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Home My WebLink About5599-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Zh~l~ ... Date .. .ttue ...29 , 19. THIS CERTIFIES that the building located at I~¢'~ Oom-t~t V~.ew /,-~o Street Map No. ~ . Block No.. ~ ... Lot No.~ 'l~¢ct%hold! conforms substantially to the Application for Building Permit heretofore filed in this office dated NOV, .~., 19 ~ pursuant to which Building Permit No. dated .......... I~'OV ' "$' , 19.~l , 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 ' P:~2~rate' 'one' faniily 'dwe~I~ng ............................ The certificate is issued to .A~E,~Je].a,uct & ~'ife' .owners ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. I~,R, ................ UNDERWRITERS CERTIFICATE No. . }t,R, .................... HOUSE NUMBER. 20~14~ . Street - ~o¥_nd Vicar Ave ....... Btuldmg Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5599 Z D~e ........................ ,~e~ ....... ~1..., ,~'....~ Permission is hereby granted to: at premises located at ........... ~..~..t~.~e~..&~ ............................................................................... ................................................................ ~a~fg~o-~...-flw~ .............................................................. pursuant to application doted ............................ .l~{~i~ ......... .~ ............ , 19...~:J., and approved by the Building Inspector. Fee $...~aJ~ ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT 'rOV~N CLERK'S OFFICE $OUTHOLD, N. Yo Approved ........................................ , 19 ........ Pemit No ................................... Application No .............. ~ ..... Disapproved a/c ~ . . APPLIGATION FOR BUILDING PERMIT INSTRUCTIONS 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 ofproperh/must be drawn on the diagram which is part of this application. c. The work covered by this c:pplication 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 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, os herein described. The applicant agrees to comply with all applicable laws, ordi nonces, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) · '"' '"" ' '"'"'"'"'"' '""" '"'"'"'"'""-- ~'1~ If applicant is a corporate, signature of duly authorized officer. ~L /~ ~ ~ .................. ......... V 1. L~ation of la~ on ~ich pr~osed work will be ~one. Map No.: ........................................ LoL No. ~ ....................... Street and N~er ...... :..: ........ ~.~..~....~ ............ ~~~. ...... ~..~.., .......... 2. State existing use and ~c~ancy of premise~nd intended use and ~cu~ncy of pr~ c~stmct~: ~ ~. ~i~ifing u~ ~ ~cupanc~ ........................................................................ b. Intended use and ~cu~ncy /( ' rt -- ~ 3. Nature of work (check which applicable): New Building .................. Addition ../~. ............ Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....~....1~.{3.0...~. .................................... 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 ........................ 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 .................. L ................................................................................................ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of~Corm, er Owner ........................................................ 1 !. Zone or use district in which premises are situated ...... J3, ........ ...................................................... 12. Does prOpOsed constr~ction Violate anyzoning law, ordinance or regulation? ......... ~..t~ .......................................... Phone No Name of Architect ...~.~ ............... r..~. ............. ;/ Address ............................................ Phone No ..................... · N~.~.~..~,~..~.......: 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 interior or comer lot. STATE OF NEW~,~ I ¢ ¢ ........... .~,Z.,~....~J.~~ ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ....................~T4-,,~:~~ ................................ ' ............................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained Jn this application are true to the best of his knowledge and belief; and thor the work-will be performed in the manner set forth in the application filed therewith. Swam to before me this -,~ ....~/~i.. , , ~~.'~'" ~' '"~'~' .......... .... NOTARY PUBUC. State of N~w York No. 52-8125850, Suffolk Cou,,n..,~ Term Expires March 30, I