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Home My WebLink About4256-ZFO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .~[..I,~,M,. II/I. I~a~. ~reet Map No.~l~ ........ Block No. x~ ...... Lot No.. ~ ..... ~O1~..I,~, ...... conforms substantially to the Application for Building Permit heretofore filed in ~.h~ office dated .........~4~r$~... 18, 19 .~. pursuant to which Building Permit No...~2~. dated .......... &l~lq~... la., 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 ... iqrlwa~ .~...(A~llo~..~) ................................ The certificate is issued to . .~O].~ .~[~llag~. ~ ....... ~ ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .....][~, .......................... Building Inspector FOI~[ ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4256 z Permission is hereby granted to: at premises located at ............. ~PJLJ.,.9.,~,..ll~...l~,ta..at..&..¥/s..rel, es~.&~ ............ .......................................... 8~ut. ho~d. ........ .11.,,.~ .. ................................................................................ pursuant' to application dated ........................... ~JJJ'~ .......~-JJ ........ , 19.~!~., and approved by the Building Inspector. Fee $..,~.~.~...~.. .......... Building InSpector TOWN OF SOtr,'~OLO ~./-~/ BuILDm TOWN CLeRic'S OFFICE SOUTHOLD, N. Y. APPLICATI(~N FOR BUILDING P'F. RMIT INSTRUCI'IONS 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 ~o adjoining premises or public streets or areas, and giving a detalle~d description of layout of property must be d. rawn on the diagram which is part of this application, c. The work covered by this application may n~t be commenced before issuance of B~fld.ing Permit. d. Upon approval of this application, the Building In spector 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 o~ in part for any purpose whate?or until a Certificate of Occupancy shall have been granted by the Building Inspe~ox:. APPLICATION IS ~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~athold, Suffolk (~k)unty, New York, and other applicable I~aws, Ordinances or Regulations, for the construction of bUild ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to cam ply with an applicable laws, ordinances, building code, - (Signature. of .applicant, or, name if a corporation) (Address State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .............. ~. If applicant is a corporate, signore of d~l~ authorize d officer. 1. l.a~ation of land on which proposed work will b e done. Map No ............................. ....................... Municipality 2. State existing use and occupancy of p~remises an d in'~ended use and occupancy of proposed construction. a. Existing use and occupancy ..]/'~V~ .............. b. Intended use and occupancy ...~.. ~ .~ 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... Cost . ~. ~.~.~..~.'~.. ................. Fee . .~.~2..~...'~. ...................................... 4. Estimated (to be paid ~n filing this application) 5. If dwelling, number of dwelling units .......... Number of dwelling units on each floor .............. If garage, number of cars .... .~.~,~..c~. .......................................................... 6. If bhsiness, commercial or mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: ~t .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .............. Rea~ ............... Depth ................ Height ................ Numbe~ of Stories ..................... 8. Dimensions ,of entire new construction: Frrmt ....~..~.. ........ Rear .~. ~.. ....... Depth ~..)~-=.. ...... Height . ./~.( ..... Number of S~ories .. ~ .................................................... 9. Size of }ct: Front ................ Rear Depth . 10. Date of Purchase ............................... Name of Former Owner ........ :. ................... 11. Zone o~ use district in which premises are situated .................................................... 12. Does proposed construetior~,~p ',~ .., ~'t/./~,.v~la'ce ,any zoning law, ordinance or regulation? ~..~. ..................... Name ,of Owner.of premises ~ .~. ~A'ddress ...................... Phone No ............ Name of Architect ............ . ~' .~i .... ~ ....... ~ddress .... ~. ....... ~ ........ Phone No ............ Name of Contrac~o~/_~ 0~.'.~~....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 ~r descript$on according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEV~ Y9/{I~,~ )S.S. COUNTY OF ~l,~l~Sd~... ) ............ ' ~.(Z,°TJ-Z~ · · 5~T~4C~ .................. being duly sworn, dep0ses and says that he is (Name of individual signing application) appli- cant above named. He is the ................... ~ ........................................ (Contractor, agent, corporate officer, etc.) of said owner ~or owne~s, and is duly auth,orized to peff, arm or have performe(l' the ,said work and to make and file this application; that all statements contained in this application a~e true to the best of his knowledge and belief; and that the work will be perfea~ed in the mann er set forth~ in the application filed therewith. Sworn to before me this .... / ..... day of .... N,~ary Public, .................... County ~c-,~,~ · (Signture of applicant) ELIZABETH ANN NEVILLE NOTARY PUBliC, State of New York No. 52-8125850, Suffolk County Term Expires March 30, 19.~