The URL can be used to link to this page

Home My WebLink About4874-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. I~..~.lP,~ ..... Date ............. Jl~...~ ...... , 19. ~1). THIS CERTIFIES that the building located at . R,-.I~$,O11. A~® ........... Street Map No. ~ ......... Block No. ~,~ ....... Lot No..~ ... MltttSt, uekt. Ii.Y,: ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... J.u~'...~. -, 19..?O pursuant to which Building Permit No. 1~8~l~. dated ............ Jul~ · .27., 19..~t0 was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .P_~.~.~$. O~e. f~l~r..dVel~l.~l~ ....................................... The certificate is issued to ...~.e~-I .N~I~..J$~ .......... 0~. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... I~..-R, ........................... ...... ( ... Building Inspecto~ FOEM 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) z granted to: . Permission Is hereby .................. ~..: ...... :_~_._77....7 .......... ~ ........ to pursuant to application dated ................~..~.'~......(~...~.. ....... , 19..../...¥', and approved by the , Building Inspector. f~ Fee $ ............. - Building Inspector ZOWN OF $OUTHOLD BUILDING DEPARTMENT TO~N CLERK'S OFFICE ~....~..:.~.x ....... .,~.~. _ ~ ~, ._ ,~ ...,..~...~....,.....~..~.~.~ ~ro~ ........................................ , I~ ........ P~rmit No... Application No .......................... .~ Disapproved a/c .............................................................................................. BUILDING PEP, Mr[~("~. . APPLICATION FOR ~te ............... ~.._ ...... ~ ........ ~.~ ......... , ,~..~...0..? INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building''~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premise~ or public streets or~. areas, and gMng c~ detailed description of laYOut of prOl~erty must be drawn on the diagram which Is I~rt of thio appllc~tion.~ c. The Work Covered by this aPPlication may not be commenced before issuance of Building Permit. d. Upon PPproval of this application, the Building Inspector will Issue a Building Permit to the applicant. Such permit shall be kept on the premises available for ieapection throughout the progress of the work. e. No building sbell be occupied or used In whole or In port for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, o,q;~onces, ,b~lding code, housing code, and regulations. ,. ............. ,, ........................ (Address of applicant) 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. Lacatton of land on Wh~h proposed~work will be done. Map No.: ........................................ ~/~ ~ ~ ~"~L°t No.: .......~.. ............. ,~[~ Municipality 2.State existing use a.nd occupancy of p~l~n, lse,~dedt,,A~ ~tJ,-JdJ/,.~ use and occupancy of proposed comtructlon: a. Existing use and occupancy ...... ~....~..-~..~.......~. ......... ..%, ..................................................... ,~ .................................. ,. n' u n, .................. '; ...... b. Inten~ea use a a acc po C' ................. aa ....... · ...................... 3. Nature of work (check which applicable): New Building ~ ................. Addition ....~. ........ Alteration .................. Repair .................. ~e ~rt~oval .................. Demolitia~ .................. ~Other Work (Describe) ........................................ 4. Estimated Cost ......... ..~.....O...O.......~... ................ 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 ................................ 8. Dimensions of entire new construction: Front ............ /......~.. ............... Rear ......... .~....~.... ......... Depth ..../....O.. .............. Height Number of Stories ~ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Na~e of FQ,rmer Owner .................................................... 11. Zone or use d str ct in which prem see are s tuated . ~.. .~..~ ....................................................................... 13.12'NameD°ee preposed construction violate any zonlngof/~J, ~J~ ~, ~.~.- ~L-' law' °rdinance °r .reg~2~~'/~'"'... --,-~--.~..... .......................................... Owner of premises .*.....~.........,..~..~-~.~..Addre~ .... / ...... Phone No ..................... Name of Architect ......... ~~ ........................ Address ............................................ Phone No ..................... Name of Contractor ................................................ Address " ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex sting or propaeed, and Indicate all set-back dimensions from properW lines. Give street and block number or description according to deed, and show street names and Indicate whether interior or comer lot. '1 STATE OF NEW(?OP-~I~F /)~ J e · COUNTY OF~ ~...~.~'"~' J ....... Z//4ff/~..Z.~ ,c~ ~ ~ -. (N~J~i;,~;~i~"~'~ .~,n, duly ~rn, d~l and ~ t~ he Is the applicant a~e named. He is the ........................~..: ...................................... 'Z ....................................................... (~ntm~r, ~t, co~ officer, ~.) ~isaid ~n~.r ~r .~w~er~t ~n~ Is d~ly auth?lze~ to pe~orm or h~ ~d the ~ld ~ a~ ~ ~ ~ file s app motion, mat a. statements contained ~n this a~llc~lon am tree ~ ~e ~ of hls~l~ge a~ ~lief; and ?at th~ To~ will ~.~rformed in~e ~nner _ ............................ LIZkBETH ANN N[VJ.~L~ New York 0TkRY pUBLIC State of