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Home My WebLink About4395-zFORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ~ .~?2t .... Date ........... ~ .~..~..F.. ~.~..., 19. ~ THIS CERTIFIES that the building located at ~.t.~...~..0~...l~..~...(P..~. ) ..... Street Map No... ~ ...... Block No...~. ....... Lot No. ~ .... .~.t!..~...~..$~. ..... .!~? ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........J...~ .... .~.., 19.$9. pursuant to which Building Permit No..l~.~..~.. dated .........J..~..~ .... .2~ .... , 19..~.9., 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 .... ~r~ate. ~e. f~la~ly .d~eXl~u~ .................................... The certificate is issued to .. ,~..h!~..]..e~..~..~, .e..~ .... . .0~..e.F ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Inspector FORM NO. s 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? 4395 Z Permission is hereby granted to: ...l~,..~s,.. &~la..A~,. J~aa,&e~ ..~a~e~.. at premises located ot ............................ ]~J~.....~;~..~ .................................................... ............................................... ~tt. elm~ae ....... ~1,~ .......................................................................... pursuant to application doted ............................ ~.15~. ....... ~ .......... , 19~1]1..., ond approved by the Building Inspector. Fee $...,~..t...(~.. ........... Building Inspector TOWN OF SOUTHOLD IUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ........ , ! ........ Approved ~.. ........................., ........... , 19 ........ Permit No...~...~-...~.i.~...~ Application No ............................. Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PERMI'f INSTRUCTIONS o. 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 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 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 Southald, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the conStruction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant cgrees to comply with oil applicable laws; ordinan.e~s, building code, housing code, and recjulations. '"~Tgnature of applica,,, or name, it a corporationj Nome Of owner of /~'/~ "~ premises ..... ~---~ ,~ .. ~.... ~...~.w · ....................................................................... : ..................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Stre~ and Number .......................................................................................................... o. Existing use and occupancy ............ v.~..= ............................................................................... b. Intended use and occupancy ........... ~~ .................................................................................................................... ~A 3. Nature of work (check which applicable): New Building . ................. Addition .................. Iteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................ Fee ..... .~......~ ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ L ............. 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 .......... ~r....~... ............. Depth ....~..~ ......... Height ....../..~4~...'~.. ......... Number of Stories ............../... .......................... .~....._...~: ................................................../j, , Dimensions of same structure with alterations or additions: Front ..... ~ ...... Rear ....~ Depth ....... ~....~...~ ..... Height ........ ..~....~.....'~... ...... Number of Stories .........../. .................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories .................................................................................................................... Depth ...... 9. Size of lot: Front .......... .~... ............ Rear ........................... 10. Date of Purchase ........ ./.~....~..~ .............................. Name of Former Owner - 11. Zone or use district in which premises are situated .................~...: ................................................................... 12. D~espr~p~sedc~nstructi~nvi~?/`te-atn~z.~n~?'~a~w~t~?n.a.nce~rregu~ti~n?.....~.~....~t~:~-~-J~-~-~-~, .......................................... 13. Name of Owner of premises .~..~..//t.~/~lc~ress .~...~~ Phone No. Name of Architect ~.~..~......~:~.....~~i..Address ....................................... 'T~'"~r)~' v .Phone N~.6/.~...'.-~....-'..$.....d~..~'~.~N°' ............."-~-~. ...... Name of Contractoa~.v ............... :.~<..~.~...~...-..~.....~..~.....~..Address .~ ..Ir::~...-:...~..~......~.. ........... Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exit. ting or prpposed, 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 whether interior or corner lot. STATE OF NE~T'T~ nff/~' t S S COUNTY OF _L_ · ............................. ~~.....~~...~ing duly sworn, d~s and says t~ he is t~ applicant (Name of individual signing ~1~) ~ / . above named. He ~s the .......................... ~~(...~ .................................................................................. (Contractor, ag~t, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~e ~d file this application; that all statements contoin~ in this application am tree to the best of his knowl~ge and belief; and that the work will ~ performed ~the manner ~t fo~h in the ~plic~i~ fil~ ther~ith. Swomto~this ~ ] ~ 1/,~ / , , ~ ~ *_~ / ............ ...... ~ ~/11 till , ~ .~~.~ ............. $..~..~ ....... 5 ........................ Nota~ Public,~~C~n~~ (Siono~re of applicant)