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Home My WebLink About7372-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town CAerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .~.1.~. ~ ............ Street 'c~nforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J..gl. y.....~..., 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 (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~ .,.R.: .............................. UNDERWRITERS CERTIFICATE No. N:.R.* ........................................ Building I~poctor [ FOBM NO. ~ TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE' SOUTHOLD, N~ Y. .P BUILDING PERMIT ~: (THIS PERMIT MUST BE KEPT ON THE PREMISES uNTIL FULL' COMPLETION OF THE WORK AUTHORIZED) 19Z4~. Permission is hereby granted.~~...~.:,....~jto:,, .... %~~.....~....-.. ~~~~.,~.....~......../,a.,~~ --- ............ i ....................................... ~ ........ ~ ............. ~ ....... ~ ............ ~' ..... pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. 'C ~4 G LE'-NWOOD M,~P 0¢' LANID ,JAMES AT MC. KILLOp Tovv~;,~ OF ,SouT~44.,~-o, ~J.V. TOWN CLERK'S OFFICE'-' SOuTHOLD, N.Y. ~ .............. Exemin~ ~pr~ .............. ~.~.~ .............. , l~....~m No ..... ~..~ ..~. .................. '( ) - ~r~ a/c ................. ~. ....... ~ ........ '~ ...... ~.,: ........................ ...~ .......... ............. ...................... AFFLICATION FO~ BUILDING I ,.7....9:. .t, Date .~.~ ............................... , ... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit 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 adjoining premises or public streets or areas, giving a detailed description of layout of property must be drawn on'diagram which is pert 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 work. ~ beer~'a e. No building shall be occupied or used in whole or in pert for any purpose whatever until a Cur. tificate of Occupancy thall have granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuan~a B]uilding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other a ,l~J;~, t'~ Laws, O~inances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein dii~c~il:~d. The app{~cant agrees to comply with ail applicable laws, ordinancai, building code, housing code, and regulations, and to admit authorized irispectors on pr~mises and in buildings for necessary inspections. (Address of applicant) State whetherapplicant,~/.,/.,/.,/.,/.,/~,~ig.~mer,.I~---.lessee' agent, architect, engineer, general contractor, electrician, plumber or builder. .................... :...~.~.~..._., . l~2.~r~w- ............................ ,, -- ; ..................................................................................... Name of owner of premises ...~;4f~.Jl~."~ ....... .~...£..4~'.1:.~.~ .................................................................. If applicant is a corporate, signature of duly authorized officer: ~Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No .................... ='. ................................ Other Trede's License No. ~ .... ~J ~ ~. ~'4,~'"~...:~o ........... Location of land on which proposed work will be done. Map No... t No .... Street and Number ~ ~_ ~l~t~g, lbmT~ ...... ~....'...~../~...j~,.l~....." .......... ~[t'J~-~M~i~i~a~l~l~ .......... 2. State existing use and occupancy of premises and intended use~d occupancy of proposed construction: a. x,stin, usea,d cupancy .............. ......... ................................ ................ ,", b. Intended use and occupancy ................ ,,, ..~' .,,,~.~,2. ,~,~ ...... .~../..~...~..~../...~..~.~ .~......~....~'......./~.~-, ........ '~ :~. :~ N~ure of work (check which apolicable): New Building ....................... Add't'on ..................... A teratmn.;..;.,,'.;.;~.. Repair ......................... Removal ......................... Demolition ........................ Other Worll~..-~.. ~,.~ (Description) 4. Estimated Cost. : .......................... Fee ...... ,.~,~.,,... ............................................................................ {tO be pa d on filing this application) 5. If dwelling, number of dwelling units .................Nun3~b~.. r. of dwelling units on each floor ................. ,~ ...................... If garage, number of cars ........................................................................................................................................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..... ~,.,%'~..~ ...... Rear ,..;)~..~'...:. ............ Depth ..~[~..i ........................ Height .t .[....~..~ ...... .t6~. ................. Number of Stor les .../~..~3f~,L, .................................... ~ .~;~; .._._. _;:*~:"' ........ Dimensions structure with alterations or additions: Front ....~.~'.. .............. 'Rear II~IE~'.--;..'..~.~..'~...~. .... Depth .*~'~l~ll'.'"'~'~..~)~&te.. Height ....... I~'~': ......................... Number of Stories ..~f..~i~- ......... i' ................. 8. Dimensions of entire new construction: Front ......................... Rear ...~/.~. ............... Depth ...../..3..., .................. Height '"~'"'a~' (~1-~-~ ............ Number of Stones ......................................................................................... 9. S,ze of lot. Fr~r~ ..~....,,~'~, ....................... Rear .....~[~...~ .......................... Depth/~..,..~..~ff.~{~.~.~.l~. ........ 10. Date of Pumhase Name of Former Owner ................................ 11. Zone or use district in which premises are situated ...... .~-..ll~'~../.~lu~;~.Z~,~.., 12. Does proposed construction'violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be re{Iraded /~. .................... Will excess fill be removed from premises: [ ] Yes 14. Name of Owner of premises,- -- -- -- -- ~ (Ad~ressl (Phone No.) Name of Architect .................................................................................................................................................... (Phone No.) ~~'~}~_'~_~-~: .... ,.,., . PLOT DIAGRAM , ~,.ocate ~.earl~ and dis inc{i -ali I~uildinge, whe:ther existingr Or ~' -~.and bzdicate a_l! est4Sack,.dj~epsions fro~ ~ lines, u~ve street and block number or description according to deed,and show stree'~ n~fi~S and ir~i~te ~;~er or corner lot. ~ ' STATE OF NEW Y COUNT~ He s the ....... ~.... ,,~.. ~¥ being duly sworn, deposes and says that he is the applicant above named. (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 file this applicatidn; that all statements contained in this application are true to the best O.~u~)i~l~.o~l~ and belief; and that the work will be performed in the manner set forth in the application filed therewith. Nolary Pubtic, Stole of New YoI~ -- . ......................... ~ ......... day ?f .................~mnY~i~l~/.ersh .o,ar¥ ............. ........................ (Signattt~ of applicant~ . . _