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Home My WebLink About5254-zFORM NO. 4 TOWN OF $OUTHOLD BUll,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~,3~l~. ...... Date ...............SSp.~...~. ...... , 19...~. THIS CERTIFIES that the building located at ....L~. ~ ........ Street Map No. ~. W~ock No ........... Lot No.. ~ ....... ~... ~gZ~ .... conforms subst~ti~y to the Application for B~ding Pemit heretofore filed ~ ~ office dated ........... ipF~.. ~, 19.~1. p~su~t to which Build~g Permit No..~. dated .........~... ~., 19. ~, was issued, ~d conforms to ~l~of the r~r~ ments of the applicable pro~sions of ~e law. The occup~cy for which ~ ce~fficate ~ ~su~ ~ .. ~lva~ .~ .f~. ~1~ ' , ................... The ce~ificate is issued to ... ~. h~ ~ ....... ~r ................... (owner, less~ or tenant) of ~e Moresad b~l~g. S~o~ Co~ty Dep~ment of He~ Approval .. &~.. ~.~.. ~ .R~. ~... Buil~g ~s~ctor FOl~/~I NO. :~ TOWN OF $OUTHOLD BUILDIHG DEPART~EHT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5254 Z Permission is hereby granted to: ..... ,~m ..~1.¢ .... ~Z~ .....~ .i~,~ .- to .. ~u/l~ ..,~ew...one ...f~,~l~.~...~'~'.~;L~,;~ ................................................................................. at premises located at ....~,..~ ............ ~'~.,~..~d.?..~,~'.~ ...... ~ ......................................................... ................................. F~/,a .... L~'i~-~ ·. £~,~ ................... ~ ~,A.t~O14 ............................................. pursuon~t to application dated ............................... ~.D~I~......~.~....., 19.~..1..., and approved by the Building Inspector. Fee $.I.0,.QQ ........... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT O~ HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located :~ive deed lo'cati~) ~ J have been inspected by this department and fbund to be satisfactory. Ghief of General Engineering BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, ". Y. '~ 19 '~/ PemJt No. ~'-~' Approved ........................................ , ............................................ APPLICATION FOR BUILDING PERMIT No ~-~'~' ~ Application ................ /... ............. 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 code, housing code, and regulations. ........ ....... ................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. ~ .................. i~;;;;;;";;;;;i"~i~'~;";;F~'g;~';';;'~;';¥ii;';';i ......... ~- .~7~ / ~ Location of land on which proposed work will be done Map No .~.-~....~'...~.../..~..;~-~t No Street and Number ........ .'.~-..~.~: ................. ~-..c.:./.....,~j~..~...(~....~..~.6.~..~........~..j~, ............. ~..~.~.~..~..(.~ ................ ~ / ~/~ Municipali~ State existing use and occupancy of premises and intended use and ~cupancy of pr~osed const~ction: ~. E~,.~.n.u.~ ~ ~cupa,~ ~f~ C 4 ~ ~ b. Intended use and ~cupancy .......... ~.~..~4.~..Z..~. ~......~.~ ~. ~., .......................................... Yu 3. Nature of work (check which applicable): New Building .... 4~..~.. ..... Addition .................. Alteration .................. Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... L.~.....~....~...°......~:.. ........................... 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 ............................ Number of Stories ................................ 8. Dimensions of entire neW cbnstruCtion: Front ............. .~.....~.. ............ Rear ...... ~...~-~... .......... Depth..-~T...~.. ................ Height .................... Number of Stories ..............~ ....................................................................................... 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 ...~..T..~....~'.../~..&/~..~..Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..%[.T~L~...~1/.....~'./~.: .~0.~..4~...¢..~...Address ..... .~..C)...~...-/.....~...~....~../~. ....... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-b~ck dimensions from property lines. Give street and block number or description' according to deed, and show street names and indicate · whether interior or corner lot. STATE OF NEW~'YOR. K~ ,- tcc t~.....~/.~..~.:.~.......[..a.~........~, lng duly sworn, deposes and says that he is the applicant (Name of indiv~ signing applic~ above named. He ~s e ........................................................... ~ ........................................................................................... (~ntmctor, ag~t, co~orate officer, etc.) of said owner or owners~ and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements conta~ined in this applic~ion are tree to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the ~plicati~ filed ther~ith. Sworn to before~~~me this ~~~, .............. ~., .812~50, Suffolk