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Home My WebLink About5464-zFOItM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT * · Town Clerk's Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at . .~.~..~.0..B..z'.~.., .A.?e.~.u..e ....... Street Map No...8.6.~. ....... Block No ........... Lot No .... .7? ............................ conforms substantially to the Application for Building Permit heretofore filed in tJ~ office dated ...A.u.g..u.s.~..~..6 ......... , 19..7.].. pursuant to which Building Permit No...~...Z... dated August 2.8 1971 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 Aee®~8o~/ Bttt~l:L~g The certificate is issued to (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No ............................................. 2130 B~y Aveauet Laurelt N.Y. HOUSE NUMBER .............. Street .......................................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 5~16'~ Z D~te ........................ ./...~... .~ Permission is hereby granted to: ~/~ ~ _ ~ . ~ ~ ~ . ............. ,e..-'..:e.c...~. ....... ~...ZZ2..~..~.~.~ ...... · 4',,?~ ~, .............. ....................... ........ .................... pursuctnt to application doted .......................................... Z.~.....~,&~ ]gZ../.., and approved by the Building Inspector. ,Fee~ $..,..,~.... ............. Building Inspector FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. 19'11 APPLICATION FOR ~UILDING PERMIT Date ............. .............. , ............ INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building aa Inspector. b. Plot plan showing location, of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty 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 approvdl of this application, the Building Inspector will issue a Building 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 until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit 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 removal or demolition, as herein described., The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, li.Z. (Address of applicant) engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... If applicant is a corporate, signature of duly authorized ;r. (Name and title of corporate officer) Location of land on which proposed Map No.: ..8~..~ .................................. Lot No.....~... ................ Street and N~ ~ ~'s~'s . ~! ~> Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....~.....0~....~.~. .................. . ...... b. Intended use and occupancy ~.e...~...e~.....G~....~ ~..~.. ..... 3. Nature of work (check which applicable): New Building ..3[. ............... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ ~ 4. Estimated Cost ..~...~..0~.. .............................................. Fee .~..~..~... (to be paid on filing this application) §. If dwelling, number of dwelling units ....~ ................ Number of dwelling units on each flo~' ...~ ................ If garage, number of cars .i..~....~...,~... ........ i i,~ 6. If bus~ness, commercial or m~xed occupancy, specify nature and e~(tent of each type of u~ ;...~ ................ 7. Dimensions of existing structures, if any: Front ~J~...~.,...~,.~l,,.... Rear ~..8...[1~.t...2......~:..? ......... Depth .2..2.....[~...,....2.....::~o Height ~....]~..,....2...:;~.~ Number of Stories i .. Dimensions of same structure with alterations or additions: Front ......... ~ ................... Rear ........ ~ ............ Depth ....~[1~. ..................... Height ......~ ......... ~....Number of Stories ...~ .................... 8. Dimensions of entire new construction: 'Front ....?...~.e ....................... Rear .....~.....~..-. .............. Depth ....~.....~f...*. ........... Height ..6.....~..?..~.....~t~umber of Stories Neae ...... 9. Size of lot: Front ....~1..;~'~ ............ Rear ...... ,~..O.....~e_e .................. Depth ..... ..~..0.....~..... ............. 10. Date of Purchase ...~..2...8a...]~. ......................... Name Of Former Owner ...~T .~.......~.......~...~....~....~.. 11. Zone or use district i~.Wl~i~h premises are situated ........... ~l~Jll~ ................ 12. Does proposed construction violate any zoning law, ordinance or regulation.;) ...... ..]~... ........................ 13. ~lame o, uwner o, prem,ses .~m~....,...~...-.., .............. /~ldress .~~/.~j~.~... Phone No ..................... 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 corner lot. hat 7 STATE OF NEW' ~ORK~/_ ,,~ t S S ~ CO~ OF ..~~,,Y ' ' .~ ~ .../Z~....~..:....~ ...... ~...:....J~ing dUly ~rn, d~es and says t~t he s the app cant (Name of~ividual signing a~lication) above named. He Js~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 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. Swam to before me this ~ ...... o .. , ......... ii., · ................ · ................................... Notary Publ'c, (Signature of applicant) FLORA S. LUCE NOTARY PUBLIC in the State of New York Su~f~olk Cou. n~/Clerk's No.52-7614300 j ,~ l~ '~