The URL can be used to link to this page

Home My WebLink About5028-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi[icate O[ Occupancy No.. Z~3.g. .... Date ........ .0.e.t.0t. Le.l'..1.7, ....... , 19.7.3. THIS CERTIFIES that the building located at ....0.!d...~..p~'ar.d. ~ .... Street Map No..~3~. ....... Block No. ~ ....... Lot No...1.0.~. .... . .501$.th.o.~.d .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ 00.t.0b.e.r. ~6~., 19.7.0.. pursuant to which Building Permit No..~02~Z... d. ated ....:... 00.t.o.b..er..2.6~.., 19.7..0., was issued, and conforms to all of the require- ~ ,, ~nen~s of the applicable provisions of the law. The occupancy for which this certificate is issued is ...1~. ~v.a. ~;9..q~..~..f. ~...~., .d_~..O..~..~. ...................................... The certificate is issued to ...!~.. g.a.r.e.~..R°..l~t..~..~r. ..... .o)~..?.x, ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ]~a ........................... UNDERWRITERS CERTIFICATE No. PIgI~D][NG HOUSE NUMBER ..... ~1~ ..... Street...0'} d..ill'/.5.1~r~,~'d, lali,l~O .......................... .......................................... Soutl~olcl .............................. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5028 Z D~e ............ ~ ....................... , 19 ........ Permission is hereby granted to: : at premises located at .................................. ~.'~...~. ......... ,,~..../~...~,..,~,,,~.~,,,?,~..~ ....... ~..~,,..,~.]*~,, ............... .................................................................................s~:~..:. ~ ............ -~, ~,_ i....~. ............................................... ~: . ................................................................... :...Y .................. , ..... ,..: ...... ;...~.~. ........ , ................. l... pursuon~ to application dated ..................................................... ~, .., 19. ,. and approved by the Building Inspector. Fee $......~...~. ...... Building Inspector DiSal~roved a/c ......... ~......................... r' ....................................... ; .............................. ...... .............. · . ....... ....... .............................. AFPLIGATION FOP. BUILDING fERMI1' iNSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in dupllc~e to the Building Inspector. b. Plot plan showing location of lot and of buildings on Premises, relationship to adjoining premlees or _public streets or areas, and glvlng, a detailed description of layout of property must be drawn on the diagram which Il pert of ~hll application. c, Ttr~ work covered by this al~licotion may not be commenced before iuuance of Bullcll~ Permit,' .~.~L---4Jpon approval of this aapllcotlon, the Building Inspector will luue a Building Permit to the applic~nt. Such permit shall be kept or/the premises available for inspection throughout the pragr~u of the work. ' ~-~ -'e: '~l~'bUll'ding shall be OCcupied or used In whole or In par~ fOr any pu~oee whatever until a Certificate of Occu~ncy shall have been granted by the Building Inspector. APPLICATION IS I-iEREBY MADE to the Building Department for the issuance of a Building Permit pumuant 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 al.terations or for removal ar demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building cede, housing collie, and, ragulatlons. __C-~t 4~ ~ · .............................. ;; ..................................... ¥ ........ ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractar, electrician, plumber or builder. Name of owner of premises .............. ~...~ .............................................................. ~ ' If applicant Is a corporate, signature of duly authorized officer. ~ .................. i~;;;;~';;;,i';,;:;;:;,'F~;i~;;;;";'~;;;;i ................... ~ I. Location of land on h p . Map No,: .,,,,g..~.,,..~,,.,~, ' & ................ ........... ., st-- and Number ~.~.~.. ...... ~. ......... ~..~ .................. /~/~- ..5~/~" ~ q ~ Munlcll~llty 2. State existing use a,nd occupancy of p~mises and Intended use and occupancy of prepared coml~uc~lon: o. t.,st, ng use and occupancy ...... ~ ....................... , ........... ~ ............. Intended use and occupan .... , .......................................... ~ c~ ~ ............. b. 3. Nature of work (check which applicable): New Building ~ ................. Addition ........... Alteration .................. Repair .............. ~r,,j.~Removal .................. Demolition .................. Other Work (Describe) .................. [ .............. : ..... 4. Estimated Cost ....~...~.~.~.. .............................. : ....... Fee ................................................................................... ! ...... (to be paid on filing this application) S. If dwelling, number of dwelling units .......... / .............. ~Number of dwelling units on each floor ............................ If garage, number of cors ............ /. ............................................................................................................................... 6. If business, commerciol or mixed occupancy~ specify nature and extent of each type of use .................... ~ ....... 7. Dimensions of existing structures, if any: Front ...~.~.[ .............. Rear ..n~...~. ................... Depth ..~. ~...~. ...... Height ......~..~...[. ....... Number of Stories ........ ~. ...................................................................................................... Dimensions of same structure with alterations or additions: Front ...... ~..~....~. ................. Rear ..~..~...~.. .............. Depth ...~...c~'../.. ................. Height ....~.~.../. .............. Number of Stories ..........~. .................... 8. Dimensions of entire new construction: Front ...m~.~.../. ..................... Rear ...... ,~-~:~'..(. .......... Depth ..,../...~..../.. .......... Height .....,/..(e..~ ...... Number of Stories ....... /. ............................................................................................................. 9. Size of lot: Front .....7~-~..~ .............. Rear ........ .~.~...../. ................. Depth ..... ..'~.J..7.../.. ........... ~,~, 10. Date of Purchase ....~'.~.., ........ ~..~.~.~ ................... Nome of Former Owner ...~..,...~ .... 11. Zone or use district in which premises are situated ....~~.~....~.. .......................................... 12. Does proposed construction violate any zoning~aw, ordinance or regulation? ...... ~ ............................. .~ .......... 13.NoName of Owner of prom ses ~.,L'..~ress ..~....~...~....~... Phone No ~...~..~...'.~...~.~.,of Arch t t . "':~ ' ' me ec ..................................................... ~Address ...~ ........................................ Phone No ........~ ........... Nome of Contractor ~--~'4~..~ ....... Address~.s~~ .......... Phone No.~'.~..7.:..~.~?~:~ PLOT DIAGRAM Locot.e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dlme~.~ ons fram property lines. G,ve street and block number or description according to deed, and show street names and indicate whether interior or comer lot. · STATE OF NEV~OP~,,, lee COUNTY O~ ~4~. ............ ~-~' ..................... ................. be,ng swo.., dep es and says he ,s th. (Nan{e of inSividual signin~g applicatio~ above named.:~l-te 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 t~ make ~ file thisapp!ication; that all statements contained in this application are true to the best of his knowledge and belief;and thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ~ . .... NotaryPublic'~F'/~ "'"~'"97'6~ ~'~h~'~'J~ ''' ' ,~,zA,~, A,, N~,~ Co, n~, ...~' .................... ~...~ii~.;.~;~..~ ........................ NOTARY PUBLIC, St~t~ of New York No. 52-8~2~S0, Suffolk Tram Expires t4nrch 30~