The URL can be used to link to this page

Home My WebLink About5078-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~.~5~ .... Date ........... ~g .... 2~ .... , 19. THIS CERTIFIES that the building located at ~lg I~ke Road ... Street Map No. Sa~t; I, ake. ~a~k No ....... Lot No. ~ . l~tti~;uek~. N,Y, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... NOV 30 19.?1. pursuant to which Building Permit No.. dated ...... .NeT .. ~O, 19.7~[ , 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 .P~.vate garaga (~c®ss~) .b~_~-~.dix~ ............................ The certificate is issued to . R~lehard. of the aforesaid building. Suffolk County Department of Health Approval .. 0w~e~ ................... (owner, lessee or tenant) Building Inspecto~ FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTJ~ENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ,, ........ ~.~,.~. ........... ~,~,~...~.O..~Z .......... .............. .~. ......... ~.~.~.~ ........ at premises located at ............................................................................................................................ pursu~n, to application dated ........... i ................. ..?..'~ .......... ...~.'..~....~..., 19..~...~..., and approved by the Building Inspector. J:ee$ ..... ...... ............. Buildin~ Inspector · OBOf'NO. ! , TOwN M SoU'm D BUILDIHG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. Approved ......................... ~..~,;r,e}_19.~,~ Permit No. '".~'~"7~.~" Disapproved a/c .............................................................................................. " APPLICATION FOR BUILDING FIRMI'T Appllccation No....~.-~.7.~:~- ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted In duplicate to the Building Inq:~ctor. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining pmmiees or public streets or areas, and giving a detailed description of layout of proparly must Ix drawn an the diagram whlch Ii part of thil application. -q c. The work covered by this application may not Ix 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 IX occupied or used in whole or in part for any purpese whatever until a Certificate of Occupancy ~ shall have been granted by the Building Inspector. cs APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the ~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable I.awl, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demalltlon, al herein d~crlixd. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, If a caq~mtlon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~:'/~:~/./,,,4) .~,.,..~ ~'! .,r.,~I. .~ L If applicant Is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will IX done. Map No.: ................................ .~.[~.... LOt No.: ...................... 2,State existing use a.nd occupancy of premises and intended use and occupancy af pra~ ¢o~l~tlon.. a. Existing use and occupanu~/ ................ ~...~.: .............................. ,~., ......................................................................... 3. Nature of work (check which applicable): New Building ~ ................. Addition .................. Alteration .............. Repair .................. Removal~ .................. Demolition .................. ~er~rk (Describe) ...................................... (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 of existing structures, if any: Front ............................ Rear ................................ Depth .................... 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 .................................... Rear ............................ Depth ....................... ?~ 9. Size of lot: Front ............................ Rear .................................... Depth ...................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zonina law, ordinance or regulation? ............................................................ · 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Nome of Architect ...................................................... Address ............................................ -,, Nome of Contractor .................................................... ^aaress ............... ~1~/~'~7'~'~7~" 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 names and indicate whether interior or corner lot. STATE OF N~~..;. }S.S. COUNTY OF ...... ) ................................................................................................. being duly sworn, deposes ~nd s~ys t~t he is the ~pplic~nt (Nome of individual signing ~pplicoti~) above n~med. He ~s the .............................................................. ~ ..................................................................................... (~ntractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authoriz~ to perform or have perfo~ed the said work and to ~e and file this application; that all statements contained in this application are tree to ~e ~st of his knowl~ge a~ belief; and tha~ the work will be performed in the manner'set fo~h in the application fil~er~ith. Swam to ~ me ~is ~ ~ ~/~ ................ ............................................ , ]9 ........ ~[/~,~ ~J/( ............. ~ ............ ; .......... ~......~ .................................................. Nota~ Public,~.~-..~.-..~.. ~~~--' ~Coun~ Ecz~ ~ ~Ev~{~gna~re of applicant) '~ ~~ ~'~~ NOTARY pUBLIC, S~te ~t New Yo~k No. 52-8t2~5o, Suff~ Term Expires ~rch