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Home My WebLink About5157-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sou~old, N. Y. Certificnle Of Oc cupnncy No..z.~08 ..... Date ..................0c~..6..., 19. THIS CERTIFIES that the building located at Seund .Av® .&. P~f~e .~. · Street Map No...~ ........ Block No... ~ ..... Lot No. ~ ..... g~ak .... ~.~ ...... conEo~s subst~tially to the Application Eot Buil~g Permit heretoEore Efl~ in this office dated ....Ma,e~ .....10 ..... , 19 ~4.. p~suant ~ which B~ding Pe~it No. ~5~.. da~ed ........ garc.~ ..... $0.-, 19.7~., was issued, ~d conEorms to all oE the r~re- men~ of the app~cable pro~sions oE ~e law. The occupancy Eot which this ce~ificate is ~su~ ~ . ~us~e ss. ~u~Z~g..(..~g. p~pose~ ~ ...... .................... The certificate ~ issued to . ~e~ .Fork .~ .~. ~t .~o ........ ~e~ .......... (owner, lessee or ten,t) o~ ~e ~ores~d b~d~g. S~olk Cowry Dep~tment of He~ Approv~ ..... ~.'~ t .......................... ~ouse ~ 12~10 ~o~d ~ve // Pacific St~,/~,, ~,~ ~ ~ ( / ~ 75o ...../v ~"~'""'~"~"Buil~ng '"Inspector/ .................. FO~I~ NO. ~ TOWN OF $OUTHOLD BUILDING DEFARTMENT TOWN GLERK~ OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5157 Z Dote ........................ ..~...~ ....... ~..~. ........ , 19.?,~... Permission is hereby granted to: at premises located at ..... .~glMIl~..i~'~ll...~...~llt,q~fJ~O...~ ................................................................. l~at t:~tuek pursuan$ to application dated .................... ~... ..........].~ ............. , 19,..~...., and approved by the Building Inspector. ~ Approved ........................................ , ........ Permit No ............................. ~o~ ~o. x TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. (Building Inspector) APPLiCATiON FOR BUILDING PERMIT Rte ........ l~tr.~ ...... LO.. ................. , ~g.?..I ...... INSTRUCTIONS o. 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 pub ic streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port 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. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bud ng 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 remove or demo t on, os herein described. The applicant agrees to comply w th all ap~licab · aws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ............................................................... ..................................................... :Name of owner of premises .....H~,~-.,.L.E,,~c,.....l~,~u.~.~....~...~.u.~.r.....~... ...................................... If appl! nt is a carp rate, ' nature o uly authorized officer. ....................... (Name arfd title of corpoFISte officer) ~ 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ....................... -- ........... Street and Number ~'> ~Sg '~'5 ~/2~, v Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~.L,~..~.l~.~t4....~tk~C3tt?. ........................................................................ b. intended use and occuponcy ...~ O.u:r.~..,*....L1~.~a~.~,~.~.....C~.r.,~-~,_ ............................ 3. Nature of work (check which applicable): New Building .................. Addition ....~ .........Alteration .~ .......... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...........~.~4.1~.1~.~:~..:....'~.. .................. 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 ...... ~1~~. .............. Rear ....... .~. .................... Depth .~....~...I. .......... Height ......~..~..! .......... Number of Stories .................. ~).l~/.t~. .................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ , , 8. Dimensions o{ entire new construction: Front ........ [~ ....................... Rear ...... I.~ ................ D~th ....~I} ................ Height ....~.~?. ......... Number of Stories ................ ..~.,1.~.~. ......................................................................................... Size of lot: Front ,...~..,~..1~. ............ Rear ......... .~.. ............. Depth ~., Date of Purchase ........ L~ .i~...~ ...... I.~. ................ Name of'Former"~"ii~i~.~...~l~./~J~..~ ............... 10. 11. 12. 13. Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or r lotion? ....... J..~.~ ............................................ Name of Owner of premises ..~...~.~...~,~ ~e~u~ , .......... Address ...~:.~.~J~ ........... P~ne No ..................... Name of Architect ~.~.~...~.~.~[O....Address ..~.~.~. ............. Phone No ..................... Name of Contractor ~.~..~.~.~.~.~l~..Address ..M.~.~.~ ............. Phone No.~.~.~..~.IS PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions fram propedy lines. Give street and block number or description according to de~, and show street nam~ and indicate whether interior or corner lot. Sou rk STATE OF NEW Y~[~K~ COUNTY OF ~,~.F,.t~,q~. ......... ....... ~~...:~.,..:~...~.1~..~ .................... being duly sworn, d~oses and says t~t he is the applicant (Name of individual signing application) above named. He is the ............................................. ~.~.~.~....~.~~ ....................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and Js duly authorized to perform or have 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 belief; and that the work will be performed in the manner set fo~h in the application .filed therewith. Swor~foremethls~.~. _a~ · -r ~ .a~--'~ ~~~~~~. ...... of ........... :., ...................