The URL can be used to link to this page

Home My WebLink About5479-z FORM NO. 4 TOWN OF SOUT~ItOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. / Certificate Of Occupancy No..ZS.Q~6 ..... Date .......... Atll~. ·. ~... 19..~.1 THIS CERTIFIES that the building located a,t ~[/8. P.~tt..lto~[ ..... /:... Street Map No.. ~ ....... Block No... ~ .... Lot No~ . .X3~...0~.ant.. I~,,Y/. ........... conforms substantially to the Application for Buil!ing Permit heretofore filed in this office dated ........... Ala~ .... 26, 19. ?.l. pursuani t~ which Building Per~it No...~)~ dated ........... A~lg.. 26 .... , 197.1.., was isSUed, and conforms to ~11 of the require- ments of the applicable provisions of the law. The occupancy for w~ieh this certifica~ is issued is . ~.vate. a~cesso=),, building. ~ .v~.th .add~t$on~ ' The certificate is issued to .. S.tephell .Ci®3.ulln~,ak .... .~,mel' .....~ ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. N,i~o ............................. UNDERWRITERS CERTIFICATE No.. ~1~, ....................... .................... HOUSE NUMBER. 580 ........ Street .... 'P'~at~' 'l~oad ................................. Building Inspector FO~.~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTH~ORlZED) N? 5179 Z Permission is hereby granted to: at premises located at .........~t~....~..~IIII1~ .............................................................................. .................................................... O~t~mt .......... 1I.,.~ .......................................................................... pursuant to application dated ............................ ~ ....... ~ ........... , 19...~.~, and approved by the Building Inspector. ,'=ee $.~,~e ............. BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Approved ........................................ , 19 ........ Pemit No ..................................... Disapproved a/c ............................................................................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ..4 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, 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. :h d. Upon approval 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) (Address of opplic6nt) ;~. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~, If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on wh~ich prapvl;;~tse~ w,,~r~will~,l~e, doney)Map No.: ................ ~. .................. Lot No....~......~.. Municipality 2. State existing use and occupancy of premiss and intended use and occupancy of proposed construction: a. Fxisiting use and occupancy ........................ I ........... ~'-'":-'~, ..............? ........................................ 3. Nature of work (check which applicable): New 'Building .................. Addition ..... ~. .........Alteration Repair .................. Removal ...: .............. Demolition ....... 11' ....... Other Work (Describe) ................................ 4. Eshmated 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 t~pe 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 ................................ 8. Dimensions of entire new construction: Front ...... ~./. ................ Rear ....... ...~.....~..~.~ ........ Depth ~'~ Height .................... Number of Stories ........ ~. ................... 9. Size of lot: Front ..... ./...~....0. .............. Rear ~"~ '"--- :' 'r----Depth'"",~ 10. Dete of Purchase ........................................................J'4ome, of~ Former Owner .................................. 1 1. Zone or use district in which oremises ore situated~/Ir~'~' ~ . ' .................. 12. Does proposed construction vi~late any zoning Iow, .ordinance. or.regulation.~.....,........~.,....C?.....,,........................,.....-.--..,.. -- ,--_,_.,__....................,~.~.......,.....................,..... 13. Name of Owner of premises ....~......~..~.~~'~Address ~ Phone No .... Name of Architect ............... ~ .................................. Address ............................................ Phone No ..................... Contractor ~ -4, Name of .................................................... ~ooress ............................................ 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 show street names and indicate whether hqterior or comer lot. STATE OF NE'~/~Y(~I~K,~ j~ t S.S COUNTY OF .~,.._.....$ ............................. ~~....,~~..being duly sworn, d~s ~nd soys t~t he is t~ opplicont (Nome of individuol signing ~licotion) above naimed. He is the ........... : ...... ~.~ ....... ~~ .................................. .............................. (Contractor, ag~t, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed the said work Ond to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~rk will be performed in the manner set fo~h in the applicat~ filed thereWith. Swam to ~fore me this ............... ? ........... ............ ................. No. 52-8125850. Surf0 k Countu Term Expires March 30.