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Home My WebLink About5117-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. ¥. Certificate Of Occupancy No. I~-4355 .... Date .. August 27, ..... , THIS CERTIFIES that the building located at B~r~. ~ ~d ......... Street (~t. Road ~ 2) Map No.~ ..... Block No. ~ .Lot No. ~ien~w ~ .~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .-3~ua~... ~X,.., 19 TX. pursuant to which Building Pemit No. dated . .~nuarF ... ~3,.. , 19.7L, was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... .p~lva~e. ~. ~il~..~ellt~ ............................... The certificate is issued to Jop~an. ~ ...... (owner, lessee or t~hnt) of the afores~d b~lding. Suffolk Co~iy Department of Health Approval .. ~ ........................... ...... ....... Building I~spee~or 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? 5117 Z Permission is her. eby granted to: at premises located at ...... ~l~Ll~i~td;~.J~tlt~L..~..~...ll~..~ ............................................. .................................................... tta,-$~%... · .l!'.,'g, ............................................................................... p_ursucu~t to application dated ................................. ~llit~--..-~ ......... , l~?...~.~J., and approved by the Bu, ilding Inspector. Fee $. ,..~.~ .......... Building InspectI TO~N OF sOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. Disapproved a/c ..~..~..~ ......... (Building Inspj~tor) ^pp,cot,on .o. ............. APPLICATION FOR BUILDIHG PERMrT Date ......... INSTRUCTIONS a. This application must be completely filled In by typewriter or in ink c~nd submitted in duplicate to the Buildin Inspector. b. Plot plan showing location of lot and of bu_ildings on premises, relationship to adjoining premises or public streets, areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appllcatio, 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 perm 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 port for any purpose whatever until a Certificate of Occupan, shell have been granted by the Building Inspector. APPLICATION IS HEREBY/v~DE to the Building Department for the issuance of a Ballding Permit pumuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other applicable Laws~ Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, ........ .................... ......... i'~;~;;~';;~,f app,cant, or nam,, if o ~or~ratlon) .... ................................. ,4 ............... ...... ,/,, ...... (Addresl of ~ppIIcant) State whether applicant Is owner, lessee, agent, architect, engineer, general contractor~ electrician, plumber or build: If applicant ls a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) Location of land on which proposed work will be done, ~ap No.: ........................................ Lot No.: .................... State existing use and occupancy of premises and Intended use and occupancy of proposed construction: a. Existing use and occupancy .............. ~ ............................................................ 3. Nature of wo~k (check whict~ applicable)' New Budding .................. Addihon ~ Alterahon Repair .................. Remov~l .................. Demolition .................. Other Work (Describe) .............................. 4 Estl.mat~d Cost ............... ..Y...b...~ ................................... Fee ................................................................................. (to be paid on fKing th~s applicat,on) ! 5 if dwelling, number of dwelhng 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 ............................................................................................................... Dimens,ons of same structure with alterations or additions: Front ................. ?...~.2.....~ ........ Rear .....J..:.?....~. ........... Depth ......~.~, .................. Height ..... ..~:....~.. ............... Number of Stories ..~ ..................... 8. Dimensions of enhre new construction: Front .................................... Rear ............................ Depth ..~..~. .......... Height ......~..c'....r. ...... Number of Stories ...... ~ ......................................................................... 9. Size of lot: Front ......./..: .f~...J .......... Rear ............. ./.....d~J..F, ........... Depth ....... /.~..~. ~. ............ 10. Date of Purchase ........................................................ Name of Former Owner ..................................................... 11. Zone or use d~strict in which premises are situated ............. ~.. ................................................................................ 12 Does proposed construct,on ~iolate~] ' L,. -any z~nmg law, ordinance or regulahon?~_ ~ ..................................................... 13 Name of Owner of premises .... ..~...'~ ......... Address .............. (J~,~¢~.~.~.;~... ........ Phone No .................. Name of Architect ................................................ Address ................ ,...;~/. .... ;;, ...... Phone No ................... Name of Contractor ...Z.~....?.....~. ...... ..~..~..~.. .......... Address .~:..~t~..7Phone No.~..2-..~.X?.~..'.( PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock d~mensmns flor property lines. Give street and block number or descriphon according to deed, and show street names and ind~ca~ whether interior or corner Jot. .?3 STATE OF NE-~/IYO~IQ,~ ...............--~-~-----~'~.~'""~ ~-~-.71~l'~;~;~t;'~'~;~"~'applic~';~~ ............... beino duiv sworn, d~oses ond s~ys that he ,s the opphc~n above n~med. He ~s the ........................... ~~.~ ........................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to m~ke and fd th~s application; that all statements contained in th~s applicahon are t~e to the best of his knowledge and belief, an. that the work will be performed m the manner set fo~h in the apphcation filed therewith. Swam to before me this Notar/~Public, ...... NOTA~. ~R~O Suffolk Co~t~