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Home My WebLink About4561-z FO$,bI NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Date d~i~ 11t 19 ~p THIS CERTIFIES that the building located at ~~~1~ Hqa~ Street Map No. ~ Block No. Lot No. . ~X T.e?uz'g3.~ ~t.y, . . conforms substantially to the Application for Building Permit heretofore filed in this office dated lq,~„~ . 19 pursuant to which Building Permit No. i{.~~y3 ~ dated j~jpgr ~tF 19 ,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~~va.t•'~tee~• •s~z'y l~rz~.ld4.i2g • . The certificate is issued to .Ma~,e~l~2rrt~ pwner . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval , Building Inspector Haase ~ ;+04~ we11~s Foxai xo. z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OEFtCE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) fl 4J 61 Z Dote ........................~Q~"`r..........~l......., t 9...~!'~ Permission Is hereby granted to: to ..........;,~A•-•at~o~~~3r••-4a~~~a.~e..,~G.tOCa3~••a~~~ at premises located at .........................~,.~..t16t~.......................y............................................ pursuant to application dated 19..., and approved by the Suilding Inspector. Fee $..~yt........... Building, tnspecta , ~ . ' Foa,~x xo. i U ~ h / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined t9. Application No...~'~t..°~./............ N ` Approved ..........................~.1..........., 19........ Permit No. ~~...(O.`........... Disapproved a/c (Buildin Ins. 9 P APPLICATION FOR BUILDING PERMIT Date .........................IV..C?.cl...... 19.~D..f. . INSTRUCTIONS a. This application must be completely fil?ed in by typewriter or m ink and submitted in duplicate to the Buildin Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicotior c. The work covered by this application may not be commenced before issucnce of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant Such permi 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 Occupanc• shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 o 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 and regulatians. (Signature of applicant, or name, if a corporation} (Address of a licant) ! 1 S v State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder (~c.u fv e 2 Name of owner of premises ~5~~ i~ ~..~..(e~..C: L-I-:.S.~.U If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) x 1. Lac n of (on on which prop~osQed~ work wdl be done Map No.' ............'t..':...1.~ Lot No.• . Street and Number .......................l.-'. ..t.... Municipality 2. State existing use and occupancy of pr ises and intended use and occupancy of proposed construction: a Existing use and occupancy b. Intended use and occupancy .............~'~::~~-~........~^'~.`.:S'!':`.-:........................................ a 3 Noture of work (check which applicable)• New Building Addition Alteration Repair Removal Demolition..............~Other Work (Describe) K 4. Estimated Cost ............................................................Fee (to be paid on filing this opplicotion) 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 Stones 8. Dimensions of entire new construction: Front Reor Depth Height Number of Stories 9. Size of lot• Front Rear Depth 10. Date of Purchase ........................................................Name of Former Owner 1 1. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or re~~ulotion~ 13. Name of Owner of premises ~c'-:~.....~:':~.ddress ....~~.:!tl.. tc............... Phone No 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 fror property lines. Give street and block number or description according to deed, and show street names and indicat whether interior or corner lot. kJc'~ ~ S R b• 0 ~ ` ~ f ~ ~ I STATE OF NEW YORK, COUNTY OF ......................JS.S. being duly sworn, deposes and says that he is the applican (Nome 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 fil this application, that all statements contained in this applicot~on are true to the best of his knowledge and Ike{ief; an that the work will be performed in the manner set forth in the application filed therewith Sworn to before me this day of 19........ ~,.CA Notary Public . County (Signature of applicant)