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Home My WebLink About7590-zNO. & TOWN OF SOUTHOLD BUiI.I~ING DEPARTMENT Town Clerk'~ Office Southold, N. Y. Certificzte Of Occupancy No..ZT..~.~.? ..... Date ............. 3'eh ..... l.~..., lg..~ THIS CERTIFIES that the bugding located at , .]~:lJl~ .St~e~ ............. Street Map No.. ~ ...... i' Block No .... ~ .... Lot No .... . .~3~......~..~.t..l..~..k....~.,..l.. ..... conforms substantiall~ to the Application for Building Permit heretofore ~ed in thi~ office dated ............ 0~l; ...l~, 19. ~. pursuant to which Buildin~ Permit No..?~. dated ........... .0~.t. ~....1.~.., 19..~., 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~iva,te. It~mp...(&e.e. eleory..blLtl~) ................................ The certificate is issued to, [ .~.a.l.l~q!'...~.Jell~i. ..... . .0~..e.r ............................ (owner, lessee or tenant ) of the aforesaid building. Sm~olk County Department of Health Approval UNDERWRITERS CERTIFICATE No. Building InspectOr mm IiI1~i~ (THIS ~. IT/~ BE K~EPT ON THE P~L~.SUNTIL FULL CQ,M, PLETIONOF ~ WORK AUTHORIZED) F eutl~ling inwpm~.tor. lrOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Approved ........................................ , 19 ........ Permit No ..... Disapproved a/c ............................................................................................ Application No ...... ; .......................... (Building Inspector) ~) APPLICATION FOR BUILDING PERMIT Date/ ' I-:- INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building~r~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises relationship to adjo n ng premises or public streets areas, and giving a detailed descr pt on of layout ofproperty must be drawn on the diagram which is port of this application. ~/I 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 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. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. ......... ........ State whether applicant is owner, lessee, ag~qt, architect, engineer, general contractor, electrician, p umber or builder ................................................................... Other Trade's License No ............................................... Location of land on which proposed work ~ill be done, ManNa.; ............... ~ ............./... Lot No ............ Street and Number ...... /~X~../.~./~..~./~... .................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed cor~ruction: a. I:xJsiting use and occupancy .. b. Intended use and occupancy ii ii~.'~i~j.~'~../>~.'.'.'~i ~>~:ii:iiii:iiiiii:iiii::iii.. / 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition ....... ~1 ............ Other Work .................................................... (Description) F~timated Cost . .~..../....~...~....... ~ .............. Fee ....... ~. .................................................................................. 4 ............ /~ "~ * (to be paid on filing this application) If dwelling, number of dwelling~/~ ..... ~Z~ ........ N~f~z~ ~d~e~ng~u~ts~each floor ........ ~ ......... 5. If garage, number of cars ?.~- ~. ........................... ~'~ ........ i ' ' ' r ' : ....................................................................... Height ........................ Nu~er of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ ~ of Stories ............ "'~'7 ....... 8. Dimensions J~i~e new construction: Front~~~ Rear ......... ~.: ............. Depth .....~..: ............. Neight__, -,--. ,,,. Number,/~f ~ories ...... ~.ft ................~ ......... ~....~.~.. ........................................................ o, ......... ...... ..... ......... 10. Date of Purchase ........................................................ Name of Former ~ner ........................................................ 11. Zone or use district in which premises are situated .................................................................. t~ ................................ ~. Does ~o~o~ ~o,~,~.~.o. ~,~,~ o,v ~o.,.~ ~. o.~=~ o~ ~.~,o.: ................. .............................. 14 Name of Owner of prem ses ~.~ Addre~ ./~~.~ Phon~ No ' . ...... ............................ -- ..... ~ .... -- ~a~ .~.~d~('ff ~o,, ~o Name aT Architect ~] /......zJ--.~. .................................... ........... ' ................................... ............ Locate clearly and distinctly all buildings, whether existing or proposed, and ink,ate a~set~c~ d' ~ons~ prope~y lines. Give street and block number or description according to de~, and show stree~ n~ an~dicate whether interior or c~rner lot. / [~'~[ ,/'~7 STATE OF NEWYORK, COU NTYj~f: ...~% ........ ~...-..~J Z~~.~..~......~~ ........ being duly sworn, deposes and says that he is the applicam / ~e of in~vidual signing contrace He is the ....... ~~"¢FCZ~fZ;"&~&~'";~;X~;Xf~'&~fi~V;'~'[f ............................................................... of said owner or owners, and is duty 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 performed in the manner set fo~h in the application filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ Nota~ Public, . ................................... Coun~ ........ ~L'.~ ................. ;~. ........... :...V.x...~....-~'..'~:.,: ......................... jLmiTH z. ~K~N ~ignature o? applicant)