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Home My WebLink About5016-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . HitS. J~ddlo .Roa~ · (CBOe) Street MaP No..:S]~ ....... Block No...~ .... Lot No.. ~....8~..~0~ ....... conforms substantially to the Application for BuildMg Pemit heretofore filed in iMs office · dated ............ ~..~.., 19.~. p~su~t to which B~ld~g Pemit No..~. dated ............ ~l..~$..., 19. ~, was ~su~, ~d conforms to all of ~e r~r~ men~ of the applicable pro,ions of ~e law. The occup~cy for which this ce~fficate is ~sued ~ 'aO~SOO~'(~S)' [~Se..~ ........................... The certificate is ~su~ to ... ~..JOeo~. ~lm~ ...... ~ ................... (owner, lessee or tenant) of the ~ores~d b~ld~g. S~o~ Co~ty Dep~ment of Health Approv~ ... ~. ......................... :.. ~e ~ ~ ~ B~ld~g Inspect~ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREAKISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5016 Z Dote ............ Permission is hereby granted to: ......... ~,,..~ep~..~ee[~ ............{. ................ ................ ~.oa~.~d~ ............................................ to ......... ~l~.~, ..~,...~ew .. &n.. ~..~e~..a~ ~ e~ .~F...b~,14~ ....... ....................................... at premises located at ..................... ~J~,.~l;~e..j~..~.) ................................................ ~.. ........................................................... /t~u'~ha,~i ....... /f~'~ ........ ~ ................... : .................................... pursua~¢ to aPPlication dated ..............~ ............... ~t~ ........~e~..,~....~ 19..~/~., and approved by the Building Inspector. Fee $...~e.f~JO ............ ~'~J""'"'"'"-- Building Inspector BUILDING DEPARTMENt' TOWN CLERK'S OFFICE SOUTHOU), H. V. ............. ....... ...... ......... . ,rmi, Disapproved a/c .............................................................................................. " (Bu' ding Inspector) r APPLICATION FOR BUILDING PEBMI'T Oct 21 19...~..0.. .... Date ............................................................ INSTRUCTIONS _~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat plan showing location of lot and of bu.ildings on premises, r~lation~ip to adjoining premiees or public streets o~,~ areas, and giving a detailed description of layout of property must be drown on the diagram whlch Is part of thio 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 port for any purpose whatever until o 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 pureuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York and other pppllcable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein deKrlbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, end regulations. (Signature cf applicant, or name, if a ¢orparatlon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................... ~amer ...... .bu~L;L~er ....................................................................................................................... Name of owner of premises ..... a:L....~T:l;e, pb..J~hee,].ez:. ..................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) ~ ........... R~. ......................... Lot No.: ...~ ............. 1 Location of land on which proposed work will be done. Map No.: Street and Number ............... ~.fi..aV~LO. cL].e..-Road...(,(~.-R~-2..~ ....... ,~o~tlu~ic~ .................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propoeed comtruction: a. Existing use and occupancy ....... ..~...b..~L.~.....G.~'.~,~el ............................................................................................. ~ b. Intended use and occupan:', . ........ ,..q.G.~Ge..~L.'~..&..&O~G~.O&.,.,~..~G.L1..~..'J.d.I.~,K, ............................................... 3. Nature of work (check which applicable): New Building ..... ~ ........Addition .................. Alteration ............. Repair .................. Remova~ .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ..... .I.0D.;~; .......................................... Fee ..~O0 ............................................................................. (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ..... .13.o~e ............. 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 ....... &¢~s~.o~'~r 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 ............. 20 .................. Rear ......... ~-0 .............. Depth ..... ~O ............. Height .................... Number of Stories ..............oZ~ ................................................................................................ 9. Size at: lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... I1 # 11. Zone or use district in which premises are situated ............... ~.....~.13~.~ ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~ ............................................... ]3. Name of Owner of premises ..~...~T,,...W~ee~e~ ...... Address ......... ~.Ol~n.o].cl. ............... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor ..... ~8rn~ ...................................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicafe whether interior or comer lot. STATE OF NEW YORK, t S.S COUNTY OF ..~.a.tJ:~,l)r ............ f · ................................... .Tb~...i]'~.q~,n~.~reel.~.eZ~ .................... being duly sworn, deposes and says that he is the applicant (Name of in-diviarual-sTg"rlmg ap~b'flon) above named. He 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 ond file this application; that all statements contained in this application are true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this 2.1...;...d_ ay of 9....2.0 ................ ....... ......... ...... .......... , ~/EL ZABETt, I A~F, rC[V~/LE COUrtt~~ -'(Signature of app icant')'~ hlotar~/ NOTARY PUBLIC, State of N~, Yor~