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Home My WebLink About5063-zF~RM NO. 4 TO~VN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Occupancy No. Z1~220 ...... Date ............. &prix..2~ .... , lg. ?.$ THIS CERTIFIES that the building located at . .I~dia~ .ll®ek .~- & .~.~l~t Map No... ~ ....... Block No. ~ ....... Lot No ..... ~ ..... Pe~e .... ~..~, ..... confoms subst~ti~ly to the Application for Build~g Permit heretofore ffl~ ~ ~is office dat~ .......... ~eV-- -~..., 19.70. p~su~t ~ which Buil~g Permit No..~.. dated .......... ~eW .... ~..., 19.~O, was issued, ~d conforms to ~1 of ~e req~ men~ of the applicable provisions of the law.. The occup~cy for which tMs certificate is issu~ ~ .... ~tvate. ~. f~ly. ~well~ ................................... ~e ce~ificate is issued to ...J*~ph- & .Je~ 'P~t~,' ' · ~e~ ................. (o~er, lessee or ten~t) of the afores~d building. S~olk Co~ty Dep~ment of Health Approval ..... N,R, .......................... ~euse ~ 2~ 1~1~ ~eek ~ ]/ ~ ........... ' B~din~ I~pector FOR3~ NO. ~- TOWN OF $OUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL 5063 Z Permission is hereby gronted to: ~ _ ~ , ~ pursua~4' to application dated ~...~., .~...~-'~ ./~-' 19'~ Building Inspector. end approved by the : ! Buikling Inspector BUILDING DEPARTMENT TOWN CLERK'S OFFIC! SOUTHQLJ), N. Y. (Building Irtspector) APPLICATION FOR BUILDING PIKMI'~ 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 bu_lldingl on premlm, relationship to adj~inlng premilee er L~bllc It.feets or areas, and giving a dotafled description of layout of property must be drawn on the diagram whlch il Ix1rt of ~il apl) m. Qttafl, c. The work covered by this application may not be commenced before i~uance of Building Permit. d. Upon approval of this application, the Building Inspector will I#ue a Building Permit to the al~lleent. ~ueh permit ~hall be kept on the premMs available for Inq~oction throughout the progre~ of the work. ' e. No building shall be occupied or u~ed in whole or in part for any purpaee whatever until a Certlflcato of O~upancy shall have been granted by the Building In~oector. APPLICATION IS HEREBY MADE to the Building Department for the i~suonce of o Building Permit _pukka. nt .to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y. ork, and .other appll~ble I~. ~ m Regulations, for the construction of building, addltlonl or alterations, or tar remevm or dm~,~lltlon, m nemen mrmee. The applicant agrees to comply with all alxolicable law~, building code, housing ~dd, and re~detlam. (Address of al~llcant) State whether applicant is owner, levee, agent, architect, engineer, general contr~tor, eleetrlcMn, pba~ber or builder. . . . ,,.IoI- N ?6NTIN.O... ....................................... ama OT owner o? premises ............................. c ............................................................................ ~ If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) ~! 1. Location of land on which propaeed work will be done. Map No.: .................... : ............. : ..... Lot No.: .~.w~.. .... Street and r~umoer ................/ ................................................................................................................................ 2. S~te exi~lng u~ and ~cu~n~ of pmmlm and Intend~ u~ a~, ~cu~n~ ~ p~ ~: .................... .......... ............................................................... b. ,nt.~ u, and ~cupon:-, ~ ~- ,~ ~.~.~ ~.~( ~...~ .................................... Nature of wink (check which applicable): New Building .................. Addition .................. Alteration ............. Repair .................. Removal ................ ~.' .Demolition .................. _Ot~e~r Work (Describe) ...................................... 4. E~t~mated Co~t ......... .~....0....O..~.. ,' . . Fao ..b~..~ ...................................... (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 ........................ .... existing structures, if any: Front ......... '-~..~.. ........... Rear ................................ Depth .......~-O ......... 7. Dimensions of Height ........................ Number of Stories ......................................................................................................... Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ................. ~ ............. Pear ............................ Depth .....~. ................ Height ..................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 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 law, ordinance or regulation? .............................. ~ ...... .~... ................ 13. Name of Owner of premises ..~...~.....~.......?...~.../~....~....A~...~...Address .....'~..~...'~.../.....~... ............... Phone ~J~'o~'. .....~..?../....~..... Name of Architect .......................... :.. ......................... Address ............................................ Phone No ..................... Name of Contractor ~ .............. ...~..~.~ .............. Address ............................................ 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 Jot. STATE OF NEW YORK, ~..~,~"'~ a~v, named. He is thel~~;[_~;;~~ ............... of said ~ner or ownem, and is duly authorized to perform or hove perfo~d the said work a~ to ~ke ~d file t~is aPPlication; that all statements contained in this applicati~ am tree to ~e ~st 0f his ~wledge and ~lief: and that the work will ~ perfor~d in the manner ~t fo~h in the applicati~ fil~ ~i~. SWam to ~m me ~is ~ ~ ~ , ............... o, ................................ o,~ ~ ....... ~.. ~ ~~ J~gi~ .~ ................ - u . Term Expires ~rch ~, 1~