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Home My WebLink About5181-zFO]IH NO. 4 TOWN OF SOUTHOI.D BUILDING DEPAI~TMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. ~1~3~ ... Date ......... ~.~g ..... 2~.. , 19. THIS CERTIFIES that the building located at .l~/S. ]~eep .~ .Drt~ · · Street Map No..~ .... Block No...~ .... Lot No ..... ~... ~¢iguek.. ~ .. conforms substantially to the Application for Building Permit heretofore filed in this offme dated ....... ~r~. ~], 19 ~]. pursuant to which B~lding Permit No..~8~. dated ....... ~. ~. , 19.~], 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 ~. ~. ~ .~?~g .................................... ~e certificate is issued to .~ . C~u~k~ ..... ~r .......................... (owner, lessee or ten~t) of ~e afores~d building. Suffo~ County Department of Health Approval .... .............. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5181 Z Permission is hereby granted to: .......... ~ ~Jm~....~J~f~e...&..ll~e ................. ................... Dee~..li~e..t~ ................................ ........................ ~t~ll~..--~li~'~, .................... at premises located at ........JJ/JJ-..--J)eej~.-JJ4l;JiJ-J~. ......... JJliJtj~lllilJl[--.-.~ ............................ pursuor~' to application dated ......................... ~ ....... jlj .......... , 19..~j., and approved by the BuJ!ding In, spector. Fee $-.-~JO ........... Building Insp~~ IPOB*M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....'~~.....~....~....., 19..7/ ,,, ,, Approved ........................................ , i9..~... Permit No ............................. Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PERMI'T ~,~ Date .................. .~...g.~....~.... ...... .~../. ............. , 19..~..../......~ INSTRUCTIONS b a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building'"0 Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn an the diagram which Is part of thio 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 port for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable I. awl, Ordinances or-~ Regulations, for the construction of buildings, additions or alterations or for removal or demolition, al herein described. The applicant agrees to comply with all applicable laws, ordinances, building code_housing c .oFle, and ragulatlons. ,',r~name, If a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... #eA ........................................................... Nome of owner of premises ..~..~.~.,~'~...'~:.. ...... C.~....c'/....~...~..a ........ ..d-.....~... ............................................................. 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.: Street and Number .~.¢~.......~..~..~.......~..~.:.~ ............................... ~..,~...?~..../....~.~..~../..~. ..................................... /~,/ ~-,-/~ / Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · a. Existing use and occupancy ~.~..~-......~l~../..~..~. ...................................................................................... goo . ..... ........ b. Intended use and occupan:', ,..- ... 7' ........................................................................ 3. Nature of work (check which applicable): New Building .................. Addition ....~ ...... Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ...........~.~..O...q.:...~.....O.o ........................ Fee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...@..~.,..~,.'~. ............. Number of ~welling 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 .... ,2~.~ ...... Height ........................ Number of Stories ...~.~..~... ........................................................................... Dimensions of same structure with alterations or additions: Front ......... ~J~. ...................... Rear ..... ~..(~ .................. Depth ....... ~.~.~ .................. Height ............................ Number of Stories ........ ~.~.L.'~.. ............... 8. Dimensions of entire new construction: Front ..... :~./. ....................... Rear .....~..~. ................ Depth ...~..~'..~ ............. Height .................... Number of Stories ........ ~.~ ....................................................................................................... 9. Size of lot: Front ....... ~'a~.~.~. ........... Rear ......... ~.~....~. .................. Depth ...../~..~.~. ................ 10. Date of Purchase ...... .6~.~.~lc~ ........ J~.~..~. ................. Name of Former Owner ~.~'~v~7.......~..~.../-.¢./~./. ................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;> ...... .~...o. ............................................... 13. Nome of Owner of premises ~..~.~..~.....~.Z.~.~'-~...*..W..Address ~..¢.~..../,~.L...~.....~x'.:.-..IfI,,f..,T?Z.:.. Phone No.-~-.~..T..~.7...Z..~.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor C,.../~M.~.~./~ ........ ..~.~..~..~':. ........ Addressl.~.'~./...~'0.*~.6(.~.~t'.~.~'..~'.~-.7...~./I/;),. Phone No. ;?.~.7..~.~..?..A..l. 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 whetl ~er interior or corner lot. STATE OF NEW YORK, ................................................................................................. being duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the ................................................................................................ ;[ ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to per'arm or have performed the said work and to make and file this application; that oll 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 forth in the application filed therewith.