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Home My WebLink About4933-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z. ~130 ..... Date ............. Ja~... !5 ..... , 19.?]. THIS CERTIFIES that the building located at .. l~,f~ .]/oxmga Ay® ......... Street Map No. ~XX ........ Block No ..... XX Lot No..XX. · .l/~t.t~.tuck .. I~.oX, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~XXg...31., 19 ~.O. pursuant to which Building Permit No. dated .......... Ax~g.. 31 ..... , 19.T0., 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 ... Pr;L~ate..¢acc~ssorT.). sw:lm~ming, pooX &. fixtures ................ The certificate is issued to . Harr~ .TurbO. il. & .~;:l. fa.. 0%rns~.s ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... ~oR. ......................... aou~ ~ ~ ~ ..... ~ ~ ?.. :..k......4:. :.../ .......... Building Inspector FO~ NO. ~ TOWN OF $OUTHOLD 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? 4933 Permission is hereby gran~l~l tO Building Inspector. Fee $ .............. FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................................... , 19 '~2 ~r~ed ........................................ , 19 ........ P~it N~ .... ~ ....................... Di~r~ ~/~ ....................................................... Application No.....~....~... ?..~.. ......... APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this 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 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 be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remoyol or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signd~bre of applicant, or name, 'if a cor~,e(ration) State whether applicant is owner, les1~ee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises .......... ~..~...:..'..~... ......................................... ~ Name of If applicant is o corporate, signature of';duly authorized off'ce . (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ...... /../.~-... .......... ~ ...... ~ ............. ~.~~.....~...:..~.~....: ........ (,/ (J Municipality U 2. State existing use and occupancy of prem~and~L4 2~/~en_~,~.s: ~d occupancy of proposed construction: a. Ex st ng use and occupancy ............. ~..~ .............................................................. b. Intended use and occupancy ............. ~......~....~ ...................................................... 3. Nature of work (check which applicable): New Bui.lding .................. Addition .................. Alteration .................. Repair ................. .~emovol ..................Demolition .................. Other Work (Describe).4~....~~..~...~'~ 4. Est mated Cost ....."~Z~.~..~)/,...~...~. ............................... Fee .......................................................................................... (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 ....... .~.o~-~ ............ 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 ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ...... ./..~'..(2. ........... Rear ...... ,Z'..~..~. .................. Depth ...~....~....~.. ................. 10. Date of Purchase ........................................................ Name~ of Former Owner ........................................................ l ]. Zone or use district in which premises are situated ............................................................ 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ....... .~...~ ......................................... 13. Nome of Owner of premises ........................................ Address ............................................ Phone ldo ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor .................................................... Address ............................................ 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 NEV)//ygP, K-/, ,, ,/.~., JSS COUNTY/i ~"-. /,~ L/..-- /~. '/~ ../. / ~-.'0F~'''~¢~'''¢~'' ..... .f ' '. ~' . (Name 'of jhd~dual sig/~g appl_l_~ion) ~v . above named. He is the .................................... :~ ................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hav. e performed the said work and to make and file this application; that all statements contained in Chis application Ore true to the best of his knowledge and belief; and that the work will be performed in~Cqe manner set forth in the application filed therewith. Sworn.#o be..fo_~e, me tills /, · . ,~ ...... d of ............ / W Z../, ............. ~ota~ Pubic, Sta~ of Ne~Yor~/ No. ~g-18~200 ~ Suffo~ ~ount~ ~mmi~qi~ ~xpire~ ~ar. 80, ~ ~/