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Home My WebLink About5507-zFOl~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~.~1~ ...... Date ........... Feb...~.~ ......... , 19..~.. THIS CERTIFIES that the building located at IIol'th' 8~1~ 'DI' ............. Street Map No.0R.$.~ .bY. $~ock No ........... Lot No.. ~1 .... ~.~.n~ ..... B,¥, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~l~p~ ...... ~1~..., 19 .~. pursuant to which Building Permit No .... ~0.~ dated .......... 8Op~' · .$1~..., 19.7~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .i~T~at,~. o~e. f~.l~..d~,ll~.'lg ...................................... The certificate is issued to . &l~tho~r. D~GI~.~,I~ ...... 0wn~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approv~ . .li,l~, ............................. ........ .... ....... Building Inspector ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PEPJVdT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5507 Z Permission is hereby granted to: Building Inspector to at premises located at ...... JtlJt~"~J~j ..... ~"J~"JJ~llJ .................................................................. ............................................ tle,,~..~a..e~ ............. e~ent ....... ~i~%~ ......................................... pursuar~ to application dated ..................................... J~itJ~..-..~JJ~..-,. 19....~$ and approved by the Building Inspector. ........................................ , 19 ........ Pemit No ................ TOWN OF SOUTHOLD BUILDING ' DEPAI~TMENT TOWN G~RK'S OFFIGE SOUTHOLD, N. ...... ........... Disapproved a/c ....................................................................... ................................./~"~ui '~"~~i ~'"':*'*; ...... : ............................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and subm~ed-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 ofpraPerty 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 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 wherever until a Certificate of Occupancy shall have been g. ranted 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 opplicqble laws, ordinances, building cede, ho~ulations. ~ . (Sign~reizn of ,alSplicant, or name, if a corporation) ....................... .................... (Ad~r.e,s.s o.f a~plicant) pp' ' rp , 'g y .................. ....... Locot on of and on wh~,~,~. ,,~,,~..~.lch pr o d k will done/V~~ ,,,,,~ot~P o · t No 2 ! ~ ~ ~/ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ~.~ .................... 3. Nature of work (check which applicable): New Building .................. Addition..................J'~ Alteration ...... L ....... ~... Repair., ............ ~emoval .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~...~...~..~...~....O.~..~.~.. .......................... 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 ............................ 7. Dimensions of existing structures, if any: Front ....... .?../..~.~..~ ..... Rear .....~../..~...~/....'..~ ......... Depth ...'~....~...~...~....~:. Height ...... ~...?...v. ......... Number of Stories J ' Dimensions of same structure with alterations or additions: Front ........... ~/....?~....~.~ ........ Rear ......~..../....~.~....*~ ..... Depth ......~..,~....~..?.i..~.~ ...... Height ....... ../...?...~ ........... Number of Stories ..........~ .................... 8. Dimensions of entire new construction: Front ........ ~,,~...~.~..~.~ ........... Rear ...... L.~.....~...~....~.:.... Depth .....~.....~.. ......... Height ....~..~...: ....... Number of Stories ............./. .............................. 9. Size of lot: Front ..... ~..?....~...'...~....~... Rear ........ ~l..~.....~'....f..~..~.. ..... Depth ..../.....~'T...~..:~..~..~: ...... 10. Date of Purchase ........................................................ Name of Former Owner ...'~....~...~.~.~. .................... 1 1. Zone or use district in which premises are situated ...... ~.e. ............................................................................... 12. Does proposed construction viola~n.~~ordinance or r.~...~lation? ...~ ................................ 13. Name of Owner of premises~...: .................................... Address ...... ~...~..,.~.~.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 comer lot. \ STATE OF NEW' YORK. ' ~ S S ,~couN'rY OF ~.~..~..~..,~'~-'...~,.. ~' · ........... :,,...~...:,fi......~,....d..,.~.~..~..~..,.....:}:}"'"~ #J/ fiJ'r ~;~'~' A/ ................. .......... ~in~ duiv ~om, d~ and ~ t~{ h~ i~ th~ opplicant (Name of individual signing a~lication) above named. He is the .......... ~.~.~..~ ...................................................................................................... (~t~tor, agar, co,rate officer, ~c.) of said owner or owners, and is duly authorized to pe~orm or h~e perfo~ed the said work and to ~ke and file this application; that all statements confined in this opplic~i~ om t~ fo the best of his knowledge and belief; and tha~ the ~rk will be performed in the manner ~t fo~h in the ~plicati~ fll~ therein. Swam to ~fore me this .... o, ..... ................... , . . ~_ ~ ~_ _ , ........ ~......~..~.~ ........ ~.....~.~~ ...... N~a~ ,ublic,///~.;.~~ ........... Coun~ ~/ (Signature of applicant) ............... ' ~ O. KLOS ~A~ pUBLIC, STATE 0F NEW YORK ~52-73~6925 SUFFOLK C0UN~