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Home My WebLink About4550-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z~.0.2Z. ..... Date ........... THIS CERTIFIES that the building located at . E/3 .Cee%ar. A,~e ........... Street Map No. ~o~ .~y Block No ........... Lot No. ~ .&. tO~ ..... confo~s substantially to the Application for B~ld~g Permit heretofore flied in this omce dated .......... Oct.. ~ .... , 19~. p~su~t to which B~lding Pe~it No... dated .......... N~w. · .12 ...., 19.69, was ~sued, and co~orms to ~1 of the r~e- ments of ~e app~cable pro~sions of ~e law. The occup~cy for w~ch this certificate is issu~ is . -~t..aeeezso~ .Bldg · · ( s~abte ) ..................................... The certificate is ~su~ to .. E~.~ .C~st~s~n ...... ~ ..................... (owner, lessee or ten~t) of ~e ~ores~d buil~g. Suffo~ Co~ty Dep~ment of Hed~ Approval ...N ~R.. ............................. House ~ '9~ ~r~ '~,' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~550 Z Permission is hereby granted to: ................. · t~a,~ ....... tt:~ .......................... to .......... Jj~e ..~-. ~ ~ ~ot,/'.-~,.~i;.-j,~t~,~.) ......................................................... at premises located at ................... ~4~;~11;..~.(10~.t0.~ ...... ~J~:t~..~/'..~J~ .................................. ...... ~ .................................... J,~t,~l, ......... ti,~ .............................................................................. pursucm¢ to application dated .................................. 0~,~ ...... .~. ......... , 19...I~, and approved by the Building Inspector. Fee $....~)jJ ........ Approved ........................................ , 19 ..... Permit Disapproved a/c .................................. ~ ............ {Building Impectof) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by t~pewrlter or in ink and submitted in duplicate to the Building Inspector. b. PI.at .pi.an sho. win.~ I.oc.ation of. lot .a.ad of buildings an pmmmim, relationship to adjoining pmmmises or public streets or ammos, ana giving a ammlea ClescripTion of I(~/out of pro~ mud' be drawn an the diagram which is port of this application. c. The work covered by this application may not be commenced before i~uance of Building Permit. d.. U.pon app.r, oval of this application, the Building Impector will Illue a Building Permit to the applicant. Such permit shall ~e Kept on me premises available for inspection throughout the progress of the work. e. No building sl~ll 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. i.A, .P. PLI_CATION !S HEREB. Y.MA_DE to the Building Department for. the issuance of a Building Permit pumuant to the u,a?~.. :or~, Orfl. ~nance o? me ~own of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or gumt~.o, ns, tar the construction of buildings, additions or alterations, or for removal or demolition, as herein described. e apphcant agrees to comply with all applicable laws, ordinar, lces, building~C,ade, I~ousing.d:ade, and regulations. (Signature of applicant, or name, if a cc/q~,ratian) ...... ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~...-~....~..~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ,9,/,~/~/,,~_ ~O Location of land an which pmpmed work will be done. Map No.: ........................................Lot No.: ,,, .................... State existing usa ~ occupancy of pmmmlese and intended use and oocupancy:of propaeed cansttuctlon: a ...................... ........ ............ .... isting u. ,nd ........ ....................... b. Intended use and occupancy ................ Repair .................. Removal .................. Demo ~t on ............... Other Work (Describe) ........................................ 4. Estimated Cost ................. ~. .............. I~ee .~.~..~..~ ............................................................................. /*j~ ~,c~ ,~,eg--~-~,~,, ~_-~'//-~v.~ (to be paid on filing this application) S. 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 end 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 L..../...~.....-~.. ................. ~ ~ Rear ........ ./...~.. ............ Depth ...... ./.. ~,, .......... Height ...... .~.....'~.. .... Number of Stories ......................... Z. ........................................................................................ 9. Size of lot: Front ...... ~...;~...~.. ......... Rear ........... -/....~...~.. ............ Depth ............. ./....~.....-~.....'~.... , 10. Date of Purchase ................ ../'...~'.'~.....~.. ....................... Nome of Former Owner .......... ...~..~....~./.~ ............... 11. Zone or use district in which premises are situated ..................... ~...~:~'~,Z~.~.7~...~ .................................... 12. Does proposed construction violate any zoning.~,~law/~.or~nance or regulation.;> ................... ~.~.. .... ~.~e o! Owner of Premises .~..~..~.~.~.~....~ddress .~...7~..T../.~...~.....~...~..'~...~. .......... Phone ~i~'~.~.i~i~.i~i~7 *'"~e ot~ 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-bock dimensions from property lines. Give street and block number or description according to deed, and show street na~es and indicate whether interior or corn r STATE OF NEW YORK, I ¢ ¢ 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 ma~e end file this application; that all Statements contained in this application are true to' the best Of his kn°Wledge'and belief; and that the work will be performed in the manner set forth in the applicat~en-fi~ therewith. - Sworn to before me this /~ ~/ /7/ ~/~. ~ Notary Public, . ........................................................... County (Signature of applicant)