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Home My WebLink About4602-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy ~o. Z .373~ Date ~'~./v/./~./ ! ~. , 19 7~ THIS CERTIFIES that the building located at ~W ~N~. Street conforms substantially to the Application for Building Permit heretofore filed in this off, ce dated , ~q~r~ /~ , 19 7¢ pursuant to wni~n Building Permit No. ~ d ~ ~ ~ dated , 19 . , was issued, ~d conforms to all of the req~re- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ~,~PJ'IAg-'~ .O~ The certificate is issued to (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . x///-/" / Building~ Inspec{or IaOILM. NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)' N? ~602 Z Permission is hereby granted to: ~t premises Io~ted at ......................................................................................................................... ~r~uo~ to o~,ica.on dated ................................ ~i.~ ...... .Z:~..., ,~...g~, o~ o~o~ ~ t~ Building Inspector. Fees ...... .~..~..... .... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c .............................................................................................. Apphcat,on No..~.../'..~..~.. ~. (Building Inspector) APPLICATION FOR BUILDIN$ PERMI~ Dot* ...................... , NSTRUCT ONS a 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, relat~onship to adjoining premises or pubhc streets or areas, and gwing o detaded description of layout of property must be drawn on the diagram which is part of this application 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 o Budding Permit to the applicant. Such permit 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 untda Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to the Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regular,ohs, for the construction of buildings, additions or alterations, or for removal or demohtion, as here~n described The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations (Signature of applicant, or name, if a corporation) ~' (Address o* (~Sphcont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. applicant is a corporate, signature of duly authorized officer (Name and title of corporate officer) Location of land on which proposed work wdl be done Mop No ................................... Lot No ' . ..................... Street and Number ... ~...~ ~.~..~.~,~.~..~..~i~.~..~.,.....~..r~..~...~ .................... ~ 1' '~ ~-~'/---') ~' c~' -- M~cipality State existing use and occupancy of premises and intended use and occupancy of proposed construction Existing use and occupancy /.~...~q b.Intended use and occupancy 3. Nature of work (check which applicable): New Budding .................. Addition ................. Alteration .... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................... 4. Est,mated Cost .................. ../....~....~...~.. ........................... Fee ........--~-~-~-~...~ ................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelhng units ............................ Number of dwelhng units on each floor ........................... garage, number of cars ...~.......~....'~...,~r~~ ........ ..~:z....~.(..../~...(x~.'~-/-~ ........................................................ If 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 same structure with alterations or additions' Front ................................... Rear .......................... Depth ......... ~ ..... Height ...... ~...~.. ........ Number of Stories ............................ n ntructi n Fr nt ~ 0 ,, ~ O 8 Dimensions of. entire ew co s o . o ................................ t~ear ............................ Depth .................. Height ........ ./....~... ..... Number of Stories .................. ~ .......................... 9. Size of lot' Front ........... ~......?~T.. .... Rear ........................... Depth .......... ~...~'..~..?~T... D~/~/~-j/~i- 10 Date of Purchase ................... ./..Z..~.7..~'~' ..................... Name of Former Owner .. ~...L~.L....~.. ...... ~...u..~..~...~...~.. .... 11. Zone or use district in which premisesrare situated ........................ ~..~/....~.....~.....z~.....-~.)...~.......Jrm~... ...................... 12. Does proposed construction wolate any zoning law, ordinance or regulation? ........ ~ ................................... 13 Name of Owner of premises~..~..~....~./...E..~.~.. ..... ..Z~...~..~,c~ress .......... ..~..L.~..~..~ ....... ..~..~.. ..... Phone No~.~.~.-...~.~?. Name of Architect ........................................... Address ..................................... Phone No ................ ~ ~___~ ~Ol~ffl~ucl-lot'J,,, . '~l¥"~H~-~'~b- Phone No/~..~. Name of Contractor ................................................. r~aaress ........................................... property hnes G~ve street and block r}~l~ber or descript,og ~ccordmg to deed, or~ whether interior or corner lot T ~--'~' ¢"' ' ...... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and ind,(ate all set-back d~mens,ons fro~ how street names and ind~cat STATE OF NEW YORK, COUNTY OF .............................. ~' .... ..................~__ ,..___~.../...~..../~...~.]/..~..~ ................. -r~ z~, ~_~.~.~_~'. ......... be,ng duly sworn, d~oses and says that he ,s the applicar (Name of individual s~gning apphcat~on) above named He ~s the ................................. ~--~., ...............% (Contractor, agent] corporate officer, etc.) ' of said owner or owners, and ~s duly authorized to perform or have performed the smd work and to ~ke and th~s apphcat~on; that all statements contained m th~s application are true to the best of h~s knowledge and belief; ar that the work will be performed m the manner set forth in the application filed therewith. Sworn to before me this 7 : ........... .... u ~~' ~'~ :~' '~ ';.q',~rV,lL[ (Signature of applicant, ......... Nota~ c ........... NOTARY PUL;' 't' ~ '~ c~ N"'./ York No 52 S123~5~, S,, ,~lk C,~unt~ Te~m E'p