The URL can be used to link to this page

Home My WebLink About5106-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. ~.ltO~ .... Date ............. De~.. 2.1 ....... , 19.7(1 THIS CERTIFIES that the building located at . ¥/~.. CR~.7 .......... :' .....Street Map No...l[x ........ Block No. XX ....... Lot No...XX... 8ollthold.. 11,¥, ........ conforms substantially to the Application for Building Permit heretofore fil~d in this office dated ......... Dee ... -~.7..., 19.-70 pursuant to which Building Pemit No...~¶06Z. dated ......... Dec.....1.7. .... , 19.70, was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...Pr~vatw. &eee~sor~..bllilxl:[l~ ...................................... The certificate is issued to ...,~9h~...P, Off. ai; ..... .t~'~.l~ ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approvai ..... n,~e ................ ' .......... ...... ....... Building Inspector TOWN OF SOUTHOLD BUILDING DEFARTMENT 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°. 5106 Z Dote ........................... I~ ......... .lt. ...... ,19....~ Permission is hereby granted to: at premises located at ...J~JJ~..~J ....... JeJJ~ ............................................................................... .............................................................. Jellrelm:l,4 · ...li,,:J.. ................................................................ pursuant to application dated .......................... J~ ............ ~J~ ......... , 19...~0, and approved by the Building Inspector. Fee $...~.*..~.. ........... / Builaing ~nspector j Examined ............................. 2. ....... , floral ' NO, I TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥o Disapproved o/c .............................................. ' Application No ............................ .~' ......... ~ar) ............... APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in d~plicate to the Building,~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premise~ or public streets or areas, and giving a detailed description of layout of praperty must be drawn on the diagram whlch It part of thl~ 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 o 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 CortJfJ¢ote of OccuIxIncy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pureuont to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable I.awi, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al heraln described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ............... ...... .......... i ........ (Addresl of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......................................... ' .................. ;....~...c~.. .......................................................................... If applicant Is a corporate, signature of duly.authorized officer. ~ (Name and title .of corporate officer) · 1. Lacation of land on which proposed ~ will be done. Map Ho.: ........................................ Lot No.: ....../~. ............ Street and Number .... ..~...~r:...~..?.....~......i ........ ~....~..~..~ ........ ..:~:.../...~......~;...~ ............. ~...~.....t. ........ Municipality ~ 2. State existing use a.nd occupancy of premises and intended use and occupancy of proposed construction: o. Existina use and occunan~'v ,..~...L~...~.°~,~m-~ ......................... b. Intended use and occupan:, . ....... ; .......... ..~.C:~..,~..~.......~.~,.,.....~.........,...........,~ .................................. / 3. Nature of work (check which applicable): New Building .................. Addition ....k~..... ....... Alteration ............. Repair .................. Rem_~oval .................. Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost ............~J.~..L..~....~..~....~... .......................... Fee .......................................................................................... (to be paid on filing this application) $. 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 ............... y ........... 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 ................................ R ! / 8. Dimensions of entire new construction: Front .......... ~...f. ..................... ear ..... /...~. ................. Depth ..... .~. ................ Height ~' /' Number of Stories ~ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................... .................. 12. Does proposed constructlon viol=to any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ........................................ Address ............................................ Phone 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 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 NEW("Y_O~J/~ .............................. :~....~....~...h~..~.~,~..~.. ............ I:~ing duly sworn, deposes and says thot he i~ th~ ~pplic~nt ~ame? in~vidual signing appfic~o~ above named. He--he ............. ~~....~' ~ ~.. ............................................. '~. ....................................................... ~ (~ntmctor, agar, co~or~e officer, ~c.) of said owner or owners, and is duly authorized to perform or have perfo~ed t~ ~id wo~ a~ to ~ke ~d file this application; that all statements contained in this application am tree to ~ ~st of his kn~ledge and belief; and that the work will be performed in the manner ~t fo~h in the ~plication filed t~r~i~. Swom to ~fore me this ~ .., 19..~.~ ~~~ ~.~ ................ ~.~ day o{ .......................................... ........................................................... .................... .......................