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Home My WebLink About5253-zNO. 4 TOWN OF SOUTHOLD BUII,I)ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at 5~aw4~. llrSV~ ........... Street Map No. ~eaveo~ .A$~ck No ........... Lot No..32 ...... I~ltl~,~l.. ][.~. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Apt. S1. · 22., 19~1.. pursuant to which Building Permit No... dated ........... Al~ll.. ~l., 19-7.t., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ...l~'$~age. o~e. £amil]~. ~lve.~ .i. in~ ..................................... The certificate is issued to .~l~en .&. 'J~amle · .l~e~ml~ ..... 0~rae~l ........... (owner, ~essee or tenant) of the aforesaid building. Suffolk County Department of Health Apprgval .. Jm~...%1,. · .%~7'Z. · -bi-R, .VLI~.. °' ..... . ........ Building InspeCtorf FOP,~ NO. ~ TOWN OF $OUTHOLD 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? 5 53 Z Permission is hereby granted to: ............. .%e~A~, ............................... to .../~3~..~e~.-.ea~...~a~.-~'~ ...................... : ...................................................... at premises located at ........ ]~..;~ ....... ~:~.,'~R~ ................................................................ ............................................ ~e~ee.....~v® .............. ~t,~ct ....... pursuan,t to application dated .................................. Ap~.~L~....~,..., 19..~.~L, and appraved by the Building Inspector. Building h~lJ~ctor ~ SCHD SUFFOLK COUNTY DEPARTMENT 0~F HEALTH Date TO WHOM IT MAY CONCERN: The sewage disposal facilitigs for a structure located (Give dee'd location) have been inspected by this department and found to be satisfactory. Ohte: of don~ral F~o~gi~{eortng Bsrvioe~ TOWN O, SOUT.OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , ]9 ........ Pemit No ................................... Application No. APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. 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 public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part 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 Building 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordi nances, building cede, housing code, and regulations. (Signature of applicant, or name, if a corporation) .... 0. ........................................ (Address of applicant) State whether applicqnt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~f~ ,. ,~,~, If applicant is a corporate, signature of duly authorized officer. ........................................................................................ (Name and title of corporate officer) 1.StreetLocati°n °f land °nwhich P'r°p°sed w°rkwill be'ed°ne"rxMap N'q':':"C'"'~"""~'~*"/'"~'and Number ~ (~/'~. ~~.... ................ LotNo .?......~.. .............. /~/ -- ,,~ 61 ...................... Muni..-..-..~......_......~...,Lil~.;...l~ ................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................. ................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~.~.~.....~.. ...................... 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 ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ...................... v.:..~N,um,b~,r of Stories ................................ 8. Dimensions of entire new construction: Front ......~..¢....~... ............... Rear ...... .~'...~......~.. ...... Depth ....c~..~ ........... Height .................... N. umbqr of Star es .. ./ ................................................ ~/ ! i ............ 9. Size of lot: Front ..... ./.~ ............... Rear ....... ././.~ .................... Depth ./...~...~.. .................. 10. Date of Purchase ....... /..~;. Name of Former Owner .~..~.~......~~:~... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation 13. Name of Owner of premises~.~~....~...~..~....~...-//-,~......~....... Phone No. ~..~..~..~...~....~'.-~" Name of Architect .....~.;~...~7~-.--,,./~///~//~,~,.,_,. ........................ Address i~.~..~2~i...-~.~..iiiiiiiiI~/~ Phone No ..................... Name of Controctorc,.~..e~.~r,,,,:~..~...: ........................ Address 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 indicate whether interior or comer lot. STATE OF NL~OI~:.,~,~ COUNTY OF ~ ............ ~'~'~ ................................................................................................. being duly swam, deposes and save t~t he is the applicant (Name of individual signing application) above named. He is the ........................ ~.~.~.~ ............................................................................................................ (~ntmctor, agar, co~orate officer, etc.) of said ~ner or owners, and is duly authorized to perform or h~e perfo~ed the said work and to ~ke and file this application; that all statements contain~ in this applic~ion am tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h Jn the applic~i~, fil~ therewith. Swam to before me this ....... ....... of .......... _ / L .... ...................... Notaw Public~.~.J~.. Coun~ (Signa~re of applicant) ..... N~ARY PUBL~, ~ 0J New Y~ No. Term ~pir~