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Home My WebLink About5081-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ~cha~d St ...... Street Map No..xx ...... Block No...~. Lot No.. ;x~ O~ient~ .~LoY, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ N. ov. ~0..., 19 ~0 pursuant to which Building Permit No. dated ...... Nov. ~0 . , 19.~0., was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Pri~te. one. f~tl~ .dwe.~ling ................................. The certificate is issued to . ~ed ~oh[~ff ..... ~er ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk Cowry Department of Health Approval .N~, ..................... ~o~ ~ 2~o / / . 1,~'~.1.'/ ..... .... . ...... , ..... ~uildi~g Inspector [ FORM NO. 2 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? 5081 Z Permission is hereby granted to:~..~ ~ . ~ ......... ?~.. ............ ..4c...~..~.~....u...~. ........ ...... ~... ...... .~ ...... ~..e..~...Z..~.....r..~ ......... at premises located at .............................................. pursuc~t tO application dated ~ t~ ~/'~),~19 7..~., and approved by the Building Inspector. Fee $......~...'..: ........... Building Inspector TOWN OF SOUTHOLD~ ~ t, BUILDING DEPARTMENT~~/*' ~ ,/<~. r) TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................. ~~ 19Z..0. Approved .................... ?..?....../...~.~.C, 19Z..~... Permit No .... ...~......~....~./.~ Applicat,on No ..... · .~...~... ,~.../. .... ~ Disapproved a/c ..................... ~..................... ......................................... ~/ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..................................................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duphcate to the Buildin, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adloimng premises or public streets c areas, and gwing a detailed descnption of layout of property must be drawn on the diagram which is part of this applicaho, c. The work covered by this application may not be commenced before ~ssuance of Building Permit d Upon approval of this applicahon, the Building Inspector wdl ~ssue a Budding Permit to the applicant. Such perrni shall be kept on the premises available for inspection throughout the progress of the work. e No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Bu,ld~ng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ,ssuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolmon, as herein descnbed The applicant agrees to comply with all applicable laws, ordinances, building code and r~gu[ations. (S'gna(~ire o apphcant, or name, if a corporation) (Address of apphc~ t~:Ti''' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ...... ~~.....~-~' ~ .. · If apphcant is a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) 1 Location of land on which proposed work will be done Map No ................. ... ..... Lot No ....................... Stree¢ anqlc~umber ........ ..~]~2L...~. - :....~.' -~..... .......................... · ..~...~"~~....]..'~....~. >..~...; ........... 2. State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction a. Ex~sting use and occupancy ...~ .......................................................................................... b. Intended use and occupancy ..~ ..................................................................................................... 3. Nature of work (check which applicable)' New Buffding .................. Addition .....~ ........Alteration ............... Repair .............. .~, Removal ..................Demohtion .................. Other Work (Describe) ....................................... 4. Estimated Cost ..~....//...~...~...~.'t.~..~.. ................................... Fee ......................................................................................... (to be paid on fihng th~s 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 Dimens,ons of existing structures, if any: Front .......... .~.~...;. .......... Rear ...... .~....~'..Z ................ Depth .....~'..?...L ....... Height ......./..~.....'. ......... Number of Stories ......... /. ................................................................................................... D,mens,ons of same structure with alterations or add,tions Front ......... ..~...~..L ................. Rear .....~....~...~ .............. Depth ........~..~..~ ................. Height ...... ./..?...~. ............. Number of Stories ....... ./. ..................... 8. Dimensions of entire new construction' Front .......... .?~.:. .................... Rear ..... ..c~....~. ................ Depth ..../../...;. ............ Height ....~/.: .......... Number of Stories ............/. ................................................................................................ 9. S,ze of lot: Front .... ..~...~./x../.~, ....... Rear .... ~. ~. ~'.~ ~...?.. .......... Depth ..../....~....~.~....~...~. ...... 10. Date of Purchase ...................................................... Name of Former Owner ....................................................... 11 Zone or use d~strict in which promises are s~tuated ...... · .~..~..~.: ............................................................................. 12. Does proposed construction violate any zomng law, ordinance or regulat~o,n~ ........................................................ 13. Name of Owner of premises~.~-- ~- ........... Address ..... .~...~ .................. Phone No.~...~..ff..,...~.?.-..?.: Name of Architect ........................... ;_":'~2~_ j~. ......... Address ................... ~ ..................... Phone No .................... Name of Contractor~.~ ............... ..~..~ ...... Address .........~...~ ............... Phone No$.~...~..q...~...~.../. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~st~ng or proposed, and red,cate all set-back dimensions fron property hnes. Give street and block number or descnpt~on according to deed, and show street names and ind~cat~ whether interior or corner lot. STATE OF NEW YORK, COUNTY OF . .?.~z!..~...~.~.(.~ ........... ~ .... ........................... ..7~..~.../~....~.. ..... ..~...~..~...~.~.~./.~ ............being duly sworn, deposes and says that he ,s the applican (Name of individual s~gnmg apphcat~on) above named He is the ............................... ~'~'~.~.~. .................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and ill, this application; that all statements contained m th~s apphcation are t~e to the best of his knowledge and belief; an, that the work will be performed in the manner set forth ~n the applicatffon filed therewith Sworn to before me this ...... ....... o, ....... ....................... , 1;1 ()~ 1) l, ~tN(; JR ........................ : ........ ~'~ ....... ~"'-~ ...... ~' Nota~ Public, . .............. ~o~l~.~.~r,..~t~te.~.~.~.¥~rk. County ~"(Signature of apphcant) .................... ~o. q'el~ i;Xl~lr~ Match 30, 19~