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Home My WebLink About4234-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupnncy No.~,~;~e ...... Date ..........feb ......8 ....... , 19 .~. THIS CERTIFIES that the building located at ~a~e. &~ .............. Street Map No. ~~lock No ........... Lot No..~ ..... ~~ ..... ~., ... confo~ substantially to the Application for Building Pemit heretofore f~ed ~ ~is office dated .:.. 'A~i' 7 ......... , 19. ~ p~su~t to which B~d~g Pemit No. ~2~.. dat~ ......... ~ri~' · ' ~O', 19~., was issued, ~d co~orms to all of the req~e- ments of ~e applicable pro~sions of the law. The occup~cy for which ~s certificate is issued ~ 'P~t~ 'one' 'f~l~"~ll~ ....................................... The certificate is issued to . .Ca~l.~k~eF ..... ~ ......................... (o~er, lessee or ten~t) of the Mores~d b~lding. S~o~ Co~ty De~tment of He~th Approv~ .. N~-R, ............................. ..... ............ ~ d~g ~spect~r FOEI~ NO. ~ TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL F~ULL COMPLETION OF THE WORK AUTHORIZED) N? 4234 Z Permission is hereby granted to: ........ ,.:.C,a~:3...~to~y.e~. ............................... ., ..... .. ............ ~taeeta ............ .~.~ ........................... to ....... ,~a,ke...a3,t ~r ~;~,~a a · ~ :ba~3ua et premises located at ......... Zaat~...~....E~la~e~ha.v. ea ............. ................................................... .... ~..~....-.. ~9.,~...,.~ay~.®w.. ~ve ..&.. gead...e~.. $~, ...... &~ae~pe~$ .............................. pursue:nC to epplicotion dated ............................... A~a~IL....~/. ......... , 19...~., end approved by the Building Inspector. Fee $...5.CL/0 ........... Building Inspector \ Approved ........................................ , 19 ........ Permit No ..... ..'~..~b...~...../..... Disapproved a/c ......... ~ .......... ~ ........................................ ~ ~ ,o~ . · ..................................................................... ;..._~ .................... lUlLDING DEPARTMENT 9/,,/7~ ~.~ ~, ,~ ~ ht TOWN CLERK'S OFFICE ~ SOUTHOLD, N.Y. ~,~,,.t,~d ' APPLICATION FOR BUILDING PERMIT ~te ..................... ~......; ./. .............. , ,~..~,Z. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or Jn ink and submitted in duplicate to the Building Inspector. b. Plot plan showin,g, location of lot and of buildings o~ premiSes, relationship to adjoining premises or public streets or areas, and giving a detoded description of layout of property must be drawn on the diagram which is part 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 ~Build. ing Zone. Or.dinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Kegu~ations, for the construction of buildings, additions or alterations, or for removal or demolition, as here n described The applicant agrees to comply with all applicable laws, or~b, uilding~ code, housing code, and regulations. --"~ ..... ;; ............ ',;,"~;;~;;;.;~-i';;.;i ......... (Address of applicant) t State whether applicant is owner, lessee, agent, architect, engi.neer, ger~eral, contractor, electrician, plumber or builder. Name of owne:~-of premises ..~.~../~.......Y~...L....~...~....~.~...~.....~..E,.~...~ ..................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) /' 1. Location of land on which prol:>o~ed work will be done. Map NO.: ...... ././...~..=~ ................. .Lot No.: ......~...~.~..'. ~ ~:~~,~ ~ .~'.~.~..~.'T ...... Street and Number [,..~..~..../~..~..~¢_ .~.,;¢~....~'~;.;,______ Municipality 2. State existing uSe and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .,~...~..~..~.~,~,.....~.~..~...~.,~....~....O....c~... ................ : .............................................. b. ~nt~,ded uSe and occupan~ ......... ~,¢....-Y..,¢.. ........................................................................... ~ ...................... ~ .... 3. Nature of work (check which applicable): New Building .................. Addition u/ Altera¢ion ~' Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... ~.v..4'....d..?..~ ...................................... Fee ~ . . (to be paid on filing this application) 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 o~ e~jsting structures, if any: Front ...........'~...O.. ............ Rear .....~...~. ....................... Depth ..~..~..x./..L-.... 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 ...... ~r2.. ......................... Rear ............................ Depth ........................ Height ....4~s~. ........... Number of Stories ......... /. .......................................................................................................... 9. Size of lot: Front ..... . .',~..O.x. .............. Rear ............ .~..~ ................ Depth ..../.~...~. ................. I/x,~ Former .~...~..~.:...~/~.~t~.~..~.~..,,~..Z-,~:5 10. Date of Purchase ...... ./:.~.~'. ....................................... Name of Owner ...... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~ ........................................... 13. Name of Owner of premisesC~...'~..~..~.~..:../~..~..c.,~//.~'~,~'~Cc~ress ..~.9?~'.../~..£..~.../.../K'..~.,~.x~'.....~,~...~'./../~n~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 fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YO~J~ tSS COUNTY Of ....... ,,~x~....j- .. ........... ................... being du~y~, ,~ says t~t he is the applicant (Name of individual Signing application)' above named. He is the ....~.~..~.; .................................... ; ..................................................................................... (Contractor, agent, co,rate officer, etc.) of said owner or owners, and is duly authorized to pe~for~ or .have performed the said work and to ~e and file this application; ~hat all statements contained in this application are true to the best of his knowledge and belief; and ~at the work will be performed in the manner set fo~h in the application fil.ed ther~ith. ,o ~'ore me this ~X~ ~~~ .... ...... .~ ........ day o~~.~ ................... 19.~.Sw°m Nota~ Pu~ ............ -;;:.... Coun~ 7" ~~~[~