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Home My WebLink About5072-zFORM NO. 4 TO~lrN OF SOUTHOLD BUH~BING DEPARTM~,NT Town Clerk's Otilce Southold, N. Y. Certificate Of Occupancy T ~ g~CERTIFIES that the building located at .. ~./~', ~dar- '~t~' Dl, ive- BeStreet conforms ~s~lly to the Application for Building Permit heretofore filed m this office dated ......... ~9¥& .21~. .... , 19. '~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 The certificate is issued to . ' '?eteT 'Ee'g .......................................... (owner, lessee or tenant) of the aforesaid building. Suffolk Cmmty Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No...l~l~.~ ............ /. ..................... HOUSE NUMBER . ~ ......... Street ... Cedar- '?ot~rt -D~e 'Erect ............ Building Inspector / 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? 5072 Z Permission is hereby granted to: .~....l~....~....~.......~....~ .................. at premises located at ~t ~ G~S41~ ~lllh P~ ................................ ..a~......~...~..~.~ ~..t...~.~.~.e. ......... ~~ ............................................ pursuant to application dated ........................ ~ ......... ..~,,. ............. , 19..~...., and approved by the Building Inspector. C~.~ (~ Building Inspector TOWN OF SOgTHOLD BUILDING ~' (Building Impactor) APPLICATION FOR BUILDING PIRMrT N Ye r ..... pet, ........................... ........ , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building>~ Inepector. b. Plot plan showing location of lot and of bulldin~ on premises, relationship to adjoining premiere or I~bll¢ ~treets m~ arem, and giving a detailed description of layout of property must be drawn on the dlagrom whlch it part of ~b application. ,. c. The work covered by this application may not be commenced before i~u.,nce of Building Pem~lt. ~ d. Upon approval of this application, the Building Irmpector will luue a Building Permit to the al~llcont. Such permit~; shall be kept on the premises available for i,~mction throughout the prngre~ of the work. e. No building shall be occupied or used in whole or in part for any purpoee whatever until a Ce~tlfk:ate of Occupancv~ shall have been granted by the Building In~ector. ~. APPLICATION IS HEREBY MADE to the Building Department for the Inuance of a Building Permit punmant to the~,. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apgllc~obie Regulations, for the construction of bullding~, addltlon~ or alterations, or for removal or demolltiae% al,he,tn descrlbed.~ The applicant agrees to comply with all apl~licable lav~, ordinances, building code, hau~tng code, and mgulcltions. (Signature cf applicant, or name, if a coq~omtlon) State wh~her applicant is owner, Iron, agent, o~hitect, englnNr, gemral contractor, electrician, plumber or builder. .................................................. ....................................................................................................................... Name of owner of premlse~ ....... .~.f~.'~fl~...~,¢,O ....................................................................................................................... If applicant Is o corporate, signature of duly authorized officer. (Name and title 'of corporate officer) I. Location of land on which preposed work will be done. Map No.: ....... ~.~.~...]~.q~..~>~.... Lot No.: ...... ~..~ ............ Street and Number .......... ~T/.~...~.f~t~'...~'.~..~)3:;LY.e..~'~iLs.~, .......... ~D,1L~O.].d ...................................................-- 2. State existing use a.nd occupancy of premise~ and intended USe and occupancy of pragoeed constl~'tl~: ])~e~J~ ............................................................................. o. F.~isting use ond occupancy .................................... " W/ detached ~ara e b. intended use ond occupan:', . .......................................................... ~ ................................................................. 3. Nature of work (check which applicable): New Building ~.:Z~Z:Z ...... Addition .................. Alteration ..........~... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ..........6.~;Q.Q ......... +-. ......................... Fee ......... ~.,.QQ. ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .QJ~. .................... Number of dwelling units on each floor ............................ If garage, number of cars ........ 2. .................................................................................................................................. 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 sarne structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~6 .................... Rear ......... ~ .............. Depth ....~..6. ................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........ .1.1.0. ............ Rear .................................... Depth .......... .1..~..Q.+.. ............ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ...F~,~...d.:J. st, .............................................................................. 121 Does proposed construction violate any zoning law, ordinance or regulation? ............. 1~O ..................................... ~ .... 13. Name of Owner of premises ..~..e..t.e..~.....~..c...O. .................. Address ............................................ Phone No ............... ~ .... Name of Architect ...................................................... Address ............................................ Phone No ...... ;: ............. Name of Contractor ....~...*....~.~...~..~.~. .............................. Address ....~..o...~.~.O..]....~. ...................... Phone No. ~ PLOT DIAGRAM .. Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and shaw street names and indicate whether nterior or comerlot. ~----- .... ~ STATE OF NI~j~/V~¥~OP~. ~k4.~... COUNTY 0 F ~...'~... ~..0...'~.. ................. ~'~' .................................... ~..~&~ .................................... being duly sworn, d~es and says t~t he is the applicant (N~me of individual signing application) above'named. He is the ....................Q~Z~.~gZ .................................................... " ....................................................... (Contractor, ag~t, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke ~d file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the applicati~ fil~ ther~ith. Swam to ~fore me this Nota, Publi~.f.~ ....... Coun~~ (Signa~re of~plicant) Term Expires March 30,