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Home My WebLink About5118-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. ~%2~.0 ..... Date ............. .A. pr.i~. · .22...., 19..~.~. THIS CERTIFIES that the building located at W./~. raradSse. P.t .Rea5... Street Map No.. XX ........ Block No.~ ........ Lot No.. ~X .... Se~t. h01d.... ~.,.Y.: ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... JaXl ....¶3'" 19'?l' pursuant to which Building Permit No.. dated ............ J~l ' ' ' 13" 19.7t' 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 ..... Pr~.v.~te..o.r~e. f..a~$1y..d.v.e.~.h~ ................................... The certificate is issued to .. D/~na. $~ari~ ....... 0~ne~,. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ]~,Ro ............................. >__..__ House 17~ ...... ',nspec,or FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPAP, TMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT Cfi-tiS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5118 Z Permission is hereby granted to: at premises located at .................... ..~ ..~.......~.{~.1~..~..~.~..~...~.~.....~..~. ........... : ........................................... .. ............................................ ~~4 ...... ~.,~,. ........................................................................... pursuant to application dated ............................... .S.~ ....... .1.~. .......... , 19..~., and approved by the Building Inspector. ........ ........ B.~,din~"i;;spector [' Approved ........................................ , 19.~! ..... Permit ................... TOW OLDy/ TOWN CLERK'S OFFICE ~OU~IO~), No ¥o Application No.......~./..../....e~.. ............ Disapproved g/a .............................................................................................. ......................................................... . ............... :....~,.., ............... ~ . APPLICATION FOR BUILDING PIRMI? oat. ............................... ./...} ........... , ,,.7..L.... a. This application must be completely filled In by typewriter or In Ink and lubmltted In duplicate to the BulldlngL~ In~ector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining pmmleee areas, and giving a detailed description of layout of property must be drown an the diagram wh'lch Is pert of ~hle application. - c. The work covered bY this application may nat be commenced before iuuance of Building Permit. d. Upon approval of this application, the Building Inspector will luue a Building Permit to the applicant. ~uah permit '~ shall be kept on the premises available for Ir,4pectlon throughout the progre# af the work. e. No building shall be occupied or used In whole or In part for any purpose whatever until a Certlfleeto of Occupancy shall have been granted by the Building In~oector. APPLICATION 15 HEREBY MADE to the Building Deportment for the Ilsuance of o Bud ng Perm t IXmmont to the ~ Building Zone Ordinance of the Town of SoUthold, Suffolk County, New York, and other applleeb e Law~ Ord nasa# or ~ Regulations, for the construction of buildings, additions or alterations, or for removal ar demo t on, a~ hem n dm:rlbecl. The applicant agrees to comply with all applicable laws, ordinoncm, building code, hauling code, and regulations. ...... ........ '. ........................ (Signature of applicant, or name, If a eeq~omtlon) .,T.,o.. .......... · (^ddre,, of opiC;ill;iii ......................... State whether applicant Is owner, Isa,#, agent, architect, engineer, general controctor~ electrician, plumber er builder. ............ ............................................................................................... Name of owner of premises ................................. ..~-.~....~....~.. ........................................................................................... If applicant Is a corporate, signature of duly authorized officer. % I. Location of land on which proposed work will be done. Map No.: ........................................Lot No.: .....~. ~' Street and Number ..... ...~/'..~.. ....... ..~...~...~,,,,~;,.~..,.(..~,,~,,., .~.,..~,; ...... ,,~,,,~,~,n~,, ............ ..,'.'~..,(:}..~. ,~.,./5....0....~..~., ............ Munlcll~Jtty 2. State existing use and occupancy of premlse~ and Intended u~e and occupancy of propaeed conltmatlon: a. E.,.,.,.. and occ.pa.~y ...... ..P..~.~..~..: ....................................................................................................... b. Intended u# and occupancy ............. .~.....~....~... ~. ........ ...~....(....T~.. b ....... ,~Z....~........~...0....~...r....~.~./...o...../~.... ............. 3. Nature of work (check which applicable): New Building ~ ................. Addition ..... .~)~ ....... Alteration .....~, ........... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost . . ...................... ~. .................... rea .......................................................................................... (to be paid on fi~ing this application) 5. If dwelllng, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancyi 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 / .............. ; .......................................... Oe~,,n ........................ Height .................... Number of Stories ................ ~ ................................................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Forme,lr p~er ........................................................ 11. Zone or use district in which premises are situated ........... ~ ......... ~. ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation;~ /~O ]3. Name of Owner of premises ............ .~.....~.....~ ............. Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~...~.r..../. ~.' ............. Address ............................................ Phone No ..................... PLOT DIAGIGKM 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 interior or corner lot. STATE OF N~Y~I~ I e e COUNTY ...~.~ .......... )'"" ................ :..I: ....................... ..~'~....e"2=.......~:~... ............................... being duly sworn, deposes and says t~t he is the applicant ~ame of individual s,gnmg ap' ~ ' plication) above named. He is the ~~ (Contractor, agar, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke ~d file this application; that all statements contained in this application are true to the best of his knowledge and ~lief; and that the work will be performed in the manner set fo~h in the appllcatl~ filed ther~ith. Swo~,~fore me ~ls ~ ....... , ............ ..... _ .......... ......... ................... NOTARy PUBLIC, State Of New York No. 52-81~5850 Suffolk Co~ Term ~p res ~h ~, ]~