ord~nanc,es, budding code, housing c~e~nd regulations. ' (Sig~.~t,,~e~of applicant', or nam, e, if a coq~rationl / (Address of applicant) State whet~ pplic, ant is owngr,/_.. _lessee' agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ................ ................................................................................................. Nome of owner of premises ....~...~....~.....~...F.~.........~..~....~..~.~...~..~ .............................................................................. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which--I~oDosed work will be don~. Map No.: .............. ~ .....................Lot No.: .......~.. .............. Str~ and Number ....... ~.~.~..~.~.~..~....~.~..~ ............ ~.~ ................................... 2, State exi~i*ng use and ~cu~ncy of premiss and intende~ use and ~cu~ncy of pr~ co~st~cti~: a. ~i~ing u, and ~cupanc~.~.....~:~.,/~....~ ~ ....... ~....~..~..../-~..~.c ....... , ........... 3. Nature of work (check which ~pplicable): New Building .................. Addition .... L ......... Alteration ....~... .......... Repair .................. ,Removal ................. ,~ Demolition .................. Other Work (Describe) ........................................ 4. timated CoSt ............................ Fee ................................................................................. (to be paid on filing this application) / 5. If dwelling, number of dwellin.g uni_t_,s ........ .~......~.....N~b,er of dwelling units on each floor .......... ~ ............... If garage, number of c~rs ..... ./.....:..~.'~..~....~..(/..~..~.~.....~....~'...~.[..C?../.-~-. ........................................ ~ ....... :~"7 ........... 6. If business, commercial or mixed occup~y, specify nature~nd extent of each type o use~e~/,~.,/~-b ...... ~.~, .... 7. Dimensions of existir~g structures, if any: Front ...~.....°~..../...~..././. ..... Rear ....~.;¢.../..~_.~x.... ..... Dept~.~..~.R~......~...~. .e,ght ~. ~ Nun*er of Sto,es /. ~.~.~.....~..~..~./..(..%..~.e.Z~ ..................... ; ........... ' Dimensions of same,,structure with alterations or additions~?Front ....~..~..../.~.....~......7. ....... ~Rear .... ~,~..~.......°~...../..~.... '~ - ,~'~ ~ ' " .... ? ~ / ~'um~er of Stories Z .~...~..~...~/~ ~,t~C/'// ~-'~ uepth ........ /........~... ............ ~elgnr ..~'~.. ..................... ~N o ............ .:......:~. ....... ~, x 8. Dimensions of ent~ construction: FrOnt ..~..~..~.~ ......... ~ ~ear/..Z..~ ....... D~th .~.~.~ ......... Height~.~u~er ~ Stories ...~..~.~..~Z.~.~.G.~ ................................................ lo. ~ o~ ~se ...... ~.~..~.~. ................................. ~ ~ ~ ~ .~'.....~.~.~-~i~.~ .......... Do~ proposed oon~t~fi~n ~iol~t~ ~nin~ I~, o~din~n~ ~ r~ul~li~n~ ....~ ............................................... Name of Contractor .................................................... A~ress ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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. ~ ~ ,~, 1 t Ca~ ........... STAT~ )F N~ YORK, - -re. cou~ .... ~¢.~~.i~ / ........ .................... .....(Name of individual ~a~lica~n~ above named. He is the .......... ~.~.~..~~..~.....~[.~;].~;~.~;;[.~[~~-- ....... ] ....... of said owner or owners, and is duly authorized to pe~orm or have perfo~ the said work and to ~ke and file this application; that all statements contained in this application arena ~e best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the appl~ fi~therewith. Swam to before me this ~ _ ............... . L ~' .... ~ ..... ~ .........~ ........................... ELI~BE~H ~N~ N[VI~LE y~tk NmTSO~ pUBLI~ S~ate of ~ew fie. 52'81~Z~ ~h 30,