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Home My WebLink About5511-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at Me~y ~X'ee]g .Av~ ........ Street Map No.. ~ .... Block No..~i; . Lot No.];ll~. CI~]~O~...l~,]g~ ...... conforms substantially to the Application for Building Permit heretofore filed in this off~ce dated ...... ~Ol~.~. ~.., 19 ~.. pursuant to which Building Permit No. ~ dated ..... J~o])~; ~7 .. , 19~ , 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 ... rri,~a~e ¢axe. f~ilI¢' .tlwelting. The certificate is issued to .Mi~:e. ~eta~h' · · of the aforesaid building. O~a~¢l' ............... (owner, lessee or tenant) Suffolk County Department of Health Approval 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? 5511 Z Building Inspector. Fee $ ........................ Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Fi. Y. Examined ............... ../...Z....~ 19.....'-~./ Approved ...................... ./...7........~..., 19..Zl Pemit No ...,...~.....~..../..~..~ ..... Disapproved a/c .......... .....~......~.. ...................................... .............................................................. ......... .............. ..... ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT .................... INSTRUCTIONS a. This apphcation must be completely filled in by typewriter or in ink and submitted in duphcate to the Buildin~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and gw~ng a detmled descnphon of layout of property must be drawn on the d~agram which ~s part of th~s application c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this apphcahon, the Building Inspector will issue a Bu~lding Permit to the applicant. Such perm~ shall be kept on the premises avmlable 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 c~'Certificate of Occupanc 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 th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply w~th all applicable laws, ordinances, building code, housing.r, ode, and regulations. ........ i~'i~'~'<~'~'i~' ] ~' 'c;l~i ','~ ~'r'[~']"o~ '~J~'~"i~' '~"~';l~';~fi~ ~i ...... (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bullde ................................................ ............................................... J,ll~l~ =~ ............................................................ Name of owner of premises ................... ...~'r .......... ;....'~...~....~)......~......~......~.....'~...~.. ............................................................... 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 ................................. Lot No ...................... Street and Number ~..~--~..-~' ~'~'-~'"/- ~J~'.E...E-_...~. ,~rcv'~-- ~-~//~7~'/-/~ ~ u/z- ....................................................................... ........... .................................... 2 State existing use and occupancy of premises and in.~ended use and occupancy of proposed construction: a Exisiting use and occupancy ................... ,~....'~....~'.. ........ .~....~..../~../...~...~.. .......... ,~....../~.....~'..Z;....~../....~/....~. .................... b. Intended use and occupancy ~-~J/~/~- /,~! ~ /J ])Z)/ "7"'/ O AJ 3. Nature of work (check which applicable): New Budding .................. Addition ' Alteration Repair .................. Removal .................Demolman .................. Other W..grk (Describe) ...................................... 4. Est,mated Cost ..................... ./...._O....~....~....-~... ............... Fee .............. ...~.....~. ............................................................ (to be pa,d on fihng this apphcat~on) 5. If dwelling, number of dwelhng units ...... ..~..~'~.'~.. ..... Number of dwelhng un,ts 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 ........................ Number of Stones .............................................................................................................. Dimensions of same structure with alterations or add~ttons: Front ....................................Rear ........................... Depth ................................ Height ........................... Number of Stones ................................ 8. Dimensions of entire new construct,on. Front ................... ./....~.. ....... Rear ........... ~...~... ....... Depth ...... ./....~.. Height .................... Number of Stories 9. Size of lot: Front ............................ Rear .................................. Depth ................................ 10. Dale of Purchase ...................................................... Name of Former Owner ...................................................... 11. Zone or use d,str,ct in wh,ch prem,ses are situated ............................ ~...~../..?. ................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation? 13 Name of Owner of premises ....~.........."~....~...L~...~....~..~'...~....Address ........ ..~.....~..?...~...~..~..~....~...~.~... Phone No ................. Nome of Architect ....................... ~ ............. ~ ............... Address ............................................ Phone No ................... Name of Contractor .~....~.~'..C.~..C .................... Address .... ..~....~../.~...~...~..~..~ .~../-.'.~. .... Phone N~o?.....~..:....~..~..''. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and ~ndlcate all set-b~ck d~mens~ons fro, property hnes. Give street and block number or description according to deed, and show street names and ind~cat whether interior or comer lot. STATE OF NEW' YORK ..... ~. COUNTY OF ......................... .~..~...~¢7... .......... .'.....4~....~..~..~...~..~. .................. being duly sworn, deposes and says that he ,s the opphco (Name of individual s~gnmg apphcat~on) above named. He is the ....................... .~'.~..4/.~./.../.~.~.....~_....,..-~-...~...~. ..................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and f~ this application; that all statements contained that the work will be performed ~n the manner set forth Swam to before me this / /. o, ........................ - ....................... " ...... ................................ .7...Z....' NOTARY PUBLIC, State of New York No. 52-8125~;50, Suffolk Ceun_t~ Term Expires March 30