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Home My WebLink About4876-zFORUM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..... ~.~ah.-&~ ...................................... Street Map No...]~. .............. Block No.31~ .................. Lot No. ~ ......... ~t,~h~t~ ....... lql[, ............. conforms substantially to the Application for Building Permit heretofore filed in t}~Js office dated .............................. ~'~r.~ ....... 28 .............. , 19.~0.. pursuant to which Building Permit No. J~8~l~... dated ......................... e,1'~ ....... 28 ......... , 19..~., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ The certificate is issued to .......eT~IBI..~T.e..~I~I~ ............ ~F ......................................................... (owner, lessee or tenant) of the aforesaid building. House ds 18~0 Building Inspector TOWN OF SOU?HOLD 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) No. 4876 Z Permission is hereby granted to: .............. ~ ......... IIoZo ......................... at premises located at ........... l.~J....Jl~..JJ~JJlJ~..A~ .............................................................. ........................................................... ~ ........... I1~ .......................................................... pursuan~ to application dated ..... ~ ...................... ~1~ ....... ~ .......... , 19.....~L~ and approved by the Building Inspector. Fee $...~.e.J~J ........... Building Inspector 'I~'WN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined. .: ...... , 19TM ........ z/E7 Approved ..k~. ................................., 19 ........ Permit No..... ............... ~o.........Z--- Disapproved o/c ~. .................................................................... APPLICATION FOR BUILDING PERMI'r Dote ...................~ ................................. , 19....~..~.. 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 Iocoticn 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 drown on the diagram which is part of this application. c. The work covered by this application may not be commenced b.,are 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 sh~311 be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY/v~,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, os herein described. The applicant agrees to comply with all applicable laws, ordinon~~g(~~gulations, ........ (AddreSs of oppllcanty State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .: If applicant is a corporate, ~j~jnature df duly ~uthorized officer. (Name and title 'of corporate officer) 1. Location of land on whic]3A3r~osed worJr, will be done. Map No.: ........................................ Lot No.: ........................ _ - Street and Number ..... ........................... ' .,,..~~'~~,,. ................................... ~/ Mu,g~L~ipa lity 2. State existing use and occupancy o~an~d intended use and occupancy ~ proposed construction: a. Existing use and occupancy ...~..¥~,~...(.e.~.~...: ........ : ........................................................................................... b. Intended use and occupon;' ....~...~..'~'"~..~ .......................................... 3. Nature of work (check which applicable): New Building /-/ Addition .................. Alteration Repair .................. ~'r~oval .................. Demolition .................. Other Work (Describe} ........................................ 4m Estimated Cost ............. ~...~,,..~...~..-. ............................. Fee (to be paid o6 fi:ina thi'~ application) ......... 5. If dwelllng, 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 existin~ structures, if any: Front ~..4~(~ .x..~ Rear / ,~ ~.. ~' r~--.L .c~ ../ '~ .,-,/ ~,, ~ .... ?~' ........... ? ..................... ~p~ ...~...,~..,r ......... 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 ................................... . ..... 0. Size of lot: Front ......../....~....~...,/. ..... Rear ........ ./.,.~..~...x. ............. Depth .,.../.~...1~./~ .......... ........................................................ Name o~, F~rm, er (~vne~- .~.~~ ......... 10. Date of Purchase 11. Zone or use district in which premises are situated ~ .......................................................... )2. Does proposed construction ,~,lat~/any/~zo~,.n~ law, ordinance )3. Name of Owner of p remises .~/~:..~,Z~c-~3,,,~..Address°~t~, '- --.°~n';). '~ ' ' Name of Architect ........... ~~ ................... Address ....... ~,/ ............................... Phone No ..................... Name of Contractor ....... ~ ................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly ond distinctly all buildings, whether existing or proposed, and indicate all set-back dimensicns from propen'y lines. Give street and block number or description according to deed, and show street names and indica~'e whether interior or corner Jot. , STATE OF NEW YORK, COUNTY OF ...................~ .......,,,f '~"~' .................... ~"~'~'"" '~'.' //~'~.~..~ ............... being duly sworn, deposes and says tho, he is the applicant (Name of individual signing application) ......... above named. He is the ............ ~.~..~..~..., .......................................................... ; ........................................................ (Contractor, agar, comorate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke 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 performed in the manner set foffh in the application filed t~with. / ~ / ~ , Swam to ~ore me this ~ . ~OTAR~ PUBLIC State ~