The URL can be used to link to this page

Home My WebLink About5487-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .. ~/$. gok®r~.y · Pol~I. ~ .Ex~reet Map No..x~ ......... Block No...XX ...... Lot No.. ggg ..... Sov.thold...I~o~.o ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .~.l~g .... ~0., 19 .?~.. pursuant to which Building Permit No...~.l~... dated .......... ~®lvt-- .3 .... , 19.?1., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ~u~ne$ S..building .... (. ~.o,mercial. g~.eer~use) ................... The certificate is issued to ~.t;eY.e..,l,. D. orosk~, ..... o~l~el' .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N,R., ............................. House * 31+0~ ekerly Pond I~. /Z' / /'--~ Building Inspector FOlt,M NO. ~ TOWN OF SOUTHOLD 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) N? 5 87 Z Permission is hereby granted to: to ......~..111~..~IIIII~JB:[~. · ~Z'~iJI~I ......................................................................... at premises located at ..... ~i4~llt~..~t~llli~..~...0~..Ji~&l~lZ.~..~..J~Ll.~..~l~ .............. ............................................... ~ ......... l~,ge .................................................................. ~ ........ pursuant to opplication dated ............................ ~i~l~.....~J. ....... , 19,....~!:J end approved by the Building Inspector. Fee $'"tlllJ.(~ ......... · V Building Inspector/ TOWN OF SOUTHOLD ;~ ~ ,~'~"/"~ ~ ~) BUILDING DEPARTMENT/,~;a-~:Z- ~;r./,~ w~-.-- ~ TOWN CLERK'S OFFICE ~"/~. ~, ~ S~THOLD, N.V. -- p,:.tio. .............. Approved ........................................ , I9 ........ Pemit No .................................... Disepproved a/c ~ ............... ~__~...----~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan shOWing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this ap.pli.ca.t!on; the Building. I.nspec.tor wi!l issue a Buil.di.ng Per,mit to the applicant. Such permit shall be kept on the premises, a~ailaDle 1'or inspection\tl~rougnout the progress at the worK. e. No building shall be occupied or used in whole oli~ part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATIONgtS HEREBY MADE to the Building ~tment fOr the issuance of a Building Permit pursuant to the Building Zone Or$inance of the Town of Southold, Suffolk County, New York, and other applic.c~, le Laws, Ordinances or Regulations, fOr the construction of buildings,~itions or alterations, or for removal or demolition, as herein described. The applicant:agrees t? comply with all applicable laws, ordinance~,~buJlding code, housing cade,.end regulations. '~'~'~;t'~'~';'~"applicont, or name, if . corporation) (Address of apPlicant) State whether applicant is OWner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ' J, D .IcL ' . ......................................... Nome of owner of premises ................................................................................... . If applicant isja corporate, signature of duly authorized officer. ~,i (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .... .~/~..Aia~-~-3r..?.a~..Zua~..~act,~?...ll~l~e~e..i~...~e, he.~ci,, --,~; ................................. nnunicipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....................~.8...e...l~.....a.,.l~d:.....J~.....l~...e...~....C..,e..ll~?..l'. ........... ,, .................................. b. Intended use and occupancy ..................... ~~e.... ......... :.. .................................................................... 3. Nature of work (check which applicable): New Building .... ~ .......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other 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 use ..G.?...e..G.~..o..qD.~.... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height Number of Stories Dimensions of same structure with alterations or additions: Front .................................... Reor ............................ Depth ................................ Height ............................ Number of Stories ................................ ! 8. Dimensions of entire new construction: Front ............ ~,5. ................... Rear ....... ..2.~.! .............. Depth ...~..C)..~. ............... Height .~,!...~d~ Number of Stories ........ ~. ...................... 9. Size of lot: Front ............................ Rear .................................... Depth ................ ~.....A..o...~..e..8 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated Business 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... LQ ................... · .'; .................... ............. ;. 13. Name of Owner of premises ~teve J. orosk~.Addres~ ....S....O.?..~..~..O...~.~.~....~..;..¥.; ........ Phone No. ?...6.~,T.~...(~...0.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....... ~..O..~. ~.. ~ .]:..e...~..~. ..................... Address...........Urd-°~dale ,... ...... ...~ ...... ' ~°.. ...... 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 comer lot. N ~ ff~l.~ L~/35~"1~z~Tl~l~l STATE OF COUN~ OF ...~.~:~ ............ ~'~ ST~VE J. ~OROS~ ................................................................... ~ ................ ~,. ........... beinG duly sworn, d~oses and says that ~e is the applioom (Name of indJviduaJ signing application) above named. He is the ......................................................................................................................................................... (Contractor, e~ent, corporate officer, etc.) ~ said owner ~, and is duly authorized to perform or have performed t~e said wor~ and to ~e ond fi~e this application; that ell statements, cont~i~d in t~is application ere true to t~e best of his ~nowledge and belief; and tha~ the wor~ will be performed in the manner set fo~h in the cpplicc~ filed therewith. Sworn to before me this ~ ~ _ ......... ..... oto. ........ : ........ ............ ...... ..... ( ....... ............................. ~ ~~ otary ~u~c m the S~at~ .,/ New York Term ~xpires M~h 30. /~ .