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Home My WebLink About4060-zFORM NO. 4 TOWN OF SOT,TI'HOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOT3T'IIOLD, N. Y. CERTIFICATE OF DP.r. UPANCY THIS CERTIFIES that the building located at ~i~ P®oon&o Bay ~vd Street Map ~..8..*?..~. ..... Block No .... ~ ....... Lot No.P~.~..*. ~ ...... ~...[2.~T.. conforms substantially to the Application for Building Pemit heretofore fil~ in this office dated ........... 8~ .... ~.., 19.~. pursuant to which Building Permit No. ~ dated ............ 8~...~..., 19. ~, was issued, and co~orms to all of the require- men~ .of the applicable provisions of the law. The occupancy f.or ~vhich this ce~ificate is issued is ... ~Y~tO..0~. f~i~. ~V$~ ........................................ The ce~ificate is issued to . ~{.~ .~ .~ ........ ~ ................... (owner, lessee or tenant) of the ~ore,said building. ,Suffolk County Department of Health Approval .... {~? ................................ ............. Building i;l;~;~)~" 'l' .......... ~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEIG~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) me t ~ ~9....e...8. N,° J080 Z ~e ............................. ~. ........................ , Permission is hereby granted to: .... ........ .111~1~.~ Lt~w~ ................................................. at premises located at ..................... pursuant to application dated ........................... ...~..~)..~....t.......~......~., 19...~...., and approved by the Building Inspector. !~0m~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part 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 progress of 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, 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. ..... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................................. ...................................................... Name of owner of premises ............... .J~., ....... J~[I/~.J~J.J~.....~.t..t~.t~.[.~l~-~ ..................................................... If e~nt isa corp~, ~ture of d~y (Name end title of corporete~ficer) I. L~ation of land on which proposed work will be done, Map No.: .~..~.~...Lot No,~~....~ Street and Number ..... , ................................. ~....~.~.~....: ............ ................... ~ ~ N ~ C~ ~ A y ~ L~ Munici~li~ 2. State existing use and occupancy of premises and intended use and occu~ncy of propos~ construction: a. Existing use and ~cupancy ..................... ~.~.~ ......... ~J.~....~.O.aJ~ .................. b. Intended use and occupancy ~ ' ~ ' ~ 3. Nature of work (check which applicable): New Building .................. Addition "'~r ......... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ............. ~.~f..~.~..~...~. ...................... Fee .......................................................................................... (to be paid on filing this application) I 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 ...... ".~ .................... I I I 7. D mens ons of ex st ng structures, f any Front ~ ~,, Rear ~ ~, Depth Height ....J...~. ............. Number of Star es .(~.11~ ~'.-.. Dimensions of same structure with alterations or additions: Front ......... .~.~... Rear ......~...~.. .............. Depth ........ L~.~).! .............. Height ........ .j...~..t. ............ Number of Stories ........~....N...~. ............ 8. Dimensions.Aiof entire new construction: Front .................................... Rear ............................ Depth ........................ Height ...... .[.~..~ ...... Number of Stories ..............~.....~..~ ........................... 9. Size of lot: Front ..]L/,~..I.:.~..~ ........ Rear ..... ........... Depth ............... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ................................................... ;.? .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ I..~.~. _ 13. Nome of Owner of premisesj)../j~N~`..~.~.~'.~`~.~J~..Address~.~..~.~.~...-..j~j~.~..t~g~h~ne No ..................... Name of Architect ...................... ~ ............................... Address ............................................ Phone No. -- Name of Contractor J.-L.~....~-~.~/~..l~O.N[t,~..~,,.Address .~.1~..~..L¢.~1.¢,.1~. ............. Phone No. ~J~.~...~..~.l.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whethe~ existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW_YORK, ~ S S COUNTY OF ..'~.C-..1~-~O.~.~. ........ ~' · · ................ ~'~.,~.-..~J~..~..~,~,.~.~.....d...~...,..... being duly sworn, deposes and says that he is the applicant (N~..-of ' dividual signing application) above named. He is the .................................................. .~.~,~'.4~i~,l~.~.....j~4~.lNi.~..l~.~.~,/~ .................................... (Contractor, agent, corporate officer, etc.) of said owner or awners, and is duly authorized to perfarm 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 forth in the application filed therewith. Sworn to before me this Notary Public, ' RESIDING IN SUFFOLK COUNTY No. 52-5895900 ....... ......... ~1 ~7-7Z777:27