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Home My WebLink About5052-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. ~.~.2.2.6 ...... Date ............. &pr.~.l ....~/..., 19.71. THIS CERTIFIES that the bulldog located at 8/S .~rk -A~e ............ Street Map No...~ ........ Block No.. ~ ...... Lot No .... ~... ~t~0k .... N~ .... confo~s subst~ti~y~ the Application for B~ld~g Permit heretofore filed in th~ office dated .......... ~e~... ~.~., 19..~0 p~su~t to which B~lding Pemit No. ~.~.. dat~ ......... ~e~ .... .~..., 19.~0., was issued, ~d confoms to ~I of the req~ ments of the applicable pro~sions of the law. The occup~cy for which ~ certificate is ~su~ is ...~te. ene. f~itF .dwe.l.t~g ..................................... The certificate ~ ~sued to . R. ,~p~ ..... ~ ................................... (o~er, lessee or ten.t) of ~e ~ores~d b~ld~g. Suffolk Co~ty Dep~ment of Health Approv~ .... N.g, ........................... .... ............ B~ld~g ~spe~6r FOIL~I ~0~ ~ TOWN OF SOUTHOLD 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) N? 5052 Z Permission is hereby granted to: ........ ........ ................... .m~.~... ........................ : ................. at premises Iocoted t ,~..~.., .~.~ .~....~.. io ~' pursuant to application dated ................................... ~...:....~.~.i...., 19 .... and approved by the Building Inspector. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE " Approved ........................................ 19 ........ Permit No ............................... Disapproved a/~ .................. Applicotion No ..TO 5 APPLICATION FOR BUILDING PERMIT Date ...J ........................................ INSTRUCTIONS o. This.application must be completely filled in by typewriter Or in ink and 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 part of this location. 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 Buii~ling Permit to the applicant. Such pqrmit 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 whoteve~ until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE ts the Building ~epartment for the issuance of ~bBuilding Permit pursuant 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 a IteretianS~ or .for remavol or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances and re~ulatlans." ' (Signature of applicant, dr name, if a corporation) .................................. ............. (Address or applicantl State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N°melf applicant°f owneris a°fcorporate,premises'""~"'""~C)'~"~"signature of duly authori_ze~ .................................................................................................................. officer. .............. 1.Location of land on which proposed work will be done. Map No: ......... "~....~;~...~'Lot No: ...~. ................ Street and Number ....~:~.~:~k~J7L-j~...~...~'~J~D~zb~...~.....~j~..~.~Je..~..T".".~.~L~.~.~L~ 0 O 2. State existing use and occupancy of premises and intended use and. occupancy 'of proposed construction: a. Existing use and oct-panty ......... ..................................... ............................................. b. Intended use and occupancy ................ .~..ei~ ................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ....~ ............ Alteration ..... ~ .............. Repair .................... Removal .................... Demolitian .......... ~ ........ Other Work (Describe) .................... 4. Estimated Cost .................. ~..r,~T~ ............................. ,Fee ....~ .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ~ ..................... Number of dwelling units on each fl~r....I ....................... If garage, number of cars ........~ ............................................................................................................................... 6. If business, commercial or mixed ~cupancy, speci~ nature and extent of each ~pe of u~ .............. ~ ............. 7. Dimensions of existing structures, if an~: Front ....... ~ .............. Rear ....... ~. ............... Depth ...~...~ ........ Height ........ 1~.~. .............. Number of Stories .~ .......................................................................................................... Dimensions of some structure with alterations or additions: Front ...... .~ t Rear ~ ~ Depth ......... .~.~ ............... Height ......[~. ................... Number of Stories ................................ 8. Dimensions 0f entire new construction: Front ............................Rear ............................ ~pth ............................ Height ............................ Number of Stories ............................ 9, Size of lot: Front ....... ~.~.[ ............ Rear ........ I.~ ...........~pth ...~.~.~...~ ......... 10. Date of Pu~hase ..~.~ ............................. Name of Former ~ner ................................. 11. Zone or u~ district in which premises are situated .............................................. ~.~ .............................................. 12. Does pr~ed construction violate any zoning law, ordinance or r~ulation? ..~ ............................................. 13. Name of ~ner 0f premises.~...~.~. ................ Address ~..~....~ ....... Phone NO ..................... Nome of Architect ........................................................ Address ............................................ Phone NO ..................... Name of contract0r.~~....~.*...Address ..~ .................. Pho~ NO.~T.~.. PLOT DIAGRAM Locate clearly and d~stinctly al! buildings, whether existing or p~posed~ and indicate all set-back dimensions from property lines. Gi~e street and bilk ~umbers or descriptio~ acco~g to deed, a~ show street names and indicate whether interior or corner lot. ~ , I / -/ ' STATE OF NEVi' YORK, ) S S. COUNTY OF ............................ ) ,~g~/-.~'~.A")~ ~'Z:glen~.~Xe~ICR~.~ being duly sworn, deposes and says that he is the applicant ...... w ........... ~-,,e.--.... o.,.~.-~-, -~.~.:~-,-, ~ . ~ ,' .......... y'~ - . - ~ (Name of indiwdual s~gning a~hcat,on) , , - ' above named. He ,, th,...~ ...................... ~ .............................................................................. (Contractor, agent, co~omte officer, etc.) of said owner or ownem, and is duly authorized to ~rform :or have pe~ the ~id work and to mak~ and file this application; that all st~ements c~tain~ in this application ate true ~ ~e ~t of his ~ledge and ~lief; and that the work will ~ performed In the ~nner set.~-h in t~e applicati~ fil~ t~ith~ ~ ~ ~ S~rn to before me ~ls ~/~ ,,~ ~. ~~~//~. J .......... ~.~.~... d~ of ..... .~~ ~9.,~.~.NOTARY~F/~a~r. of applicant) ...... ~ ~ . ~ ~ /~ ~ ~ ~No. 52-3233~20 Suffolk County