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Home My WebLink About5111-zFOBM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z~22~ ...... Date ........... Apl'~.... ~ ..... , 19. THIS CERTIFIES that the building located at .Traek. kV~ ................ Street Map No.M,~,tian&.. Block No. LI ....... Lot 1~1~.. 7~ .. Cutchmgu~ ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Deo.. 2~..., 19.70. pursuant to which Building Permit No. 511 dated ........... Dec...~). ·., 19.?0., 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 .-&CC~SS~ .Bt~l,ldl~... (Stable.). ................................... The certificate is issued to ...l/ar.t~. Htt~k~a .& Id~l,£®.. ~el*s .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... .N.,.B.; .......................... Building Inspector I~ORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMEN'I' TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT ('i'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLk-HON OF THE WORK AUTHORIZED) % Permi-,ision is hereby granted to: application dated .............................. .~.~ ......... ~., 19Z~., end o~rov~ by the Building Inspector. Fees ..... ...~.....~.C ..... Building Inspector IeOBOf ' NO. I BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E~mlned .................. , I¢ Approved ............... .~....~....~ 19-~... Permit No. "~/// ~' Di~pproved a/c ....~ (BUildinG Inspector) APPLICATION FOR BUILDING PII~4II' ~ INSTRUCTIONS ~ a. This application must be completely filled In by typewriter or in Ink und submitted In d~pllcote to the Building/~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premi#s or. public streets or areas, and giving a d~ailed deccrlptlon of layout of prc~erly must be drown on the diagram which Is pert of thio ~.~:~Jllcetion. c. The work covered by this application may not be ~ommenced before iuuance of Building Pemdt. d. Upon approval of this application, the Building Impector will luue o Building Permit to the el~ll~nt. Such permit shall be kept on the premises available for in~oection throughout the pragrecl of the work. e. No building shall be occupied or used in whole or in port for any purpoee whatever until a Certlfl~te of O~auponcy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pumuant to the Building Zone Ordinance of tho Tayto of Southold, Suffolk CountyANew York, Grid other applic~ble I.ew~, Ordl~nces or Regulations, for the construction of bulldin~, additions or alteratJroJ~s, or for removal or demolltll~, aa, herein deecrlbed. The applicant agrees to comply with all applicabl, laws, ordinaQf,~, bulld~ouslng ~code, a, nd#egulatlon,. ........ (Addres~ of eppll¢~t) State whetherapplicant is owner, I architect, engineer, general contractor, electrician, plumber or builder. Narr~ o{ o~n~r o{ pr~ml~ ................................................................................................................................ .If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) ~/~,/ I. Location of land on which proposed work will be done, Map No.: ........................................ Street oncI INUmDer ................................................................................................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of praposed construction: a. Existing use and occupancy //,,~ C.,,6-'~,' 7' /4/~'~2)~"~) /..a '7' b. Intended use and occupan:, . ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. Other W~rk (Describe) ..................................... 4. Est mated Cost ... ~ ........ ~......~-.....~. .... Fee ... ~......~ ........................................................ (to be paid on fi~ing 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,,~tire new construction: 'Front .................. ~......~.. ....... Rear ......... ./...~ ...... Depth ....J..~. ......... Height ...... ~ .......... Number of Stories ........................~ .......... -. .................................................................................. 9. Size of lot: Front / OC~ Rear ................................Depth (' ~' 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ...................... .~....~'~....~..~....~....t ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ~ ..................................... "am fOwnerof re ~ ~q~NA'£4/~ (,e/f=,-- ~//~A/'T'A~C~ /--,7-_ _, ,. 13. r4 · o p m'ses ............................. ~ .......... ^aaress ........................................... ; enone r~o...... ............... No. Name of Architect ...................................................... Address ..~.~.~.......~.~y, ........... Phone .................... . . ress . ' Name of Contractor . ................................... .~ ................ .~.../~..~.C.Z~..~......~..... Phone . PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or pro~xsed, and indicate all set-I~ck dimensions from property lines. Give street and block number or description according to deed, and show street nameS and indicate whether interior or comer lot. STATE OF NEg'_ (~p,K~i Iee COUNTY OF .~. .............. ~'~'~' ......................................................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ........................ ..~....~..,~,..~...~.......-~. .......... ..~...?...~....~..?~. .................. ~ ........................................................ (Contractor; agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or haj~ performed the said work and to make and file this application; that all statements contained in this applicatiog~a~ true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the al~61ic, e'tion filed,,therewith. Swam to before me this '// ............... do of ................................ ............... . ......... ............................. 4~r-- -?,.,- I_.,~e,~s.,~.,~.~ NI/TARY PUBLIC, State of New Yor~( v No. 5278125850, Suffolk Cou,~y4 Term ~xpires M~rch