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Home My WebLink About9223-zFOB, M NO. 4 TOWN OF $OUTHOLD BUH~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Map So .... ~. ..... ~lock So...%. .... Lot So..X. ............... ~.~ ..... conforms substantially to the Application for Building Permit heretofore fried in this office dated ......... ~.f,-c]..~. , 19..~?. pursuant to which Building Pei:mit No.C~..,~..~.~....2''- dated ....... ~4.F,~¥..~. .... , 19.').~.., was issued, and conforms to ~11 of the require- ments of the applicable provisions of the law. The occupsncy for which tl~ts~cl~rti~jc~$1~.~_ (owner, lessee or ten,t) of the ~oresaid b~]ding. S~olk Cowry Dep~tment of He~th Ap~val [~. ............................... ~DERWRITERS CERTIFICA~ No~ ~ ~ - , ~ 7, "" ~ ......................... ~./p/~. ~o~= ~~ ~ ~ ...... S~e~ .~~.~ ...................... Building Inspector TOWN OF SOUTHOLD TOWN CLERK S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th~s apphcat~on must be completely filled ~n by typewriter or m ~nk and submitted ~n triplicate to the Budding Inspector, w~ :3 sets of plans, accurate plot plan to scale Fee according to schedule b. Pict plan showing location of lot and of buddings on premises, relationsh~p to adjoining premises or public streets or areas, a g~wng a detaded description of layout of property must be drawn on d~agram which is part of th~s apphcat~on, c The work covered by th~s apphcat~on may not be commenced before ~ssuance of Building Permtt d Upon approval of th~s apphcat~on, the Budding Inspector wdl ~ssue a Building Permit to the apphcant Such permit shall be kept the premises available for ~nspectlon throughout the work e No budding shall be occupied or used m whole or in part for any purpose whatever untd a Certificate of Occupancy shall have be granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Bu,ldmg Permit pursuant to the Braiding Zo Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulatmns, for the construction braidings, addmons or alterations, or for removal or demoht,on, as herren described The apphcant agrees to comply w~th all applicable lay ordmanc,.~s~bu drag cdde, hous ng ~ode, and reg_u at ons and to adm t author zed nspectors on prem scs and n bu drags for necessary mspectto~- ~ ) ~ (S,gnature of apphcant, or name, ,f a corporation) State whether applicant is o~6~, ~nt~tect, engineer, general contractor, electrician, plumber or bu~ld~ Name of owner of premises ............. :Y~ .......... ~~.~..~:.~.~ ........................................................... If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. Map No.: .... )~...~ ~ Lot No ............. Street and Number .... ...~..~....~..~......~. ................................................................................................... -- --~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... 4~...~....~, ............. / ........... .a .......................................... b. Intended use and occupancy ..................... , ................................................................................ 3. Nature of work (check which applicable): New Building ....................... Addition ......~ ........ Alteration ............... Repair ......................... Removal ......................... Demolition,. ....................... Other Work .................................... O/ ~ /~'-' o-r,) IDescrlptlon) 4. Estimated Cost ....~ ........................................ Fee ..(.. ............................................................................................ {to be prod on filing th~s 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 sameC/structure with alterations or additions: Front ..... ~....~ ............. Rear ........ .z-/..~4. ......................... Depth ............ ~.....7~.. ....................... Height ........ ./...~ .................Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..... /1&.¢. ............ Rear ....... ~..~ ............. Depth .......3;......:~.. .................. Height ......... (...~.~. ..................... Number of Stories ......................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 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 (Address) (Phone No.) Name of Architect (Address) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sions fron property lines. Give street and block ~n~umber or description according to ~ames and STATE OF NEW YORK, ) SS COUNTY OF .............................................. ) ................................................................................................. being duly sworn, deposes and says that he is the apphcant above naJne, (Name o.t' mch~Mual ~,~zng contract) He ts the ..................................................................................................................................................................................... (Contractor, agent, corporate officer, etc. ) of sa~d owner or owners, and ~s duly authorized to ~rform or have performed the sa~d work and to make and file th~s application; that statements contained m th~s apphcat~on are true to the best of h~s knowledge and belief, and that the work will be ~rformed m the mare set forth in the apphcat~on fded therewith. ...................................... davof ................................................ 19 ............. ~ ff ~ iff ~ ff , ry ubhc ................................................................... Uoun~ .... ~ ..~...; .............................. ~ .............................................. ~ (St~ oFav~licantJ