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Home My WebLink About4854-zlrOB,M NO. ~l TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...... G~.o~re..~..&..~|.i.l.:t..Ck...[~ ............. Street Map No. ~ Block No. ~1: Lot No....:1~[ ......... ~.O~l. ta~LQl~l ....... ~'.e.~, ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................... ~T.1~....,.1,3 ......... , 19..?.0.. pursuant to which Building Permit No ..... 14~'14,./~ dated ....................... ~.1~ ........ ~ ........... , 19...?.0., was issued, and conforms to all of the requiremen[~ of the apphcable provisions of the law. The occupancy for which this certificate is issued is ...~,!; ......... &~.~ ~.a ~.Q :~....(.S ~:~ ~g ~ ~..,~U~C~ .............................................. ~ ' ~ ~ The certificate is issued to ..... ~Ql~t,t'L.~..~Ll~Lk..x~..:~.~t~.e .......... ~e&t.a. .................................. ?' (owner, lessee or tenc~qt) of the aforesaid building. ~ House ~ 1~0 Mill Ck Dr Bu~ afng inspector [ ,, / / FOIIM NO. 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? 485 Z Pennission is hereby granted to: at premises located at ........... JJJ;~.~..J~.Jl..~'JJJJl~ ................................................. ....................................................... ~ ......... 1-,~ .................................................................. pursua~¢ to application dated ........................ ~l~ .........~J~' ........... , 19.,..~jjand approved by the Building Inspector. SOUTHOLD, N. Y. Ex min ' a ...... ............. ^ re -'' ~ ~PS-R/~ pp vea,,.,;; ................................... , 19 ........ Permit No....~... .................... TO~N OF $OUTHoLD "UILDING DEPARTMENT TOWN CLERK'S OFFICE Appli~tion No..~..~. ...... Disapproved a/c ................................................................... ~ (Building Inspec~r) APPLICATION FOR BUILDING PERMIT D~t,~. . ..... , ~...?...P.. INSTRUCTIONS ~ ~ a. This application must be completely filled In by typewriter or in nk und submitted In duplicate to the Build~g~ Inspector. ' b. Plot plan showing location of lot and of buildings on premises, reMflonshlp to adjo n ng pram ers or public stree~'/or~ areas, a_nd giving o detailed description of layout of proparty must be drawn on the diagram wl'~ch Is part of fhle oppllcafi6n;~ c. ~ne 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 Perm t to the applicant. Such permitl~/~ 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 Bul d ng Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remora or demolition, al herein described. The applicant agrees to comply with. all apl~licoble laws, ordinonces,....~ ~,~;~'bullding code, houslnLcode, anf regulations. (Signature cf applicant, or name, If a corparatlan) ........................... ....... .................. ...... State whether applicant Is owner, lessee, agent, architect, engineer, general contractor, electrician0 plumber or builder. Nome of owner of pram S ~--~~ ..~....~... JDL/',.~'., If applicant Is a co~omte, signature of duly authorized officer. (Name and title.of corporate officer) 1. L~otlon of land on Which proposed wo~ will be done. Map No ................. .~. .................. Lot No.: ..X ............. ...~ St.. and Number ..... ~ .............. ,~,.,.,~.,~,~ ~g ............ ' ~. ~l~tl~ u~ ~nd ~eupancv ............. ~,~ ........... ~ ............................... : ....................................... b. ntend~ use and ~cuoanc,- ~ 3. Nature of wink (check which applicable): New Building ~ ................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ ............. /oo .~... 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. 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 ................................ 8. Dimensions of entire new construction: Front / Rear ............................ Depth Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction vi~e~..any zoninig~!aw,~r, dinanoe or [~__u!a,t,~..?,~ .......................................................... Name of Owner of rem~se 13. p ' s . ..[~.....~ .... .'.~d ess ............................................ Phone No ..................... Name of Architect ............................................... : ...... Address ............................................ Phone No ..................... Name of Contractor ...................... .~T..~ .............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 lot. ................. ~.~J..~~ ......... bein~ duly sworn, dep~es and says thor h~ is the applicant (Name af Ih~vldual signing al~l~atl~) above named. He is the ............................................................ ~ ~ .................................. '~ ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have 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; and that the work will be performej~.Ln the ~anner set forth in the application filed therewith. Swam to before me this (' ~ ~ /~ ~ ............... ......... ...... ........... ,,, ........ - Notory Public,. ...................... LZ... ............................. ¢o-n~ ........................ i~i~;;~'~':;:/'~;~;ii~',~';,i:f .............................