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Home My WebLink About4358-zFORM NO, ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlific te Occupancy o ............. Date ................................ THIS CERTIFIES that the building located at .... ]~eq~Lt~. &gl .......... Street Map No.. ~ ....... Block No... B ..... Lot No. Zl ..... ~OhOl~l... ],y, ....... confo~s subst~tially to the Application for B~d~g Permit heretofore ffl~ ~ ~s office dated .......... ~... ~ .., 19. ~ p~u~t to w~ch Build~g Pe~it No... ~ dat~ ......... ~ .... ~ .. , 19. ~, was issue, ~d confoms to ~ of the req~r~ ments of the applicable pro~sions of the law. The occup~cy for w~ch ~ ce~icate ~ issued is .... ~. ~a~a~ .-. ~ee~. ~d~ .......................... The certificate is ~sued to . .. ~.. M~~ .... ~ ................... (owner, lessee or ten~t) of the ~ores~d b~ding. Suffolk Co~ty Dep~ment of Health Approv~ ....... HeRo ........................ .... .......... B~d~g Insp~tor FOltM 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.° 4358 Z ~ote .......................... ~ ....... 1, ....... , ,~...~ Permission is hereby granted to: ............. ~1~. J~e&~m~ ...................... at premises located at ~.~.....'~.../...~......~,..~....~l~....~ll~.~lqt ........................................................ pursuan¢ to application dated ................................ ~ ......... ,~ ...... , 19...~ and approved by the Building Inspector. Fe. $....~.~ .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Ye ......... ....... Approved ........................................ , 19..~~. .... Permit No ....................... Disapproved a/c .............................................................................................. 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 location 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 by this application may not be commenced before issu~flce 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 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE 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 Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or fo[ removal or demolition, as herein described. The applicant egrees to comply with all applicable laws, ordinonc, es, building code, housing code, and regulations. ..~... (Signature of applicant, or name, if.a corporation) ...... o' ................. ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ....... ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which praposed wo~ F.j~Je. be ~o/o/z~, Map No.: ....... ...~...........~.. ............. ~..l~t~....~......~. ........... ~tr - an .... . . /,//~' ,, ~G .-c/~ ~ ~ ~ a ~u~r ................... ~.~......~...~ ................................ : ....................................................... 2m State existing use and ~cu,~y off, and intend~ u, and ~cu~ncy of pr~ co~tmcti~: a. ~isting use and ~cu~y ..... ~..=.~ ........ ~ ....................................... ~...,.....~ ~, __.__.......... , ................................... , .............. ~........~.~., 3. Noture of work (check which c~oplicoble): New Building ...~.....~.. ...... Addition .................. AIterotion .................. Repoir .................. Removol .................. Demolition .......... Z--...D.~ther Work (Describe) ........................................ 4. Estimated Cost ............................................................ ~ _ . Fee "~'"'"i~"~"~i~"~"~iii'~";~i;~"~ii~i~i"'l "~'"" .................. 5. If dwelling, number of dwelling units ..... ~ ........ Number of dwelling units on each floor ............................ If garage, number of c, ors ............................................................................................................................................. 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 olterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... /.....~m.. ................... Rear ....L.~ ............... Depth .../....O.. ............. Height .................... Number of Stories .......... ~... 9. Size of lot: Front ..../...~... ................ Rear ........ /...~... ................. Depth ....../.-~....~.....-~... .......... 10. Date of Purchase ....................................................... Name of,,Fornler Owner .......... t~A ~ J~ ~ · ...................................... ! 1. Zone or use district in which premise~ are situated ..... /~......~ ........................................................... 12. Does proposed construction viol~ate any zoning law, o,rdinance 9r?egu~ation~.....~ .............................................. 13. Name of Owner of prem,ses ....... ~.~ ........... 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-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate /.,- f whether interior or corner lot. STATE OF NEW~OJJI~, n COUNTY OF .t::~'~..,/,t~..~.....~ ....... ,f'"'o' .......................................................................................... ing duly ~wom~ d~es ond ~y~ t~ h~ i~ t~ applicont (Name of individual sianing ~lication) above named He sthe ~ ~~ ...... (Contractor, agar, co,orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke ~d file this application; that all statements conta~ined Jn this application am tree to the best of his knowledge ond belief; and that the work will be performe~ in the manner set fo~h in the applicati~ fil~ therewith. Swom to before me this ................ ....... ....... . ~D · I ~ ~/7 ~ ~.._.~_~ ~ ........... ~.~:......4.~ ............................. ~ ........................ Nota~ Public,~.~.~~~~ (Signature of applicant) No. 52-8125850, Suffolk Cou~t~ Term Expires March 30.