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Home My WebLink About4540-zFOF, M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificnte Of Occupnncy No..Z.. 3.8.2Q .... Date .......... .0'..tm.e. .... 8. ........ , 19.~.0. THIS CERTIFIES that the building located at . .p~,/$. 'l(irv -~m-B.lvd ........ Street Map No6.~8 .Arum.,... Block No ........... Lot No..$62. &. 163 ..... G-l'eenpol, t ....N oY confoms substantially to the Application for Building Permit heretofore filed in this office dated ......... NOV ..... 3 ...., 19.69 pursuant to which Building Permit No .... b~51+OZ dated ......... Boy ..... 3 ....., 19.69, was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...busSness. bulld.$ng .... -- s.~orege, ere .............................. n ........................... The certificate is issued to . ~Toim' E-o' 'Bempe ' · · er, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... N°P~, .......................... .....:.-':7 .......... Building Inspecto~ ~e~O0 FORM 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) N? 45~t0 Z Permission is hereby granted to: to ........ ~..je~..~~..l~J~14~.. ¢..~Jm.'.i...at~J) ..................................... at premises located at ............... ..................................... ~1~..~.~ .......... .~,,,~;e~ ...... ~ .................................... pursuc~t to application dated ........................... ~ ...........'9 .......... , 19....t~ and approved by the Building Inspector. - Bu, ld~ng Inspector J Aapmved ........................................ , 19.~.....f. Permit No. .BUILDING DEPARTMENT ~ ,~,,//~, TOWN CLERK'S OFFICE 0 . ~. SOUI'HOLD, N.Y. ~ Application No. ~7/'~/"/ 0 Disapproved a/c .............................................................................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Det. ..... ............ .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. PI.at .pi.an showin~ I .oc.ation. o.f lot .a.nd of bu,ildJngs on premises, relationship to adjoining premises or public streets or areas, ana g~wng a deta,ea aescnpt,on at myout OT propert7 must be drawn on the diagram which is port of thie 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 ir~oection 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~Build!ng Zone. Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Kegu~ations, tar 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,~ bull_cling code, housing code, and regulations. · State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premi*~ .............................. ~ ................................................................................... If applicant is a corporate, uly authorized officer· (Name and title of corporate officer) ,., , 1. Location of land on which proposed work will be done. Map No.: ... ~ ~u' ~e~/ Lot No.: ../..&...~..~.../.('..~. ..... 2. State existing use and occupuncy of premises and intended use ond occuppncy of proposed construction: a. Existing use and occuponcy .............. . ..................................................................................................................... Nature of work (check which applicable): New Bud ng / Addition .................. Alteration Repair .................. Removal ......... ~.... Demolition ................ 6' Work (Describe) ........................................ timated Cost ........... ........... ................... ...J. .................................................................................. (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 ....~...,~.~.~ .......... 9. Size of lot: Front .......... ~ .............. Rear .................................... Depth ................. .~,~ ........... 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violc~'e any zoning law, ordinance or regulation? ....... ..~...o. ............................................... Name of Architect ...................................................... (/ Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ 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 comer lot. ~/O ' ~-~ STATE OF NEW YORK, COUNTY OF ................................ }' ""'~' ................................................................................................. being duly sworn, dePoses and says that he is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (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 b~st 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 ........................ do o, ............................................ ........ Notary Public, ............................................................ County ~ (Signature of applicant)