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Home My WebLink About4052-zFOR~I N~. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. EP. TIFIEATE OF oP.r:.UPANCY THIS CERTIFIES that the building loc.ated at ..l~..1~..~..~..a.n.~. ................. Street Map No ............. Block No ............. Lot No..C..~.~.~l.~g~.~.,. ~q~..YO~]q ......... conforms substantially to the Applicati,on for Building Permit heretofore filed in this office dated ...... .~.~.]~.t.~...m~..~....1..~., 19.~.~.. pursuant to which Building Permit No...4.Q52..Z dated ...... ~..~.t.~.~....1.8.,., 19.6..~., was issued, and conforms to all of the require- ments .of the applicable provisi.ons of the law. The .occupancy for which this certificate is issued is ...B.U..~.~.n.?.~.~...b.u..~.l.d.~..n~..~.;]..t..h..a..d.d~.~;.:l,O~l .................................... The certificate is issued to . .H..e.n.~.~f..~.....1~..~1.]:..~.. ...................................... (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health Approval .... '. .................................... FOR~ NO. ~ TOWN OF SOUTNOLD 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) N? 4052 Z Permission is hereby granted to: ....... ir~.t~..~,~..... A~......~.ei~L. ~eM~lc ge at premises located at ........... .~j~.....J~III~....~I~MI .......................................................................... ............................................. ¢..~ .~.... ............ ~.,.~.: ........................................................................ pursuan,t to application dated ............................ ..~..~.11~..~......~..~. ............ , 19....6.8., and approved by the Building Inspector. ~ui ding nspector I TOWN OF ~SOUTHOLD BUILDING DEPARTMENT TOWHCLERK'S OFFICE SOUTHOLD, N. Y. Application No.....~....O.;...~.....~Z~... ..... Disapproved a~...~ .......................... (Building In~ector) APPLICATION FOR BUILDING PERMIT Date 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 Iocatmn of lot and of buildings on premises, relahonsh~p to ad ommg premises or pubhc streets or areas, and giving a detailed descript on of layout of property must be drawn on the diagram 'which is port'of ~his application. c. The work covered by this application may not be commenced before issuance Of Building Permit. d. Upon approval of this aoplicatlon, the Building Inspector will issue o Building Permit 'to the applicant. Such permit shall be kept on the premises available for inspection througF, out 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. APPLICATIONIS HEREBY MADEto 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, Ordirmnces or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant ocjrees to comply with all applicable lows, ordinances/buildingS;ode, housing code, and regulations. (Sight, re,of ~Jicant, ot,name,J~a comoratio~) ~ ~ ~^aaress or pp ,I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) I. Location of land on which proposed work will be dane..MOP No.: ................ ~. ................. Lot No.: ...... ~ ........... street and Nurnber~....~-~f,~....;...~~-.~x....~..;.;;;;..;;;.; ..;.;;;..,; .................... ~ .................. ~' ~ Muntcipality 2. State existing use and occup?ney of premiaes and intended use and occupancy of proposed constructibn : a. Existing use and occupancy ~.~....,~.~.;..~...,..~.~..;.~f.:~;~, ~e.~,~....~.~....~.. ......... b. Intended use and'ocCupancy 3. NatUre of work (check which applicable): New Building .................. Addition ......~?...........'~ Alteration ...~ ...... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .............. ~.~..~....].~. .......................... Fee .....-~..... ................................................................................ (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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front / O ~ I 'J ~-,3 ~ .................................... Rear ............................ Depth ....,.~,_i,..,,,.-7, ..... Height .................... Number of Stories ...................................................................................................................... 9, Size of lot: Front ............................ Rear .................................... Depth ................................ ]0. Date of Purchase ........................................................ Nome of Former Owner ........................................................ l l. Zone or use district in which premises are situated ......................... :Z.~...'.]....~..~.~,..~.. .................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ..~'.....0.. ........................................ 13. Name of Owner of premises ..N;.. ,~.~.~.~'..~,!.~,...,~.,.O.,...Address ...~..!.,(/.~ .~..~}.,~./~. ,~. ............... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....~,..'...,~'~..~...~..~,..~.:/( ................. Address .....,/.~,,[.V,.~]/',~.~,?,~..~., ........ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether 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 Iot.~~ ~I'" STATE OF NEVV~-~QR~ , ~, 1 c c COUN OF ....... ..................... ~~......~.,,~ ................ being duly sworn, deposes and soys that he is the applicant (Name of individual signin, g.gpplicati..m~7 above named. He is the ............... ~...o~...~..' ......................................................................................... (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 application; that all statements contained in this application are true to the best of his k~----~ed, ge and belief; and that the work will be performed in the manner set forth in the application filed therewitl'y~--'~ Swam to before me this ('~ , ~ ~ ' ) ) ................ of .................. ........ , , / , '. .................. Notary Public, ..,4/.E..t~.~4vk,~/,f,~....~.~ount,/-,'~ (Signature of applicant) MILDRED CHAP/~AN ~ NOTARY PUBLIC, S(a¥,~f New York No. 52-0618100 ~lolk County Commms~on Expires Ma~h 30, 19