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Home My WebLink About5514-zFO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at . '$1~ort' R~at .............. Street Map No. X~ ......... Block No... ~ ..... Lot No .... x-r~. · · ~'l~gtl$ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............a~pt' · 20, 19.7t. pursuant to which Building Permit No.. ~.tl~. dated ..........6&i~ 20 ....., 19. '~t' was issued, and conforms to all of the require- ments of the applicable provisions oI the law. The occupancy for which this certificate is issued is .. Prl~va'~e · stozag~ '(ao~essorlr) 'bul~din~ .......................... ' ........................... The certificate is issued to .. C~rl' 8~lr ...... 0 er, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 200 Building Inspector] FO~ 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? 551,~1 Z Date Building Inspector. ,Fee $ ........................ Building Inspector Exam ined ~~,4....~...., Approved ........................................ , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ,, 19 ........ Pemit No ........................ Disapproved a/c ........................................................................................... (~'uilding Inspector) APPLICATION FOR BUILDING PERMIT Date ...~.....~..fg...., 19..~..l... INSTRUCTIONS a. Th~s apphcat~on must be completely filled m by typewriter or in ,nk and submitted in duphcate to the Buildir Inspector. b. Plot plan showing Iocabon of lot and of buildings on premises, relationshzp to adlo~nmg premises or pubhc streets areas, and gwing a detailed description of layout of property must be drawn on the d~agram which ~s part of th~s applicaho, c. The work covered by th~s apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this apphcabon, the Building Inspector wdl ~ssue a Budding Permit to the apphcant. Such perrr shall be kept on the premises avadable for inspection throughout the progress of the work. e No budding shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occupan, shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances. Regulabons, for the construction of buildings, additions or alterations, or for removal or demolition, as here~n describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of apphcant, or name, if a corporation) (Address of applicant) State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildc ................................................................................................Name of owner of premises (~//~ ~ L ~'~"~"~' .................................................................. If appJicant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) 1. Locabon of land on which proposed work will be done Map No · . ............................... Lot No ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ................. Addit,on .................. Alteration ............... Repair .................. Remova~ .................. Demoht~an .................. Other Work (Describe) 4. Estimated Cost .................... ./....~'...~......~.. .................... Fee. (to be pa~d on fihng th~s apphcat~on) 5. If dwelling, number of dwelhng units ............................ Number of dwelling umts on each floor ......................... If garage, number of cars ....................................................................................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................ 7. Dimensions of ex~sting structures, if any: Front ........................... Rear ................................ Depth .................... Height ........................ Number of Star,es .............................................................................................................. D~mensions of same structure with alterations or add,t,ons: Front ....................................Rear ......................... Depth ................................ Height ............................ Number of Stories ................................ 8. D~mensions of e~ire new construction. Front .................................... Rear ............................ Depth Height ......... ~ ....... ~' Number of Stories ........................O.....~....~..'-~ .......................................................................... 9. Size of lot: Front ........... ~.~.~ ........ Rear ! f 0 Depth / ~ O ]0. Date of Purchase ........................................................ Nome of Former Owner ..................................................... 11. Zone or use d~strict in which premises are situated ....................................................... ~/~.~ .................................. 12 Does proposed construction violate any zomng law, ordinance or regulat~9~.~ ....................................................... 13 Name of Owner of premises ...~...?...~........~.....~../I.../..~.. ....... Address ...~.?..~..~..~¢..~.T..~...?.~.~.?..~.~. ...... Phon~e~N~ ..-..~..??.....~'. Name of Architect ..................................................... Address ........................................... Phone No .................. Name of Contractor .................................................... Address ............................................ Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and red,cate all set-back d~mens~ons fro property lines. Gwe street and block number or description according to deed, and show street names and indica whether interior or corner lot. STATE OF NEW YORK,~//~::~, COUNTY OF ................ ..~¢....:.:.:...~. ~ "'" ............................... ............. t,~....,~...~.../.,?'.. .................. being duly sworn, deposes and says that he is the apphca, (Nome of indw~dual signing apphcat~on) 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 fi this application; that all statements contained m th~s apphcation are true to the best of h~s knowledge and belief; ar thor the work will be performed in the manner set fo~h m the application filed therew,th Sworn to before me this ........................ . .................................. :.... .... . .......... ....................................... ELiZaBETH ANN ~EVILLE NOTARY PUBLIC, State of New York Ne 52.~]2~50 Suffolk Count~ T.~m F~mr~s March 30,