The URL can be used to link to this page

Home My WebLink About4468-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupency THIS CERTIFIES that the building located at .Bay~ater, &. F&lhel~a~.~--.~renetR~ad Map No. Pe.e .l~4a~..l~'~lock No ........... Lot No.3,~ ..&. P.~. .... CU.t.e.h..o/0~......~.*.~. ? conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 0C.t. .....~..., 19..b~. pursuant to which Building Permit No..~?'..'~... dated .......... ~e.t .... ~ ..., 19.69, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...~?~.~..~e..~e...f.alA~. ~,y..d.w..~.l.1..~.[ ..................................... The certificate is issued to ... l~erhert. T~Lgh$ .... 0wn~r. ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. I~,R, ............................. FORM NO. ~e 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? ~1~$$ Z D~e ............................... ~.~....~.., ~9.......~ Permission is hereby granted to: ...~..~.......~/.........I..~...~ .............. ............. .e.~..e~....e.....i ........................................ pursuant to application dated ..... ..~..P~.......~...~......~ ................ , 19......~.~ and approv.ed by the Building Inspector. Building Inspector BUILDING DEPARTMENT ~.~ TOWN CLERK'S OFFICE · SOUTHOLD, N. Y. Application N ........... m (Building Inspector) APPLICATION FOR BUILDING PERMIT D, ate ............................................................ , 19 ............ 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 drown on the diagram which is port of,~t~.~',~tppllcation. 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 oppliee~ji~ 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 for removal or demolition, as heroin described. The applicant agrees to comply with all applicable laws, ordinance/es, building code, housing code, a~d regulations. //x~ v (Signature of applicant, or name, if a corporation) ......... } ................. State whether applicant is owner, ~essee, agent, omhitect, engineer, general ¢ontro~l'or, ele~rician, pluml:~r or builder. If ~plicant is a ¢orporote, signature of duly authori2~t officer. (Name and title of corporate officer) 1. Location of land on whicboroposed work will be done. Map. No.: ..~-~.../.....~.....~. .................. .Lot Nod ...~...~ ............ ... Street and Numbe ...... ,~r~--:~..l...~~.. : ...... 2. State existing use and occupancy of~R,remises and intended, use and occupancy of proposed construction: a. Existing use and occupancy .~....j~...~[~. ,,9. .......................................................... b. Intended use and occupancy ................................................................................................................................. of'work (check which 3. No e icable): New Building .................. A n ..... Alteration .................. Repair .................. Re~gv~. J~.~....~..~ ....... Demolition .................. ~l~ther Work (Describe)...., ................................... 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on filing this application) If garage, number of c~rs: ...... .-~-.~..~..~..;..;._~ .......... .~...:....-~:~..~ .............................................................................. 6. If business, commercial or mixed occupancy, specify,nature and extent of each ,type of use ............................ 7. Dimensions of exi,sting,~t,uctures, if any: Front ....... ./:.~i.:....!~..~... Rear ...~.;.)...~....~....i~ ......... Depth ............ ; ....... Height ~ ............... Number of Stories ................................................................. ;..~ ....................................... ,.~. Dimensions,~f sam~ structure with alterations or additions: Front .......... :~....:....z. ........... Rear ...... .~.~..:....~. ........ Depth ......~.:....~. .............. Height .'~.~'${~.....~....'....?...':.Numb~r of Stories ...... ../.......~ ....... ,'7 ...... ,, 8. Dimensio,n] of ent?e new construction: Front ..... ./.~!....'..?... ................ Rear ..... ./..~....':..~ .......... Depth ....~.Z...:....~. ....... r.. . . Height .~.~.. ............. ~umber,o~. Storms ....... /.....~ ............. ~ ...................................... ~...~...~., .............. :..~ ...... ;.~ ............ 9. Size of lot: Front .../...~....~...:....~...~.... Rear ........ ~.~..c~..:....(.~. .......... Depth ......L.~..:...~....~.~..~.,..f 'i ~; -" 10. Date of Purchase ........................................................ N~e,o~,_rr~.e~O~ner ..-...//~:..~;'~....~..~.,~. ............... Zone or use district in which remises are situated L.~....~.~.. ~' ! 1. P ............................ 7;~ .............................................. 12. Does proposed construction Vio~t~ qny ZOninn )aw, ordinance or regulation? ....... ./.~./.......: .......................................... 13. Nome of Owner of premises ..~...~...~.~..~.......~/.~..~....~....Address .~Y..~......~...~..~'...Z~....~...~....~.....~...~..~hone No ..................... Name of Architect .....;...~ ......... :'r"-,'~ .......................... Add ess ........................... ~...~..~/.; ...... Phone No ............... ..~.... Name of Contractor .~'..~...~.......~.:....~....~....~...Z...~...5. .......... 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 narfles and indicate whether interior or corner lot. STATE OF NEW YORK, ~ e¢ COUNTY OF ................................ $~'~' ......................... ; .............................................................. ......... being duly sworn, deposes and soys theft 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 rnoke and file this application; that all statements contained Jn this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set [orth in the application' filed therewith. · S..-w-°-..m...t..°...b.:.f..°-r.:drnaeytho~S ............................................ ,19 ........ ............... ..,~. :..~.-~..._~-..__....______~ ~, /~~, Notary Public,. ........................................... , ............... County ~,/~' '(S ig n ~t~' ~' '~ ~)-