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Home My WebLink About4830-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.. Z~3~,?..1+. .............. Date ............................. THIS CERTIFIES that the building located at .l',o~.13...Tb&t~e ........................................... Street Map No....K~ ..............Block No .....3~ ............. Lot No. "~3C]¢ .......~OtJ. t~'~o"l~l,'"'.~l.;,'~'i .................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... · ~e"'"'~ ......... , 19.r/0.. pursuant to which Building Permit No, ..br.~.~... dated ....................... eT.'c,~e,.-.,2~ ............. , 19..r/~),, 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 ........ ...... D~4_.va.t~e,.~rte-.~e&r~:~,Z~..d.~re~.~.n~ .......................................................................................... The certificate is issued to ' - ....... ,~u~r~..z~a3e~ek ............... 0~rneZ~ ................................................. (owner, lessee or tencmt) of the aforesaid building. [ouse Building Inspector FOF~ 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) N? 830 Z Permission is hereby granted to: .................................................................. ~.QutJ~o~ .......... li.o.'Z ~ ........................................................ pursuon¢ to opplicotion doted .............................. ~.1~. ....... ~ ........ , 19..~., end approved by the Building Inspector. Fee $.._~.~...0~.. ............ Building Inspector Examined Approved TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Permit No .........~.. .......... .~. ..... - Disapproved o/c . ~ ~ . r) APPLICATION FOR BUILDING PE~T ~ ....... ' ................ 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, relationsh p to adjoining prem sas or public streets or areas, and giving a detailed description of layout of property must be drawn on the d agram 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 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 N~DE 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 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, housing code, and regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land onwhichproposedworkwill be done. Map No.: .......... ~ ............. i .......... Lot No.: ...... ~' ........ ~ Street and Number ..... ...~....?....~-~......~.....~.....~.~..........~.....~..;. ............... ...~...,~....?.....~......./~......~.....~'.....~..., ............................... ~J Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ~...~.'~..~. I ~'~' ...x~..(~ ~ ' b. Intended use and occupancy .....~.......~......~...~. ....... ...'~......./...../.'~.....~..........~.......~.'.....~....~.~ ~ ..................... 4. 5. 6. 10. 11. 12. 13. If business, commercial or mixed 7. Dimensions of existing structures, if Height ........................ Number of Dimensions of some structure with Depth ................................ Height 8. Dimensions of entire new construct Height .................... Number of St Size of lot: Front ...... .J....~....~. ........... Locate clearly and distinctly all built property lines. Give street and block nt whether interior or corner lot. Nature of work (check which appli :able): New Building .................. Addition ..... ~d~..~...... Alteration ..~......~:.. ........ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ ................. Estimated Cost ........................................... Fee -- ~"~'-- (to be paid on filing this application) If dwelling, number of dwelling units ..~ ......... Number of dwelling units on each floor ............................ I~:~J~J~, number of cars .............. occupancy, specify nature and extent of each type of use .'~.~ ............ any: Front ............... : ............ Rear ................................ Depth .................... Stories ................................................................................................................. alterations or additions: Front .................................... Rear ............................ ............................ Number of Stories ................................ ion: Front ................ ~....'~... ........... Rear ...... (..~ ............ Depth ..~..~ ........... ~ries .......... ~ ......................................................................................... Rear .................................... Depth ....... J~9...~. .............. Date of Purchase ........................................................ Name of Former Owr~er ........................................................ Zone or use d~stnct m which premL es ore s~tuated ........... Does proposed construction vi~te ,ny zon~ g.. ,.a~. ~o/y.i~an~ce or reg~Jo, t2.o.n~../.~ ...................................... Name of Owner of premises ~ . .~......~~ss ....... ~: ............. Phone No ..................... Name of Architect .................. ,_. ~-'"' ................................ Address.........~....~............... Phone No ..................... Name of Contractor ..... ~....~..~.. ~ ....... Address '"'"'"'~'.~.'"'"'"'""' Phone No. PLOT DIAGRAM ings, whether existing or proposed, and indicate all set-back dimensions from mber or description according to deed, and show street names and indicate STATE OF NE'~/~O.~, 6 ~/~ ! ¢ c (Namefof individual signing opp above named. He is the .......................... of said owner or owners, and is duly autl this application; that all statements cont~ that the work will be performe~-i~ the mar Swam to before me this [ ~ No,a H6 ~,~t25850, S~lfolk C ~ ~l~h~s March 30, I ~ ........ being duly sworn, deposes and says that he is the applicant ic°~kj.~_ ' (Contractor, agent, corporate officer, etc.) ,orized to perform or have performed the said work and to rr~ke and file ~ined in this application ore true to the best of his knowledge and belief; and ner set forth in the application filed therewith. -./2 ff., . ..... ~/,$~.J~. Countyi~'X~,~' (Signature of applicant) AT'