The URL can be used to link to this page

Home My WebLink About4734-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificale Of Occupancy No..~..~..? ...... Date ............. &..~J ..... 30 .... , 19. ~ THIS CERTIFIES that the building located at K/~ .Jl~le. 1~.. (~)... Street Map No. ~ ........ Block No...~ ...... Lot No.. ~... ~lJ .... ~.~.. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .........~ ..... ~..., 19.. ~ pursuant to which Building Permit No. ~.. dated ...........Ma~... ~ .... , 19.70, was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. &~~aX. ~ .-. D~ .&. 5~JblJ .......................... The certificate is issued to .. ~j,. B~t~nzJ ....... ~. ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~,R, ............................. UNDERWRITERS C~RTIFICATE No ..... ~R.* ......................................... HOUSE NUMBER...~ .... Street... ~a~0. ~..(.~7). ........................ . .... Building Inspector FOileR NO. ~ TOWN OF SOUTNOLD 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) No. d734 Z Permission is hereby granted to: .............. tl~mll~..JM~.t~e~ ................... : ............... .................. ~ ....... st.X. ......................... to ~ ,m e~.~..~ .e.~.t.....S~..$~.~ ........ ............ ..(.....,...~.......~.........~.....,.Z.t...S.~..~...~...~.....,....~....~.e). ........................................................ at premises located at ............... ~l...~j~l~..~..~.~ ........................................................ ..................................................... ~.~.....~ ....... st.t, ...................................................................... pursua~¢ to application dated ........................... ~ ......... ~ ............. , 19...~...., and approved by the Building Inspector. BUI.DING DEPARTMENT TOWN CLERK'S OFFIC:E ~TH~D, N. Y. ..... ~- ~e~ .............. .............................. : ......... . Dis~ppraved a/c ....................................................................... APPLICATION FOR BUILDING PERMIT Date ........... ~,~..~/. ............................ 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 prem ses or pub c streets or areas, and giving o detailed description of layout of property must be drown on the diagram which is port of this application. ~ c. The work covered by this application may not be commenced before issuance of Building Permit. to Shadl.i Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ~4 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 port for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATI~)N IS HEREBY MADE to the Building Department for the issuance of a Bud ng Perm t 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 alterations, or for remova or demo t on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applic ntIL~, name, if a corporation) (Address of applicant) ' State whether applicant i(~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ~.~...~...~..~/~:2 C~ ~/~/7-7'/Y,~_~:), ~ If ~licant is a co~orate, signature of duly authoriz~ officer. ~ (Name and title of co~orate officer) ~ 1. L~ation of land on ~ich p~ work will be done. Map No.: ........................................ Lot No.: ........................ Strem and Number ................ ~.~.~ ........................................ .~~ ........... ~ -- ~ T ~ OS Munici~li~ 2. State exi~ing u~ and ~cu~nw of premiss and intended use and ~cu~ncy of pr~ constmcti~: a. ~i~inO ~ and ~cupan~ .......... ~.~ ... ~ ................ b. Intonded use ~nd ~cu~ncV~.~.~.....~.~ .......................................................................... 3. Nature of work (check which applicable): New Building ....... ~ ........ Addition .................. Alteration .................. Repair .................. ~e_moval .................. Demolition ......... .~....~.~her Work (Describe) ............................. 4. Estimated Cost --..~'~./~..~.-.~.~. ................. Fee .~.,...~./..~.. ....................................................................... (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 u~...~ 7. Dimensions of existing structures, if any: Front ...... ~ ...............Rear .~,~ ....................... Depth .~>~0. ........... Height........................~:/ Number of Stories .............. /... ........................... ' Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ....~ ................. Height ......t~... .............. Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... .~..O. ...................... Rear ...... .~..~. ............... Depth ..~7,.~. .............. Height ...,.~'.~...~. ...... Number of Stories ........... ./., ...................................................................................................... 9. Size of lot: Front .......~...O~...~. .............. Rear ..~ ......................... Depth .../...?....o~... .................. 10. Date of PurChase ........ ~....~.....~..~. ................................. Name of Former Owner ....~.~..?..~.. ...................................... 1 1. Zone or use district Jn which premises are situated .......... .~.~'.~..~./~'.('~9~ ....................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ .../~..~. ............................................ 13. Name of Owner of premises.."~.Z,Z~u~.,..~..o .~..../.?Z-d/~.Address .~21~.M~/.A..L/./.Z.~..~.I/~. ...... Phone No.~.~,~...~.~{~.. Name of Architect ..............~..~..~.~'/~'.. ..................... Address ............................................ Phone No ..................... Name of Contractor .......... 4~/..,~'.~,~.~.~ ./..-. .................... 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 corner lot. F ]~-X'/GT"/)'l/g-- 0~, o U P STATE OF NEW/~'~,,. · [S.,S. couNTY ............ ......................... being du v sworn, deposes and says he the app,can (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 Jn this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... .......... . ............................. "' f £LIZAB£TH ANN NL~/ILL~ NOTARY PUBLIC, State of New York No. Term52-8125850, Suffolk Expires March 30,