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Home My WebLink About5021-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z.~.3.3~ ..... Date ............ kugus~ ~. 13 .... , 19..7.1 THIS CERTIFIES that the building located at .Eill .Creek .Dx' ........... Street Map No..xx ........ Block No ..... xx...Lot No;X:X;~.. S.¢atth.old.. ~,~, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 0ct ..... ~..., 19. ?0. pursuant to which Building Permit No .... ~0217' dated ........... Oct,..23 .... , 19.7.0, 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 . Prtval~e..garage. [acce~.~ory. building).. ~apprav. ed. hy .Bd...appeals ) The certificate is issued to .t~ar.o. ld. ~her..~ .wife .... ?whets ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N....H... .............................. ~ouse ~ ~27~ .. i.:!~.:,.( .~ ..... "J' Building Inspector FOR~YI NO. ~. TOWN OF $ouTHOLD } BUILDING DEPARTMENT TOWN CLERK'S oFFICE ' SOUTHOLD. N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMiSEB UNTIL FULL COMPLI~ION OF THE WORK AUTHORIZED) N? 5021 Z O,~e ............................. , ................ ' ......... , ........ Permission is hereby granted to: ........... .~4~a~og,~ ............................. ~: ................ at premises located at ............. ~...~t~-..~D,~k..])-~,~*....~ ............... ;- ...................................... ............................................ .....~u~oX,~,....~.~,..., .......... :....~..:...,; ........ ~ ...................................... pursuon¢ to apphcahon dated .............................. '{~:'"+'"~;"?'"'i"*'; 19... .and opproved by the .Foe $...5.*.~.0. ........... ,? IPOBM NO. I I~3~VN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Examined ........................................ , 19 ........ Approved ........... ~...~.....~..'~...,, 19...'~.~ Permit No .... ...~....,~....'..~..../.......~-. Disapproved a/c .............................................................................................. " , o/~ ~/? ~ ......................... L-....L ...... ~ ............. / (Building Inspector) APPLICATION FOR BUILDING PERMIT ,~ Date ....... ~.....~... ............................ , 19.?..~.....~ INSTRUCTIONS a. 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 diagram which Is pert of thle 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 Deportment for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York ~.nd other applicable Law~, Ordinances or Regulations, for the construction of bui dings, additions or alterations, or for remove or demolition, al herein described. The applicant agrees to comply with all applicable laws, ordina~nc~, building code, housing code, and regulations. O'~ ~atu[~~(~ :a~~ratl°n) .......... ........................ - ~a~ress or applicant)/ State whether appficant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~.~..~....~rt~,~.,~'~..~~..~.~..,.~~ ................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title'of corporate officer) , ,~ 6 ~ _. ~, (~ ~ 1. Location of land on whlch praposed work will be don,. MapNo.~~.~'..¥..'~ · - ........ Street and Number .~....~),~...P~ ........... ~n~-~.~~.,..~).;..~.. .................... Municipality 2. State existing use and occupency of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................................... 7' ............................................................ b. Intended use and occupant', .~.....~.~....~......~~ ....................................... .... 3. Nature of work (check which applicable): New Building ~ ...... ~ ......Addition .................. Alteration ............... Repair .............. .~ Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ...~..9.P. ............................................... 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 ............................ 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 .......... L...~....~. ............... Rear ......... / ~ ............... ' Depth ....-~.....~..../. ......... Height ..../...O.....~ ..... Number of Stories ...~-.~.~..~..~ 3 ' 9. Size of lot: Front ...... L......~ ........... Rear ........ ~...~.. .................... Depth .ff/..~..../.~.d 10. Date of Purchase .......... /....~.....~...~T~. ....................... Nome of Former Owner .~.,.~....~,,~.. ....... 11, Zone or use district in which pram Sas are situated ...~.~ ............................................................. 12. Does proposed construction violate'any zoning law, ordinance or regulatio_n?, .....{~,.-. ........................................ a f premises' 13. N me o Owner of m~;~*~...r.,.;.~...Address Phone No Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~...~; .......... Address....~_:~~'n~,,.J'/..'.y.. 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 comer lot. ',STATE OF NDW YORK,' Je-e ' COUNTY, OF~ ..............:.'. ...... ,.~.....J ,~,'~' ........ ~.,~.~e,ed~ ....... u'--"-," ,..~;.being ~u)y sworn, d~s~ 9,d says t~t he is the applicant (N~eof ihdividual'signihg application) ~ ' '- ~ ' a~ve named. He is the .......................................... ~~ .............. '., ....................................................... (Contractor, ~t, co~or~e officer, ~c.) of said owner or owners, and is duly'authoriz~ to pegorm 'or, h~e .perfo~ the said work and to ~e ~d file this application; that all statements contain~ in this applicati~ am tree.to ~e ~st of his knowl~ge a~ ~lief; and thor the work will ~ perfo~ in the manner ~t.fo~h inthq applicati~fil~ ~ith. Sworn to ~fom ~ ~is ~ ...... ........ ............. No. 52-812~. S~ol~ ~ Te~m ~pites M~ch ~, 1~