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Home My WebLink About5263-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate Of Occupancy No...Z~'1~62 .... Date ............ 8el?.te~ber .~.9,., 19.?~. THIS CERTIFIES that the building located at .. C.~ater. .~MaP No...X~ ....... Block No. X.X ....... Lot No...I~..~tgl. t~o.k ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... April. 26~.., 19 .~.1. pursuant to which Building Permit No.. %2fi3Z. dated ......... April. 26~..., 19.71., 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 .. Private..Qne. £.a~ll~..dveL~.ing ...................................... The certificate is issued to ...Lo~.o,~O..~i~.zj~ ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...l~,~.. ............................. UNDERWRITERS CERTIFICATE No...P.~I..d.~.~.l~ ...................... HOUSE NUMBER.. ~.0.~ ...... Street .....~ .,~?.~..~..O.O.'.,.~.o....~.~.o ............................. ............................................ l~t~ tu~ .......................... Building Inspector FOP~I NO. 2 ?OWN OF $OUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERN~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5263 Z Permission is hereby granted to: ............. ~;~,~ ~......~ 11~me~ ..................... ............ ~.~..~.~.,~..~...~.~.~.x'. ..................... at premises located at ........... '~'~'~:;'e~;'~ ~' "~,fie~'t;~,~' ~ ........................... ................................................................ ~?~: ~..~-.~.~; ............ .~.~.~'., ..................................................... pursuan¢ to application dated ....................... ~p~.:[~[ ........ ~ ............ , 19...~1., and approved by the Building Inspector. t Building Inspecto f IV.B . Examined ........... , Approved ........................................ , FOB~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 1c) ........ Pemit No ................................ Disapproved a/c ...~......~.....: ........................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .......... ~...~....~.. .......... , 19~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildi~ Inspector. b. Plot plan showing location, of lot and of buildings on premises relationship to adjoining prem ses or pub c streets grease.and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this opplicatio~-~ c. ~l~e work covered by this application may not be commenced l~efore 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, ordinances, building code, housing code, and regulations. ....... /..: ....... ...................................... (Signature of applicant, or name, if a corporation) ................................ State whether applicant is owner, lessee, agent, architect, engineer, geheral contractor, electrician, plumber or builder. ................. .............................................................................................................................................................. Name of owner of premises ....~..~./~/,(.~..~........J~.,/~.,~.~/~.~...S:..~y/~. .................................................................................. 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 N~,~/~..~..~..~....~..~'z...Z~....~x/~...~.~....~-v~..f....j~'~.~./..~..~'..~;... ..... ~ ~ ,~ ~,~ Municipality .............. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ...~..~...~..:.~.~./~..~/'.~..~.., ~_¢x.~.,~./.~. ~..~.... ....... b. Intended use and occupancy I/ ~/ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition......~.. .......... Other Work (Describe) ')(- ~' 4. Estimated Cost ...J~..~......~./~r#.....~,~.... .................. Fee ~....~' (to be paid on filing this application) 5. If dwelling, number of dwelling units ...Z ............'[[[J ....... Number of dwelling units on each floor ............................ If garage, number of c~rs - .. 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 construction: Front .................................... Rear ............................ Depth ........................ I~ Height .................... Number of Stories ...................................................................................................................... (/~ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ -'~.' Date of Pumhase ...,~...~.~.~...~...~'~..'~.. ......................... Nome of Former Owner /,~x'~.~...~/..~.....~/..~./q/.~.. ......... 11. Zone or use district in which premises are situated ...~4~.~.../.~.~,,<~./.~ ................................................................ 12. Does proposed construction violate any zoning law, ordinan, ce or ~egulation? ...../~...O. 13. Name of Owner of premises ..../~...~...~'....~.../..'~'..~:......~..../~..~....C~..~l~/ress ....~.! .~..,.~.!..~'~.)~/~'~.~ . Phone No.~..~....~... Name of Architect ../,~/.~.../.~<~e~...~./..~.~..~..~../~'........Address ....c~.t~..l~. ........................ Phone No.~. ..... Name of ../~-,~,6~f'~'~---.~//-/~'X~'.G~-..Acktress ..-.~:~ ....................... Phone No.~.'.~ ........ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimens~ans, a~rom 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 NEW,,'~OP-J(~ /)/ J,, COUNTY OF . t .............................. ~~~..~~eing duly ~rn, d~es and says t~ he is the applicant (Name of individual signing application) above named. He is the .................................. ~~ .................................................. (~tmctor, agar, co,orate officer, etc.) of said owner or owners, and is duly authorized to perform or have peffo~ed the said work and to ~ke ~d file this application; that all statements contoined 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 in the pppllc~i~ fil~ therewith. Sworn to before me this ................ ~d~o' .~....~..;...~...., 19~. ~ ~~ ~'~~ Nota~ Public, .~..~.~...~~un~ ............... ~,;~'~'~'~plicant"'"~'~'~ ............................ ~ota~ p~bl c~ 8~te of New Yor.