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Home My WebLink About5604-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~[~. ..... Date .............. ,~i~ .... 11.., 19.~. THIS CERTIFIES that the building located at . 0:1~ .0~1~. b ........ Street Map No..l~ .l~a7 ~ck No ........... Lot No... 1~ .... kit MIII'~I~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. lift...$.., 19. '71 pursuant to which Building Permit No. ~11~. · dated .......... l[f...¶ ...... , 19.~1., 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 . .l~$T&t~. ~l~e. 1~1~ .4~1~1,1~1~ ...................................... The certificate is issued to ...l~h~.l®l. & .~ ~WO~I~olI~ ...... 0~1~.1 .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ . 1~,I~ .............................. UNDERWRITERS CERTIFICATE No...~i~l~e .......................................... HOUSE NUMBER.'I~.~O ....... Street. 01~,. Ol*olMl:l~ ./,,~ll~ ............................ . Building Inspector / 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) Permission is hereby granted to: ..:....l~m~;le~..&.Au~a..~ ................... ..................... ~.. ~**~L~ ................................... to ....... ~..~...~.~.....m.....~..~.~ ....................................................... pursuant to application dated .............................. ~ ...........~ ........... , 19..~[~.., and approved by the Building Inspector. Fee $ ...... : ........... FOB~ NO. 1 TOWN OF SOUTHOLD //~f?,~....~,~.~~,.~ ~ BUILDING DEPARTMENT ~/ TOWN~uTHOLD,CLERK'SN.OFFICEY. ~~ ~ ~. ~. Examined ....... ~../ ............... , 19.~.~. Applic~ion ~ .................. ~ ........... ~pro*~d ........................................ , ~ ........ P~mit No. ~ O ~ ~ Disapproved a/c ....... ~ .......................... ~ .~ /~__--~ (Building Inspey APPLICATION FOR B~ILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink Qnd submi~ed in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on pram ses, re at onship to adjoining premises or public streets or areas, and giving a detailed description of layout °fproperty 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. ~^PPLICAT[ON IS HEREBY MADE to the Building D~_epartment' for the issuance of a Building Permit pursuant to the ~Build!ng Zon,e O~inance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ord nantes or t~egu,ations, tor tt~e construction of buildings, additions or alterations, or for removal or demol t on, as here n described. The applicant agrees to comply with all applicable laws, ordinances, building cede, housing code, and regulations. ....... ....... i.i .... . r (Signatur~Sf applicant, or nc~(, if a corpora~i;~) ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .O..~.er' . . . ' Nameof ofpremises owner ...... ..... .............................................................................................. . ................... If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed w~rk will be done. Map No.: ........ .~.0..~..~. ........ Lot No ./.7~...... Street and Number ..... .~...~..~.....~...~..~...~.£~.....~.~r~.~. .... iiiii~iii i.i.i ".. "ii. ' ........ ;. Municipality ................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .~.~..~...5'...~.. b. Intended use and occupancy .......................... ~ ......... ~. .............................................. 3. Nature of work (check which applicable): New Building .................. Addition .......... ~ It orion .................. Repair .................. Re_~noval .................. Demohhon .................. 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 occdpancy, specify nature and extent of e.ach type of use ............................ 7. Dimensions of existing structures, if any: Front ..... .'...~.. ............... Rear ....~.~..i .................... Depth .....~r.~. ......... Height ...... ~...~../. ........... Number of Stories ........ /.. ...................................................................................................... Dimensions of same structure with alterations or additions: Front ........ X..~.. ...................... Rear .... .?..'~.. .................. 15' Depth ....... ..~-..~.. .................. Height ............................ Number of Stories ................................ · 8. Dimensions of entire new construction: Front ..... ..~..~... ......................... Rear ....~ .................. Depth ..~...~ ................ Height ...]..~'.. ........... Number of Stories ........... ~. ......................................................................................................... 9. Size of lot: Front ....... ~..~..O. ............. Rear ....... ~.O~... ..................... Depth ..... ~,.~.;.o. ................. 10. Date of Purchase ...... [~...~.~. ......................................... No[~e ,of For.re. er Owner .~..'~..~...~..~.~..~.~.~.......~.~.~...~.~... 11. Zone or use district in which premises are situated ........ J~'~.~..~J..~.l~/.. ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....~.~) .................................................. 13. Name of Owner of premises ~,~.....~..?...~...~./.~..~. ........ Address ..~../..~./.....~..~.~..~.....~.~..~..o~. ..... Phone No.~/..~7..; Name of Architect ...................................................... Address ............................................ Phone No ..................... Name 0f 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 I~terior or comer lot. - -/404 ........ STATE OF N EW~¥OJ~/~'/ 1. S~ ......... .~....;.;...;.;.:T....~ .~ ......... .~2.. ~,~.... ~...~r.. ;. ~ ..................... being d~ly (Name of individual signi¢~lication) above nome~ He is the ............................. ~ ............................................................................................... (Contractor, agar, co~orate officer, etc.) of said ~ner or ~ners, and is duly authorized to perform or h~e performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and b61ief; and that the work will .~ performed in the ~nner set fo~h in the app~ati~ fil~ therewith. Swo~fom me ?is ~ ~. , ~/ . ............................. arch ~, t ~ / ':