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Home My WebLink About5005-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .... P¥/~..W. eli. t..RO~d .................................. Street Map No. ~.[t..J~r~ ....... Block No ......313[ ........... Lot No..X31~.....(J3Z~;13hO~33,e......~.~.~ .................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. OlJ.t~ ....... .'JJ~ ............ , 19.~.(~.. pursuant to which Building Permit No..~'0~J~.... dated ......................... O~,t ........ [1~ ............ , 19..~.0.., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ...... Privet®..one..ff. em.i.l.¥...d~e.l:t.i~g. .......................................................................................... The certificate is issued to ..~Cly...i~.e...~.~hf~ll~8~ ............ .O]l(Jl~J~. ................................................... (owner, lessee or tenant) of the aforesaid building. ouse ~ ~' Buildi~ i~spect7 FORM NO. 2: TOWN Or S0u'rHGLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5005 Z Permission is hereby gronted to: ............ ~'~,-~-..~~ ........ i, ................ ............ · ~e'~t'"~ ............... ~.~e~l~.-~]~ .... ................. ~'~...-. ?.!~.,~'.,,....? ................ to ........ ~..~a~..a~,t~e~..~..e~t~-~l..a~e-~X~ ...................................................... at premises located at .............. ~t~.~. ...... ~.~Le~..~ ................................................... .................................................. ~~ ........... ~.~. ........ ! ........................................................ pursuc~r~t to applic<3tion d~ted ........................... ~ ......... '~"?"i"", 19..%.~ ond approved by the Building Inspector. Ir'Om NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam ned ~ / .............................. ...... , Approved ~ ~' .~"'~'~ ~-----~ ........................................ , 19 ........ Permit No ............................. Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PERMIT Application No....~.,.~,, ........ ..~ INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plo, t .pl?n sba. win.g, location, of lot and of buildings on premises, relationship to adjoining premises or oub c streets oS areas, ona g~wng o oeto.ed descrfption of layout of property must be drawn on the diagram which is port of ~hls opplication~ c. The work covered by this application may not be commenced bafore issuance of Building Permit. d. Upon approval of this application, the I~ilding Inspector will issue a Building Perm t to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the wark. e. No building sh~ll 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 purauant 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, add tions or a rotations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build~uJatlons. (Signature cf applicant, or name, If a corpo~.rg,tlon) State whether oppl~ont is owner, lessee, agent, arc~itect, engin~r, ~l~ltol controctor, electrlclo~, ~J~mblr or builder. Norn, of owner of ,rem sos ~ ~ ~;~5~" - ...... If opplicont is ~ corporate, slgn~ture of duly outhorized officer. ...... and title,of corpomte officer) 1. L~ation of land on Which proposed work will be done. Mop No.: ........................................ Lot No.: ........................ Stre~ and Number ............ ~ .... ~- . ............ ~ ................... 2. State existing u~ and ~cu~ncy of pr~mises end intended use and occupancy of propos~ construction: . . . ' ................. a. ~,st,ng use and ~cuponcy ..... ~ ...... ~ ............. ~ .............................. (to be paid on fi!lng this application) 5. If dwelUng, 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 en~re new constOruction: Front ....... ~ ..................... Rear ............................ Depth ........................ Height ..... .7...~. ....... Number of Stories ...................................................................................................................... ~ f /..la ' ...... . .~.~....7.. ............. 9. Size of lot: Front ...... //. ................. Rear .................................. Depth ~ / 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction viol~te~,~.,L .i,/,,~,~x~ / W~,-~ /2 .~any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises .~`~...~.~..~/...~.~.~...~.../.~...~.~Address/.f..~/.~.~.~.~-~..~.~.~.~.~..'. ........ Phone No/'~-..~...l~..~-~. Name of Architect ............. ' ......................................... Address ............................................ Phone No ..................... Name 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 Jot. / STATE OF NEW YJ:~K,,~/ C OUJ~IDF . .f'~'...,,~..~...~..~...,~...~..... J ....... -~....~~~ .................................. being duly sworn, d~oses and soys t~t he is the app, ican, ' i (Name of individual signing application) above homed. He is the ........ ~~..~.....~.~Z~ .......................... ~ ....................................................... (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have p~formed the said work and to ~ke and file this application; that oil statements contained Jn this application are true to the best of his knowledge and belief; and tha~ the work will be performe~in th~manner set fo~h in the application filed therewith. Swam to b~re me this ~ / ~ ' / ~ .................. ..................... ...... ...................... t~ PP£o K \ SURVEY FOR ROY 6: $CHOENHAAR CUTCHO(;UF: SCAL~ t" t ' t. Al~ ~UR¥~YOR ?~co~\C NOTE · = &4ONUMENT 'i