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Home My WebLink About4867-zFORM NO. ~ TOWN OF SOUTHOLD BUH,DING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. ~..~..!~ ...... Date ............... .O.q~; .... ~.~..., 19.?.~. THIS CERTIFIES that the building located at .. 1/adeline. A.v.e ........... Street Map No.. ~x ........ Block No. XX .......Lot No... X~X.. F~.sher.a .I~Land .... i~ ,¥.. conforms substantially to the Application for Building Permit heretofore filed in this office dated .........July... 20...., 19..7.0 pursuant to which Building Permit No..~.~7~. · dated ..........Ju_l¥ .... 21.., 19..?0, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...P.r.~.v. ate..(.a¢ce.$ser.~ .bld~ ~ara/~e ................................ The certificate is issued to . ~.qg.ep.e...P~..s~l~ ......... .~e~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ~; .t/.; ........................... .... /.~..~.'. ~ . ~.. ;.', } Building InSpector t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) 4867 Z Permission is hereby granted to: ............. ~a~e~...L-'~k~Z. .............. .................. ................ ~6~e~ ~:r~e..a~e ................. .................. ................... ~e~te~.-.]i:e~ ....... [¢.~. .......... to ........... ,~u~..z~e~..J:~o..~a~...~,:p~':L~z~,e.),..~a~..i .......................................................... at premises located at ............. ][~.~..~;~e~],~c~e..~,v~. .............. .......................................................... ................................................. l~.~ahe:~...Is&~ ............ t~.~/~ ....................................................... pursuan,t to application dated ......................... '~:O~l,~r .......... ~....:....., 19..~0., and approved by the Building Inspector. Fee $...5,~)0 ............ Building Inspector FORi~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT! TOWN CLERK'S OFFICE souT,o,D, N. ¥. Examined ........................ Approved..!,./-. ......... /. ...................... 19 ........ Permit No ................................ Disapproved a/c ..~_ ................ (Building Inspector)( Application No....~..~...~..~. ......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in i¼k and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship toad oining premises or public streets or areas, and giving a detailed description of layout of property must be dra~n on the diggram which is part of this location. c. The work covered by this application may not be commenced befor issuance df Building Permit. d. Upon approval of this application, the Building Inspector will issue a Buildipg Permit to the applicant. Such permit shall be kept on the premises available for inspection th~oughouf~he progres~f the work. e. No building shall be occupied or used in whole or in part for any pu(pose whatever until a Certificate of Occupancy shait have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for thel~ssuance of a Bu'lding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y~rk, and ot~er app cable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and r~gulations. ~ignatur~ of applicant~r ~if a corporation) ' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gene~a contractor, electrican, plumber or builder. .......... ...................................................................................... ................. ...................................................... Name of owner of ........... .................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ................................. Block .................................. Street and Number ............... ..~....,...~. : .................................... ~ .............. 2. State existing use and occupancy of premieses and ntended b. Intended use and 3. Nature of work (check which applicable): New Building ...... ~ ......... Addition .................... Alteration .................... Repair .................... Rem~ .................... Demolition .................... Other Work (Describe) .................... .............. ................... Fee ..¢... ................................................... 4. Estimated Cost (to be paid on filing this application) FEES: 5. If dwelling, number of dwellina_ units ............................ Number of dwelling units o'n each floor ............................ If garage, number of cars....C~l~.)......~..~.~l ........................................................................................................... 6. If business, commerical 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 .~j:~i~.. .............. Rear ....~ ......... Depth .............................. Height .............................. Number of Stories ................................ 8.. Dimensions of entire ne~w~construction: Front....¢~,..~....~. ...... Rear ...... ¢~...~.....~.....'~..... Depth ..~¢,.~....~.. .......... Height ..~.~...."~'.~ ~1 ~u~mber of Stories 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Zone or use district in which premises are situated ........... ~ ................................................................................ 1 1. Does proposed construction violate any zoMn0 Iow, ordinance or regulation? ...... ..~..~.. ....................................... 12. Name of Owner of premises.~.,....~..,..~..l~.~.~i~..~..~... Address ..~./..~tLC..I...,~..~./"~.....Phone NO. Name of Architect../-~'.......,~..~.~..~, ........................ Address ............................................ Phone NO ..................... Name of Contractor../--.-~,$.....~t~...~..¥..~-.. ....................... 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF t~i~l(, ) COUNTY OF ..1~./~.~?...}~....~...~.......) ....... ~.~..~...M...~.......I..~..:....J~..d..~..l~..~...~.~ ................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ....... ..O....~...N...E:..~ ................................................................................................................................. (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 in this application are true to the best of his knowledge and belief; and that the work will be performed in. the manner set forth in the application filed therewith. Sworn to before me this ...... ~'.0..¢..~. ....... day of ...~..~d...~..~'.. .......................... 19..~...0. ..... Notary Public,.. . : ~ .: ...... NOTARY PUBLIC: My Commission EXlfires March $],, · g pp a~nt) ~1 ¥~t~.oo,1