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Home My WebLink About5006-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~3 ...... Date ............. ~an .... 29 ..... , 19..7.1 THIS CERTIFIES that the building located at . ~. l,i,~..}l. Ro~d ............ Street Map No...xx ....... Block No. ~cr ....... Lot No.. :r. xx. · · Mattt. tuck. · .!i,¥, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 0et .... 1'9" , 19'-70 pursuant to which Building Permit No..~00~. · dated ............. 0c~.... 19., i9.?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 . .Pr:L~te. acceasor.y..(stc~.age), build.:l..ng ........................... The certificate is issued to . Cynthia- 2~ulneky ..... Swner ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... I~.~[A. .......................... Building Inspeeto~ FOR~ N'O. 3 TOWN OF $0UTNOLD BUILDING DEFARTMENT 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? 5006 -Z Da~e ........................... ~.....~. ......... , 19.~).. Permission is hereby granted to: pursuan¢ to application dated .......................... J~....~.....~J~ ....... ~.,.., 19...~., and approve(~J by the Building Inspector. IOB~ NO. I TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN C~LERK'S SOUTHOLD, N. Examined .....~...x~...../..~....., 19..~7....~. Approved ........................................ , 19 ........ Permit No .......... -~,,- ~- '2 x"~'~,-'.','~'-'? Application No...~...~....~.... ~ Disepproveda/c .............................................................................................. APPLIGATION FOR BUILDING PERMIT / ~ Date ....................... ,....t...~,~y~ ................ ...., , ............ ~ INSTRUCTIONS m o. This application must be completely filled in by typewriter or in ink und 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 d~ogram which Is part of thio application. c. The work covered by this application may not be commenced before issuonce 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 wurk. 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 pureu.a, nt to the Building Zone Ordinance of the Town of Southold Suffolk County, New York and other applicable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remova or demo ition, al here n described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ...... ................... (Signature cf applicant, or name, if a ¢orl~ratlon) .......... ........ /~A~dress of appllcallt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar builder. If applicant is a corporate, signature of duly authorized officer. ,. L~ation of land on ~lch pmp.ed work will be done MapNo' , 2. State existing u~ and ~cu~ncy of promises and intended use and occupancy of prop~ conitmctlon: o. ~isting use a~ ~cupancy ........ .~ .............................................................................................. ................. b. Intended use and ~cuF:anc', . ............................................. ~ ........................................ 2~ Nature of wo~k (check which applicable): New Building ~ ......... Addition ................ Alteration ............. Repair .................. Removo~ ....... ~ .........Demolition ................ ;. al'her Work (Describe) .................................. 4. t, oted Cost ............ ........................ Fee ........................................................................ (to be paid on fi!lng this application) 5. If dwelling, number of dwelling umts ...~ ........ Number of dwelling units on each floor ...................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature end exten, t of each type of use~.~....~'~-......c~......'~ 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 .......... ./.....~.. .......... ,.,..y,q Rear ......../......'~.. ............. Depth .../..~..'~.. ............. Height .................... Number of Stories .... ............. (,..7....~.. ............... · ........................................................ 9. Size o~: lot: Front ..... ~'.?.....%~... ........... Rear ..... ./.'...O....(. .................... Depth ....7...?'./...../..../..C. ..... 10. Date of uP~rcd~ }..,.2..~i~.~i~..e}..~2.~.i~2~.~2~......l'~..~of Former Owner .Z~.~....~...~........~... .......................... I 1. Zone or c 12. Does proposed construction violate any zonir~g law, ordinance or regu~j~l........~.....~.. ........................................... 13. Name of Owner of premises ...~..'.~'./~..~...f..~....~.~...~...~?.~./.~ddress~' '~ ..... ~,s.____ o_.~..?...r..~...~..r.....,~.... .................. Phone No 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 oil set-bock dimensiens 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 NEVv'~O,I~K~z Ice COUNTY OF .~t~. .............. ~'~' ..................... ~/,W~-~....~.~ ........................ being duly sworn, deposes and says that he is the applicant (Narf{e of individua~ signing application) above named~iHe is the .................................. ~ ....................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; teat all statements contained in this application are true to the best of his knowledge and belief: and that the work will be performed in the manner set forth in the application filed therewith. Sworn/,~/~t° before me this Notor/ Public,~~Z,~.~.~.. C~'~':~~'~t~ ~,, ~/~ ( g ure ......................... at appllCar~ No. 52-8125850, ~ulfoJk Co~y Term Expires Ma~ch