The URL can be used to link to this page

Home My WebLink About5099-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at ~7~ /V~SS)~ I/ '~I~/T ~,e A,D Map No. ~ ~.~. ~.. Block No... ~ .... Lot No...~ ........................... conforms subst~tially to the Application for B~lding Permit heretofore ffl~ ~ ~s office dated ......... ~..~/~. ~..., 19. ........... p~su~t to which B~d~g Pe~it No. ffvg~ Z, dated ....... ;~.~......C ~ ......, 19. ~was ~su~, ~d confo~s to ~1 of the r~re- merits of the applicable provisions of the law. The occupancy for whi~ ~ ce~ficate is issu~ is . .~ ...... A (~. ~.~ ~. ]~. ~[ ...... ~. ? ~ .~ ~.~. N .~ ...................... The certificate is ~su~ to ~ ~l t ~ ~ ~ ~ ~ L ~ (owner, less~ or ten~t) of ~e afores~d buil~g. Suffo~ Co~ty Dep~tment of He~th Approv~ ~ ~ ~ .............................................. ............... Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5099 Z Permission is hereby granted to: to ....... _~__.~.~,~. ae~..a, eeeaam,~3r...bu,L~La& .............................................................................. pursuant to application dated ............................. ~ ...... ~1~ ............. , 19....~1~ and approved by the Building Inspector. WNOFSO"T"oLD BUILDING DEPARTMENT / ~ ' - ~ f, ~'- TOWN CLERK'S OFFICE (,'/~ C~l~ L~'-~-, ~ ~m ~ ........................................ , I~ ........ A~ll~fi~ N~ ................. I... ........ .......................................................................................... ~ .............. -¢~' . APPLI~/ION FOR BUILDIHG PEril ..................... .............................. ............ ~. Thi~ ~pplicotlon mu,t be c~pl~l~ fill~ in b~ ~rit~r or in ink und ~u~mitt~d in ~11~ In~r. b. ~1~ ~l~n ~ho~ing I~a~i~n o{ lot ~ o{ bu~ldi~ on ~m~*, ml~tion~hi~ ~o ~dl~l~ ~m~ or or~s, a~glvl~ a d~afled ~ri~l~ of I~t of pm~ must h drown on the dl~mm ~lch Is ~ of~b ~llcati~ c. ~e ~ ¢~e~ by ~ls a~llc~i~ ~y not be c~menc~ b~fore iguame of Bulldl~ permit. d. U~ ~r~al of this appltcati~, the Building Ins~ctor will i~ue a Bulldl~ Pe~lt ~ t~ ~pllcant. ~h ~it~ ~all ~ k~t ~ the premiss a~ilable for ins~ction throughout the p~re~ of the wo~. e. No building s~ll ~ ~cupi~ or used in whole or in pa~ for any pu~e whate~r until a Ce~iflc~ of shall h~ been gmn~ by the Building Ink,tar. APPLI~TION IS ~REBY ~DE to ~e Building De~rtment for the issuance of a Building Pe~lt ~ant to t~ Building Zone O~inance of the T~ of.~thold, Suf~lk County, N~ York, ~nd other ~ll~ble ~, amities or R~ulatl~s, ~r the construction of bulld,ngs, additions or alterations or for rem~l or demolition, al heroin ~rl~. The applicant ~r~s to comply with all applicable la~, ordinances, building c~e, housing c~e, and ~ulatl~l. ........................ ................... (Signature cf a~llcant, or name, If a c~mtl~) ........ ..... {Addres~ of a~pll~ant) U State whether applicant is owner, lessee, agent, architect, engineer, general contractor, elKtrl¢lan, plumber or builder. Name of owner of premise~ ........ ..~...~ ...... ~...,.....~.~.~... ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ,~.~.~.. .. Lot No.: .....~.~ ............ ~ ............ 8o st,,,, and -- ~7 ~ ~-- Munlclppllty ' 2. State existing use and occuppncy of premises and intended use and occupancy af pmpoeed comtructlan: a. Existing use and occupancy ............ ..~..~.J.~)./~-~[7.~.....~..~.(..O;~;D~.~.t~ ................................................................ b. Intended use and o coupon? . ....... ....~. ~.... S~ll~---~"~ ....................................................................................... 3. Nature of wink (check which applicable): New Building ..... .~,...., ..... Addition .................. Alteration .............. Repair .............. ~,~ Removal ..................Demolition .................. Other Work (Describe) ..................................... 4. Est'mated Cost ..~.../..~... .................................. Fee .................................................................... (to be paid on filing this application) 5. If dwe[Hng, number of dwelling units__~ ........~.~.. ....... Number of dwelling units on each floor .... A/t~..., .......... if g°roge, number of cars ............. ~..y~.., .............. ~ .................................................................................................... 6. If business, commercial or mixed occupancy, specifY nature and extent of each type of use ....~.~.~..e. .......... 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 .......... J.~:....~.., ........... Rear ....... L~...~...~..' ...... Depth ..... ...~...J~...~ .... Height ......~.../f..T..~.! Number of Stories .......... ~.ld .~,.., ............................................................................................... 9. Size of lot: Front .........I~.,~../... Rear ....... L.o~..:..f?..,~r.../. .......... Depth ..... .~..~...~....~. ............ 10. Date of Purchase ..... ..~.~..../..~.~..~... ................... Name of Former Owner ...~.../~..(/~.~.....~.~.~.~.~.../~.....~....~.../....~.., 11. Zone or use district in which premises are situated ..................................................... ~.j ............................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ !.¥...~.. ........... .~ .......................... 13. Name of Owner of premises ~.~.~.,..~'..@.Z..~...~..~..~//l~'hfo~';'No.~.~.~....-~...~.~..~ Name of Architect .................... ~.~... ........................ Address ............................................ Phone No ..................... Name of Contractor .................. ...~.....~. ........................ Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions from properb/ lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF N~Yg~K~ Iee COUN~ OF~ ............. ~' ................... ~'~.~.~.~..~.~.~.~ ....................... being duly sworn, d~oses ond s~ys t~t he is the eppl~c~nt (Nome of individuol s~gning opplicoti~) o~ve nomed. He is the ............................... ~~ ........................................... ~ ....................................................... ~ (Controctor, og~t, co~orote officer, ~c.) of seid owner or owners, ond is duly outhorized to peHorm or hove perfo~ed the seid w~rk o~ to ~ke ~d file this opplicotion; thor ~11 stotements contained in this opplicotion ore t~e to the best of his knowledge ond tho~ the work will ~ perfumed in the monner set fo~h in the opplic~i~ filed t~r~ith. Sworn ~ ~fore m~ ~is ~ ~ biota, public, , . .... I ......... C~,~'~~'""i~i~;;';~';;;Ji~ ............................. , ' - ~m~UBL~, S~e of ~ ~o~ ~ I" Ho, 52-8[2~50, Suffolk