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Home My WebLink About5248-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. ~1,2~0 ...... Date ............. &pr~.l...~'~ .... , 19. ~ THIS CERTIFIES that the building located at .... ~' '~ 'R~ ........ Street Map No. ~.~ ....... Block No..~ ....... Lot No.. ~ ..... S~el~..~.~., ....... conforms subst~ti~ly to the Application for B~ld~g Permit heretofore ffl~ ~ ~s office dated ....... A~$i .... ~9'" 19.7~. p~su~t to which B~l~g Pemit No..~. dated ........... April- - · '$9, 19. ~.$, was issued, ~d confoms to M1 of ~e r~e- ments of the applicable provisio~ of the law. ~e oeeup~cy for wMch th~ ce~ffieate ~ issued is .... ~e~s. b~l~..-.~rd~re. Mter~ .......................... The ce~ificate ~ ~sued to .. ~,. ~t ..... 9~ ................................ (owner, lessee or ten~t) of ~e aforesMd b~dMg. Suffolk Co~ty Dep~tment of He~th Approv~ .-' '],R'. ............................ ~ouse ~ ~Ot~ /~ .~..~, ......... ........ B~d~g Insp~r FOItM NO. ~ 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) 5248 Z Permission is hereby granted to: at premises located at .......J/~..llll~..~oli~..&..~ll~l~:..~r,..Dl~ ................................................. pursuan$ to application dated ....... ~ ................ A~. ...... .~1~ ........... , 19.~'.~,.., and approved by the Building Inspector. Building ~nspector / ill VI~OPOS~.D AD'PIT N~W TO .~A~'C '4 I~OB, M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN .CLERK'S OFFICE N. Y. Examined Approved...: .............. .C.! ........... !~.....19...7../.Permit No......~.c~......~....~.......~... Disapproved a/c ......................................... ~ .... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted Jn duplicate to the Building ~ 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 descriptian of layout of property muSt be drawn on the diagram which is part of this location. ~ c. The work covered by this application may not be commenced before issuance of Buil~ling Permit. d. Upon approval of this application, the B~ildlnG Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the prem~es available for i~spectlon ~hroughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever unti, a Certificate of Occupancy shall have been granted by the Building Inspector. ^PPLICATION IS HEREBY M~DE to the Building Department for the issuance of a Building Permit jxJrsuant to th& Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~ _~rdinqnces or Regulations, for the construction bf buildings, additions or a Iterations, or for removal or demolition, as he,in ch~cribed. The applicant agrees, to comply With all applicable laws, orcl inances and regulations. (Signature of applicant, or name, 'if a calq~oration) Name of owner of prem,ses ........ ~,~ ....... .~-'~.. ........... ~ ........... : ................... ;. ................... ~ I If applicant is o corporate, signature of ~luly authorized of..ficer I) (Name and title or corporate officen 1. Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... 2. State existing use and-Occupancy of premises ancl i~nt~nded use and a~:cupancy of prapased comtruction: .: a, Existing use aha eccupancy ........................................................................... 3. Nature of work (check which applicable): New Building .................... Addition ........~...... ...... Alteration ................... .Repair .................... Removc .................... Demolition .................... Other Work (Describe) .................... (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 ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................ Dimensions of same structure with alterations or additions: Front .....~.U ~T. .................. Rear ...... 2.0,~..~ Depth 8. Dimensions of entire new construction: Front .......... ~ .............. Rear ..... ."L~...I .............. Depth .......~.~*.. ................ Height ......... ~,~.*t~,~ ......... Number of Stories ..... ~ .................... ! 1. Zone or use district in whi~:h premises are situated .....'~.t~.'~.~L..-= .................................................................. ]2. Do~s praposed construction violote ony zoning Iow, ordinonce or regu~otion? ................................................... 13. Nome of Owner of premises.~......~.,~,~'.-~.. .......... Address ........................................... Phone NO ..................... Nome of Architect ........................................................ Address ............................................ Phone NO ................... PLOT DIAGRAM locote cleorly ond distinctly oll buildings, whether existing or proposed, onc~ indicote oil set-bock dimensions from show names property lines. Give street and block numbers or descrip~on according to deed, and street and indicate whether interior Or corner lot. ~ ~,~l~---~ STATE OF. NEW YORK, ) S S. COUNTY OF ............................ ) ~J, dd~......f:,,~L~)::~l~.~ ................. .................... being duly sworn, deposes and ~s that ~ is the applicant ' ,(Na~e '6f individual signing opplicat'on) a~ve named. He is the.....~~ .......... ~$~ .................................. : .................................................. :.. (Contractor, ~ent, co~ora~ officer, etc.) of. said owner' or owne~, and is duly authorized to ~rform.,or hgye peered t~' said work a~ ~ make and file . th~s application; that all state~io~ in this a~pli~ation are tree-to the ~ of his ~l~e and ~lief; and that the work will be ~~~r set to~ the applicati~ fil~ the~ith. f thi o ---~ ~ n~ ~ -~,,~. SWorn ~o ~ ore me s ~. 52~. ~k ~-~: - ~--/ -_ .-