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Home My WebLink About4081-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. S.3~2 .... Date ....... i~y ..... ~., ........, 196.~.. THIS CERTIFIES that the building located at IIO~t, ll .~a~, I~$Y~ .... Street Map No..lLamcel..r · Block No ........... Lot No. ~.&. 29.. Lauz~t, .l[ol~ .... -..~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... O~.ol~r...10, ..., 19 .U. pursuant to which Building Permit No.&Q01,. I~.. dated ...... ~tob~r...~0,. ·., 19. ~8~, 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~l',~&to..one. tam~.l~ .~ee, t].~ ....................................... The certificate is issued to . .Joa~tph. ~.~.e~xleann .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... FOF. M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~051 Z Permission is hereby granted to: ............ ~..~ ....... .~.~...s...~,~,f..~./. ......... ........................................................... ~/..~...~ ~ ............................................................................ ..Z....~....~....E..~......./~ ....... ~; ....... ~..~ ............. pursuon$ to application doted f ~ Ot ?'- 19...~.Sand approved by the Building Inspector. ,~ Building Inspector IUILDING DEPARTMENT TOWN cLERK'S OFFICE SOUTI~OLD, N. Y. Dis~l:~rov~ a/c ~ .................................................................... .............. · .............. ......... ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT D~te .................. ~.....~,Or ............. , 19U ...... INSTRUCTIONS a. This application must becompletely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing !ocation 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 port of this application. c. The work covered ~y 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 perrnJ.t~ ~ ~I shall be kept on the premises available for inspection throughout the progress of the work. e. No butlding shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY/v~ADE 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 Lo~s, Ordirmnces 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 regulahons. (Signature of applicant, or name, if a corporation) ~.~ F~,,.,~ ~).,A~.~ ~j. (Address of applicant) State whether opplicar/t is owner, lessee, atent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~Mllt~.~.te4ezllizt~ ..................................................................................................... If applicant is a corporate, signature of duly authorized officer. on land hlch proposed work will be done. N[ap No.:Z~Ma~'~I,..~ .......... Lot No.: ~J..&i.~.~ ....... Street and Number ~l~zt~..Oal~lezx~..~,~.....~L13~l~i,.~.~...l~al;r~...~ ......... ;;....; ................................... Municipality 2. State existing use aod occupancy of premises and intended use and oc..cupancy of proposed construction: a. Existing use and occupancy ..~l~J,t~,teg~.i.g~lL..:~tlill~...~l~)lt~ ............................................................... b. Intended use and occupancy ..... ~l[~ll~...~..~t~...~.t~.t~l~.~ ................................................................................ 3. Nature Of work (check which applicable): New Building .................. Addition .......X ....... Alteration .................. Repair .................. Removal , .................Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..... Jl~,.000e.01~ ................................. Fee ...~.(J{I. .......................................................................... (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 .........4~6..~ ............ Rear ........... 4~6.*. .............. Depth ....~!. ........ Height ........ .1~.*. ......... Number of Stories ....~. .......................................................................................................... Dimensions of same structure with alterations or additions: Front ....... 42..* ...................... Rear ......... 4~.*. ............ Depth ......... .~.~.l. ................ Height ........... ,1~.e. .......... Number of Stories .1 ............................. 8. Dimensions of entire new construction: Front .............. ~:! ................. Rear .......... ~ ............. Depth .......... 2&.". ....... Height ............... : .... Number of Stories ...................................................................................................................... 9. Size of lot: Front ~,.....$~..e. .............. Rear .................................... Depth ...~00.e. ................... 10. Date of Purchase ................... ~....? .......................... i...Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12~ Does proposed constr,uction violate any zoning law, ordinance or regulation? ....1~ ................................................... 13. Name of Owner of premises .I~.e...~LCI. I~II~IMtI~I ....... Address ...[~lMl~e~,~..~',~&.....~ ...... Phone No ..................... Name of Architect ................... i .................... . ............. Addres~ ............................................ Phone No ..................... Name of Contractor .~II)...~.~ ................. Address ~II~...~, .......... Phone No~'/.l~.?.3~... PLOT DIAGRAM Locate clearly and distinctly al! buildings, Whether existing or proposed, and indicate all set-back dimensions from p~et.erty ~l_i~ne~.. Give stre~r.t and block number or description according to deed, and show street names and indicate w emer interior or ¢orner~ot. ~ 4~ /~ 0 STATE OF NEW YORK, COUNTY OF .......... ......................... ~ ~~...~.~.~.~ ......... bei. ng duly sworn, d~es and says t~t he is the applicanl (Name of individu6J signing a~lication) a~ve named. He is the ..... ~~ ..................... ' (Contractor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or ~ve performed the said work and to ~ke ~d file this application; thor all statements contained in this application are true to the best of his knowledge and belief; and t~at the work will b~ perf?med in the manner set ~o~h in the application filed therewith. Swam to before me'ihis ....... ....... .......................... MAR~ON A.,REGENT NOTARY PUBUC, state of New v~ NO. ~2-3233120 SuHolk