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Home My WebLink About5050-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..~?.8.1. ..... Date .............. .Feb.... 5. ..... , 19..?.~ THIS CERTIFIES that the building located at ....N~.S...g.f..d.d. 1..e...R~...(..C.B.~..7.). Street Map No .... ~x ...... Block No... xx ..... Lot No...xxx... C~tehogue.. 1~ ,~[, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... llo~...i~ ...., 19. ?[1 pursuant to which Building Permit No.. ~.0.5.0..Z. & dated ....... N..o? .... !6. ......, 19..7.Q, 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 . P~.lva.te. orca .fa~¥. d~elllng .w~h .addtt$oll ./~. ][~lCe~.QI~I..b.~d. g. vith addition The certificate is issued to . .T~.o..~..F.,C .Gp.n.n.$g~.~.... ~e.~. ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Dep~rtment of Health Approval ...~. :~: ............................. UNDEBW2ITE2S CE2TIFICATE No. p.e~2~ ................................... HOUSE NUMBER ... 1.~.~[R~. .... Street ....~[.dd~e. ~c~d...(.C.l~.) ................ Building Inspecto~ FOEM NO. '~ TO~VN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5050 Permission is hereby granted to: at premises located at .......... ][~/-e,..JJ,f~t~,l.e..,Jl~ ........................................................................... ........................................................ Gu/bet~J ....... 1~,~.~ ............................. ~ ................................... pursuan* to application dated .............................. ~ ....... J~ ............. , 19...J~Jj and approved by the Building Inspector. $..5-a0 ............ Building Inspector / IN)BM NO. I ·OWN OF SOUTHOLO BUILDING DEPA~',TMENT TOWN CLEKK'S SOUTHOLD, No Approved ........................................ , 19 ........ Permit No ............................. Disapproved a/c .................................................... ~ (Buildi~ APPLICATION FOR BUILD1NG FERMI1' 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 premlee~ or _l~bllc streets or areas, and giving a detailed description of layout of proparty must be drawn on the diagram ~Vnlch le part of ~hle appllcatian.~ 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 al~llc~nt. Such permlt~ 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 Department for the issuance of a Building Permit I~nmant to thex~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein deecrlbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatlans. (Signature cf applicant, e~name, If a corpamtlon) (Address of agpllcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eleotrlclan, plumber or builder. Name of owner of premise~ ...~l~.~..~O..._n..~:Lgl"' ........................................................................................................ If applicant is a co~mte, signature of duly authorized officer. ~ ~ (Name a~ title 'of co~orate officer) ~ 1. ~ation of land on which pmpmed work will ~ done. Map No.: ......... ~ ....................... ~t No.: ...' ..... Stre~ and Number ....... ...... ........................................ 2. State existing u~ a~d ~cu~ncy of ~mi~s and intended use and ~cupancy of p~ c~m~: o. ~sti~ use ond ~cuponcy ...... ~.~ ....................................................................................................... ~. Intend~ use on~ ~cupon:*, . ....... ~.~..~.~..~..~~ ..................................................................... 3. Nature of &olk (check which applicable): New Building ................. Addition.....~"..~..... .... Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ....... ..//.~..(~ .......................................... Fee ..................................................................................... (to be paid on fi!lng 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: Fron!' ....~./~. Rear ..~./. ........................ Depth ..~'./~/~ Height .~.. ................ Number of Stories .....~.. ....................................................................................... Dimensions of same structure with alterations or additions: Front ...... ?../.. ........................ Rear ...~./. ................... 8.Dimensions of entire new construction: Front ~.~,,~ .................. Rear ./..~/ ..................... Depth ...~...~. ................ Height ../.,..z~,. ............ Number of Stories ...... ./. ............................................................................................................. Date Purchase 11. Zone or use district in which premises are situated ..................................................... ................................................ 12. Does proposed constructlon ~iol~.te any z~,,?ng law, ordinance or regulation? ....~ .............................................. 13. Name of Owner of premises ....;..../......C~..~. .................. Address ................................ Phone No Z~.. ~.. Name of Contractor~'" "" ~'~ !...~ Address Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or'prC~Sed, and indicate al 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 YORK, COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to b~fore me this - ............. · .~.~ ... aoy o ............ ~. .............................. , ....... E- .... P'loTar't I"UOllC, ..............~IIIII, II~"'~/:'PI~'CrlEL1 ............... f oppl NOTARY PUBLIC. Stele ef N~w Yor~ ~)#llli{ied In Suffelir Terlll Ex~Tres ~ereh 30, 19...~