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Home My WebLink About5249-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.g~3~13 ....... Date ............. .~.1~ .... 9 ...... , 19. ~. THIS CERTIFIES that the building located at . R~I~..P. oIIlg .R~[ .......Street Map No..1~ ........ Block No...I~. ....... Lot No. ~....g. aSt...l~.r$..~.., ll.o.~. ? ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........gprll... 2~) 19.?.~. pursuant to which Building Permit No..~.2.~... dated ............ gpl~,l...21, 19~ ?.l., 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 .. l~ive, te. one..fala~ly. ~welllng ..................................... The certificate is issued to .Ke~e.n...R~t.z..e.~ ........ . .0~n..e.~ ............ . ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ .~.~.~..~ ....................... ,,o,,,,. ...... ........... -- Building ~nspectc~ FORM NO. 2 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) N? 5249 Z Permission is hereby gronted to: · ..~[ea~.. ~q~.a ~ ..A,~.,.~e~e~..ae~ ......... .......... ~)~£e~ ....................................................... to ct premises located ot .......~y"'~'"RO&~ ............................................................................... .................................................. ~t"~rJ~t)~a ............ ~'"'~ ......................................................... pursuant to application dated ........................ ~.~}......~ .........i'"'" 19.~J..., and approved by the Building Inspector. Fee $.~.~0~ ............. TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICI SOUTHOLD, N. Y. Application No...~...,~...?,..~.. .......... .~ ' ( " 19...!:... ,erm,t No. ~'&q ~ -~' Disapp~ a/c ...................................................... APPLICATION FOR BUILDING PIRMrT '~ ............ ~ ................................ , i9.....z../.... INSTRUCTIONS ~ a. This pppllcatlon must be completely filled In by typewriter or in Ink und submitted In duplicate to the Buildln~ Inspector. b. PI.at plan showing location of lot and of bu.lldings on premises, relationship to adjoining premiere or _i~llc streets or areas, ana giving a detailed description of layout at property must be drawn on the diagram whlch Is part of thle al~llcatton. c. The work covered bY this application may not be commenced before issuance of Bullcllng Permit. ,~ d. Upon app.?al of this application, the Building Inspector will I#ue a Building Permit to the applicant, Such permit shall be Ir. apt on me premlm available for nspect on throughout the progre~ of the work. ~. e. No building shall be occupied or used In whole or In part for any purpoee whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pumuant to the . .Build!ng Zorn. O~lnance of the Town of Southold, Suffolk County, New York, and other applicable Lawl, Ordinances or :~ Kegutatlons, mr the construction of buildings, additions or alterations, or for removal or demolition, al herein deicrlbed.~, The applicant agrees to comply with all applicable law~, ordinances, bulldlnll code, housing code, and regulations. U (Signature of al~llcant, or name, if a corporation) ................. ....... , .............. (Address of apl~llcant) (~ State whether appllcantqls owner, leilee, agent, architect, engineer, general contractor, electrician, plumber or builder. Non~ of owner of pr~ml~ ................................................................................................................ If applicant Is a corporate, signature of duly authorized officer, (Name and title 'of corporate officer) I. Location of land on which prapmed work will be dane. Map No ............... ' st.. and Numbe .... ~'/~ '- /~-~o ............................ Municipality ~ 2.State existing use a,nd occupancy of Premlsel and Intended use and occupancy of propoeed comtructlon. ~/A.~,,-;~I,~, ' ' a. Existing use and occupancy ,,,,,~'~,,;,:T;',,,~,,.~ ..................................................................................................... b. intended use ond occupan~...~...~. 3. Nature of work (check which applicable): New Building ~ ................. Addition..................~/' Alteration .................. Repair .................. Removal ,..~. ...........Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... 2c...~.-~ · . ................. Fee ...... [ ........................ (to be paid on fi!lng this application) 5. If dwelling, number of dwelling ur{its .......................[Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If busine~, commercial or mixed occupancy~ specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, If any: Front ....... ~. ............... Rear ..../.~... .................... Depth ...~.../. ....... Height ......j'...~.. ........... Number of Stories ...... /. ......................................................................................................... Dimensions of Same structure with olterations or additions: Front ......... ..~...~..~ .................. Rear .../..~...~ ................. Depth .......... '~m'.~>... ............. Height ......... /...~:.. ............ Numb/r of Stories ...... /. ....................... 8. D mens ons of ant re new construct on: Front ............ /.~.~. .................. Rear ................ ............ D.~.-,~tk ......................... dC Height ...../.~....r. ..... Number ~f Stories ...................................................................................................................... 9. Size of lot: Front ..... ~..~ ............. Rear ......... ./.Z~.. ................ Depth ....... .~.~I~. ............... 10. Date of Purchase ........................................................ Nome of Former Owner ..... .~,.~.~ ! 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance 9r regulation? ..... ~ ...................................................... 13. Name of Owner of premises ./..~.;.';:~......~ ....... Address ~~,.~'Phone No...~.~.7..T../.?...7.~Y Name of Architect .i...7.![I, _~ ~_._~, . .~~ .......................... : ........... Address ........................................... i,...~,.-j Phone No ..................... Nome of Contractor ../.~.~ ........... Address ..~'...~: .......... '..;.. Phone No. ~.~...~...~...~../../., PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ind cate a I let-back dlmens ons from propert~ lines. Give street and block number or description according to deed, and show street names and Indicate whether interior or corner lot. I STATE OF NEW ~.RI~.~/).~ COUNTY OF ..,~) ......... ~' - · ~Name of i~ivldual slgnln~l~atl~ L ' a~ve named. He is the .............................. ~~ ................................... '~[ ....................................................... (~ntmctor, ~t, co~r~ officer, ~c.) ~hf. said ~n~.r or 9wner~/ and is duly authorized to pe~orm or ha~ perfo~ed the said work a~ to ~e ~d file · s app,~cohon; that a, statements contained in this applicat~ am tree to the ~t of his ~l~ge and belief; and tha~ the work will ~ perfo~ed in the manner let'fo~h in the aPpIl~l~ fll~ ~er~lth. ....... d~ ....... (Slg~m of applicant) NOTARY pUBL C, State of New York N0. 52-812~50. ~ff01k C~t~ Term ~pires ~rch