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Home My WebLink About4873-zFOI~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 ....... i~mquamh..&we. .................................... Street Map fla..F.[.~..I..~..~..~..?~I~ No ....................... Lot No. 13..&..pt..l..l~ .......... (~tttCho~13~ .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................ J1A~'.....~ ...................... , 19...~L~0 pursuant to which Building Permit No. I~ .... dated ...................... ~'.1~.~ ....... 2.~ ............ , 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 ........ ........ I~'.:1.~ te.. gao..£ma~,],]r.. 4vi t.t]L~I ......................................................................................... The certificate is issued to ....~t,~f-.l~&...:~F~%l', ............ O~I~,F .................................................. (owner, lessee or tenant) of the aforesaid building. Howe f u,ld,ng Inspec~r ..... /. ..................... :...: ............................................. FOEM NO. ~ TOWN OF $OUTNOLD 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? 873 Z Permission is hereby granted to: ...... il~..ll....~,'e,~a~J, .......................................... at premises located at ............ ,?~:t.~...~..~,..~,.l~t...l.k.-..~t3XlM~..~lJ ................................ ................................................... l:,~jiJ~..&we ........... g"et, etee ~ae .......... J...'~.. ............................. pursuan¢ to application dated ................................ J~ ....... J~ ...... , 19....~ and approved by the Building Insp~tor. Fee $....~,,,t~e .......... ding Ins ~"/'~ ~N OF SOUTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. A~r~ ........................................ U ' ' t' , 19...~.. Permit No. ~.~...~ ..... APPLICATION FOR BUILDING PERMrT Application No....~....~....~...~. ........... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. L/) 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 an 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 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 port for any purpose whatever until a Certificate of Occupancy'l shall 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 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. ath lda Burrovs (Signature cf applicant, or name, if Q corporation) Cuteho ........... (Address of opplica~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ....~th~ 'l~,..]~ll~'~l)~l ......................................................................................................... If applicant Is a co~orate, s~gnature of duly authorized officer. 1. L~ation of lan~on ~hich p~oposed wo~ will be done. Map No.: Lot No.: .~...~..J~.J · Stre and Number ......... ................. .......................................................................... · Munici~li~ 2. ~tofe exi~lng u~ and ~cu~ncy of p~mises and intended use and occupancy o~ prapos~ constmcti~: a. ~isti~ u~ a~ ~cupancy ..... ~l~ .......................................................................................................... b. Intend~ use a.d cupa, ., . ........ ............ 3. Nature of work (check which applicable): New Building ~ ................. Addition ...... ..~...~; ..... Alteration ...~.. ............. Repair ..... ../~'... ........ Removal ....... ,~. ........ Demolition ......... ~ ...... Other Work (Describe) ................... ..................... 4. timated Cost . ................... ........... (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 S~ories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... /....':'1~ ................ Rear ....~/.~,,.~ ............. Depth .../....O.. .............. Height .................... Number of Stories ............................... ~ ............................................................. 9. Size of lot: Front ............................ Rear .................................... Depth .............. 7l~l_:;_.:j~.~.~..,~ 10. Date of Purchase ........................................................ Nome of Former Owner .~.r..~...~T...~.. ........................................ 11. Zone or use district in which premises are situated .......... .~...~....~..:.....~..., ................................................................ 12. ~ Does proposed construction ~;iolatq any zoning law, ordinance or regulatloJ~? ...... .~....O. ............................................ Owner 13. Name of of premises ..~ ................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractort'AJ....../...L.J'..../...~..~...~..~..~.~.O..~..-~.....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 namos and Indicate whether interior or corner lot, ~. .... ~ ............ '.....~ ......... ~/~~(....~ ....... ~.belng duly sworn, d~s and says ~t he Is the applicant (Name of individual signing appllcatl~) ' above named. He is the ......................... ~ ......................... '~[ ....................................................... (~ntmctor, ag~t, co~omte officer, ~.) of said owner or owners, and is duly authorized to pedorm or have perfo~ed the said work and to ~e ~d file this application; that all statements contain~ in this application mm-t~ to the ~st of his ~owl~ge and ~lief; and that the work will be performed in [he manner ~t fo~h in the oppllc~l~ fll~ ~e~ th. Swam to ~fme me this ~/ ~ - ~ . ~ . .. ~z o~ ...~ .... . ~.2~ ~/~.-, ~ ..~ ................ . ........... . .... ~ .... ~ ~.: ~.~ ~ _ ./L .L'~e ~.~ ............... ~ ........................... motaw ~ubhc~l..~,~ ..... Coun~~ (Slgna~m of applicant) Te~m ~ires MItch ~, ~ : ,