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Home My WebLink About5122-zFORH NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z1+38~ Date THIS CERTIFIES that the building located at Map No. ~ , Block No. ~ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated . ,~a~ 21 , 19 ~2~ pursuant to which Building Permit No.~] dated .. .~a~ 2~ , 19 ~ , 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 .Private Mo family, dwollilag .............. The certificate is issued to lirs lt,B,$1al~;h .... 0wlae~ .. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~.eR, .... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 5122 Z Permission is hereby granted to: .~S,~..~b~a..~.....:l~....~,la,,ae:L~a ........ .~~ .......... ~.,.~g.,. .............................. to ...~l~.a~,..e~'~..~.~.~..e~..~c.~.~,~,~§..~e..~.-~ .......................................................... at premises located at .......~(~O.....~.~,..~O$~..~(Lt..:~.7.....O~;~..I~..~]~L~..~ ............... ................................................ ~t~t'~e~ ....... ~'~t; ......................................................................... pursucm~' to upplication dated ........................... .~.1~ ...... .~,~ .............. , 19....~, and approved by the ]3uilding Inspector. APPLICATION FOR BUILDING FEB.MIT ........................ ....... ...... INSTRUCTIONS ~ This application must be completely filled in by typewriter or Jn ink und submitted in duplicate to the Building Inspector. b. Plat plan showing location of lot and of buildings on premises, relationship .to adjoining premMs or public streets or areas, and giving o detailed description of layout of property must be drawn on the d.agram wh]ch is part of thle application. c. The work covered by this application may not be commenced bafore 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 wurk. 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 pumuont to the'~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~, Ordinances or~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building ~e, housi,Qg ced,e, and regulations. (Signature cf applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar builder. Name of owner of premises ............ ~......~...:....~..'...~ .............................................................................. If applicant is a corporate, signature of duly authorized officer. ~'~ (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...................... : ................. Lot No.: ....................... "umber ..... ,~...~..0. ........ ..~...~..?....~....~.......'~.../..?. i"/C&~9=, ~,~'~-'~D Street and ................................... "'~i~"il~'(l~, ....... ~'~'~J; '~' ~Y'~J ~';~ ..... 2. State existing u~ and ~cu~ncy of promises and intended use and occupancy of pmp~ co,traction: .. / b. Intended use and ~cupan:*, . 3, Nature of walk (check which applicable): New Building ' Addition r Alterntion Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... ~ o oO0 _~ 4. Est mated Cost ...'~.~/ .............................. Fee ......................................................................... (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ..... ..~'.../~',....~.Z ........ 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 st'ructures, if any: Front. ........................... Rear ................................Depth ........... Height ........................ Number of Stories ............................................................................................... Dimensions of same structure with alterations or additions: Front ............... ..~....~., ........... Rear ......................... Depth ............... ,~,,.-~,,, .......... Height ....... ,~,..~,~.. ......... Number of Stories ... ,,.c~2~., ... 8, Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front . / O O Rear ................................... Depth ~ ~O ~ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated ~j'l'~_/='_~"/,E~ , 12. Does proposed construction violate any zoning law, ordinance or regulation? /t/(3 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No .................... Nome of Contractor .................................................... /~aaress ............................................ 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 indicaS:e whether interior or corner Jot. STATE OF NEWL~RI~ .~ COUNTY Of ...~ ......... $~'~' ............................ · ~....'~-~. .......... ~.~.i~..~. .............................. being duly sworn, deposes and soys that he is the applicant (Nome of individual signing application) above named. He is the ........................ ..~...~[..V~.....'~.....~..?....~..~....~.. ....................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rn~Ee and file this application; teat all statements contained in 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. Sworn to before me this / . ,/1 ~ / ................. o, ............................ VB/g - hlotor'! Public,,4~t/~......./)....~t,-.//~,~,.,...~....~.~C~.~....,. Cou~"";~;;~;E~;'~;;';~;L'~i§'~;¥;~.;;';~ ~';7)' ....... .'x ................. ~/,~_~ ~...C~/~//U ~(..J.,EJ/~ NOTARY PUBLIC, State of New YO~ t~ ~ No. 52-8]25850, Suffolk COL[Et[ -- ' Term Expires March 30, 19J.~qf'