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Home My WebLink About8055-zTOW~ OF SOUTHOLD BUn.nl~G DEPAR~ Town Cl~k', O~iee Somhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the builai,g located at Oardin~rs. lane ........... Street Map No..xx. .......... Block No...x~. ....... Lot No, . conforms substantially to the Application for Building Permit heretofore filed in thi. office dated ..............J..u~.....~., 19.~.~. pursuant to which Building Permit No...8~.~... dated ......... .J.~? .... 2. .... , 19.7!, wa, issued, and coaforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thll certifi~te i~ued is .l?r~..v.~t,e..~.s. Or3'..(~tor~e .In~,l¢~) ............................ The certificate is issued to..C3.:L~om], .&. lt~.®~,, liel~ief~ ..... (h~m~.s ........... of the aforesaid buildi~. Suffolk County Department of Health Approval (owner, lessee or tenant) }tol~.o ............................... UNDERWRITERS CERTIFICATE No. N,]R, ........................................ HOUSE NIJI~I~R .............. Sh'~t .......................................... ''' ~i,n~ ~ FOBM 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) Building Inspector. (~/ ' TOWN OF IUll~lNe DIfARTMENT TOWN ~K'S O~FI~,~ IOU*rHOLD, H. Y. Ap~.~ed ...~. ................................ ,; ~ ........ ~e..~t ~o. Application No. Disapproved a/c ....................... i ........ ~ ................................................ ...................................................... ........... ........ (Buildir~nspector) APPLICATION FOR IUILDIN$ fE~,MIT ,.STRUCT'O.S ........ ..................... a. This application must be completely filled in by typewriter Inspector, with 3 set~ 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 stree.ts, or areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this applicahon. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Build!ng Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspechon 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. 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, Hew York, and other appli.c..uble Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demohhon, 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. ........... ; ......-*~..'; ......... ;.~;... ....... ~.~.~: ...................................... (Signature of applicant~ o~ name, i{ ~:orparation} ....... .... / ~/' (^dd~ess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature 6f duly authorized officer. (Name and title of corporate officer) Builder's License No ..................... ~ ............... Plumber's License No ....... ~ .......................... Electrician's License No .......... ~ .................... Other Trade's License No .....................) ...................... Location of land on which propo~d work will be dene. ,Map No.: ........................................ Lot No.....,~=... ............... ~ Street and Humber ....................................................... Mu.,c,pa,i ' State existing use and occupancy of premises and in~e)nded use and occupancy of proposed construction: a. £xisiting use and cccupancy ....................................... ~ .......... b. Intended use and occupancy ................. 3. Nature of work (check which applicable): New Buildi ..... ~ion .................. Alteration ................ · D Ii i n ~ Other ork Repair .................. Remaval~ ................. emo t o .............. ~,~'" W .............................. 7": .................. (Description) Fe ~//") -- "'"". , 4. Estimated Cost ................... 4m..c.,,.~..~. .................... e ....~....~.. ........................................................... ; .............. (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 ....../....~.. ............ Height ...... .7..::...~... Number of Stories ....................................................................................... --v ....... '_'": ............. 9. Size of lot: Front .............. ./..X~...~-~. ........................... Rear ........... .~..~..~.. ................. Depth ....~...O....? ................ 10~ Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded. ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No. ...................... Name of Architect .............................................................. Address ................................ .Phone No. ...................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate cleaHy and distinctly all buildings, whether existing or proposed, and indicate oil set-tx~k dimensions from property lines. Give street and block number or description according to deed,/ond show street names and indicote whether interior or corner lot. / I IOO STATE OF NEW.,~ORK. COUN r ~_.~.~..~..~...~2......~..~'..¢:~....~. ~ b~ ng duly sworn, d~oses and says t~t he is the applicam (Name of individual signing contmcO above name. He is the ............................. ~ ...................................................... ~ .............................................. ~ .......... (Contractor, agent, co~orate officer, etc.) of s~id owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; t~t all statements contained in this application are true to the best of his knowledge and belief; and thaz the work will be performed in the manner set fodh in the application filed therewith. Sworn to before me this ........ ..... ........... , Nota~ Public, . ............ _ . .. C~n~ ../~ ......................... ~~~Z /~,gna