The URL can be used to link to this page

Home My WebLink About5671-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificale Of Occupancy No. ~-'~'0 0 ~ Date f~6~ / 6~ ~ .............. ~i;~ ~' ~'~);;'~' '~;~ .(~.~9 .... ............................ Street THIS CERTIFIES ~at the building located at CUT e ~ 0 ~0 ~ f~ Map No..~ ~ ~ 9~ Block No ........... Lot No .................................. conforms subAtantially to the Application for Building Permit heretofore filed in th!s office dated ::i~:::::o~:::: lg.:??.pursuant to which Building Permit 1~'o. dated 7 , 19 , was issued, and conforms to all of the require ments of the applicable provisions of the law. The occup~cy fo~.w.hich this certificate is (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ h' "r~ ....................... .ou E Building Inspector FOF~ NO. 2 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? 5671 Z Permission is hereby granted to: .......... ~'"~'t~;~' ....... " .... ................... 4~.... S~g..~l~. ........ ................. ........................ ~1~..e~.~ ................. ................. to ..~l~e~te..~.t~..~:~,r,~.. ~. at prer~ises located at ........... ~1]~'~ ....... t0~*'~{~9~": ...... ................................................ pursuam to opplication d~tod ................................. 1~t~tt~ ....... ~,...,...., 19...*~., ond oppro¢~l by lhe Building Inspector. Fee $.,..~*0~ ........... TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. '~' Disapproved a/c APPLICATION FOR BUILDING PERMIT ~ ............... ................ , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the BuildingI Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premieee or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram whlch Is part of ~hle appllcatlon~ 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 pragress of the work. e. No building shall be occupi..ed.or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bulldtng Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk-County, New York, and other applicable I.awl, Ordlnance~ or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein deecrlbed. The applicant agrees to comply with all applicable laws, ordinanc~te~buildJng c,~le, h~sing code, and rngulatlonl. .... ~ ;.~.,.....:. ................................................................ (Signature cf Ppplicant, or name, I:f a~,~arparatlon) .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. ..................................................................................................................................................... Nome of owner of premises ........ ~.~.......~...~.....~....~..../-T..~.. ........ . .(~....~.....~.....~...~. ........................................................... If applicant Is a co~omte, signature of duly authorized officer. ~ / ~ -- ~ - Stre~ and Number ................. ~.~.~.~.~ ........ ~,,~.~ ........... ~.~.~.~.~.~.~ ~ ~ ~ Munlcl~ll~ 2, State existing u~ and ~cu~ncy of promises and intended use and ~¢upancy of .. ~.,ng., ond ~u...~y .................. ~.~..~...~/ ......... b. Intend~ use and ~cupan:-, . ................................... , .......................................................................................... 3. Nature of work (check which applicable): New Building ~ ................. Addition ~ ..............Alteration .................. Repair ...~(. ........... Removal .................. Demolition .................. Other Work (Describe) ........................................ 2..O. ooo .. 4. Estimated Cost .......................................................... F ............................................................................................ (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 occupancyi speci~ nature and extent of each type of use ............................ i Fr n '~ ~ .......... ~..~... ............... Depth .......~...7.. ....... 7. Dimensions of existing structures, f any: o t ............................ Rear Height ...... ~'~. ........... Number of Stories .......... /.. .................................................................................................. : Dimensions of same structure with alterations or additions: Front .......... ..~......~.. ................. Rear ..... ..~......~... ............. Depth ................. 5~:~Z... .......... Height .......... ~' ............ Number of Stories ........ ./. ..................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........... {..~......~.. ....... Rear .............. ~...'~......-~.. ........... Depth .....~...~...O.. ................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed Construction violate any zoning law, ordinance or regulation? ....... .~....O.. .............................................. LSEN · . No. ]3. Name of Owner of premises{~J~:~.....0.. ....................... Addres .. , ..................... Name of Architect ..............~..~.~.~..(A~i~.~.L ........... Address ..~I..U...I~,...E~....~..~..~..,,~.. .......... -- Phone No.7~,~..'...~-../../5. Name of Contractor ........... ..~...~...~......C~..: ........................ Address ............. !! ............................. Phone No.7..~. ~...-...~...~.1..~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or prepaeed, and indicate all set-back d mens ons from property lineS. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. TATE OF NEW YORK,: / COUNTY OF ...... ....... '. / / ........................ · ..~...~.-(~. ....... ~.~.,~..~.(~.A~:~.6 ............. being duly s~rn, d~s and says t~t he is the applicant (Name of individual signing a~licati~) a~ve named. He is the ..... ~~ ........................................................................... ': ........................................................ (~ntmctor, ~t, co~mte officer, ~c.) of said ~r or owners, and ~ duly aut~rized to PeriOd' or have ~o~ t~ ~id work a~ to ~ke ~d file this ~llcation; that all ~atements contain~ in this ~licati~ am tree to ~e ~ of his kn~l~e a~ ~lief; and ~hat ~e ~rk will ~ ~rfo~ in'the manner ~t fo~h in the applicati~ fll~ ~t~. ~m~m~is ~ . / ~ . . ....... _ ................. Nota~ ~blic, ~~.~C~n~~ (Si~of~ca~ H ANN H~ILL Tl~m Expires March ~, ~ · . ,/ 7 ,¸5