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Home My WebLink About5266-zFORM NO. ~ TOWN OF SOUTHOLD BU~,r~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at l~. ~, .Ball~k .I,~ ·. · Street Map No..~ ....... Block No .... ~ .... Lot No~... ~ttl~ .~.~. ...... conforms subst~tially to the Application for Building Permit heretofore filed in this office dated ......... ~ .... ~., 19 .~l. p~suant to which Building Pe~it No..~. dated ......... ~p~. .... ~, lg.7i., was ~sued, and conforms to all of ~e requir~ merits of ~e applicable pro,ions of the law. The occupancy for w~ch this certificate is ~su~ is .. P~lva~ .~lo~ .~d~. (l~e. ~l) ..................... The ce~ificate is issued to . .bl~. ~ ..... ~ ............................. (owner, lessee or ten,t) of the Moresad b~ld~g. Suffolk Co~ty Dep~tment of He~ Approv~ . .~ ............................. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5266 Z Permission is hereby granted to: at premises located at ........ ~J,a~il~J....~Ji~.~,~jl...j~j..~,..JJ~(~- ....................................................... ..................... , ................................... !~.~ ~,~ ~,tml~' "'i~ ,"Jw ................................................................... pursuant to application dated ...................... .J~J'.~L~ ....... ~) ............. , 19..~.'[., and approved by the Building Inspector. FORUM NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. /~pproved ~ ~' ~....~.. ~ ~ ~ ........................................ · 1c) ........ Pemit No ............................. Disapproved a/c ~~......~ 0'¥c. o . APPLICATION FOR BUILDING PERMIT ~ Date ....... ~:~...~ ................. 19..~.J......kq 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 o detailed description of layout ofproperty must be drawn on the diagram which is port 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 o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 o corpoJation) ........ .......... ................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... H...~....~ ........ ~ ........ .13m.("~ .................................................................................. 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..~ .................. Stre. e.t and Nurta~r./.~m%'~.~.l..J~L-4J~,...g~~. ........ oL.(:~_ ............ ]~.~.~J,..~..~l.c~.~_... ................ ~,t~ · '~ '~'r( / ~)5 ' Municipality ..... 2. State existing use 'a~occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ..................... '"~"~i ............................... ~../.....~:~-~ ........ ...~......~ ............ ~2-.~ ...... 3. Nature of ~york (check which applicable): New Building .. Addition .................. Alteration .................. · 'Repair .................. Removal .................. Demolitio~ .................. Other Work (Describe) ........................................ EgtJmated Cost ~ // (to be paid On filing this application) 5~ If dwelling, number of dwelling units ........ ~ ............. Number of dwelling units on each floor ....-,...---'. .................. ~_67' 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 ~l~'x~ Depth ....... J~.~.. .......... Height ............................ Number of Stories .................. ~ ........ ,, ' 8. DimenSi~ire new construction: Front ......... .[~....~... ............. Rear ........ ~.1~. ............... Depth ...... )..'~....~.. ....... Date Purchase ....... Iq.~.~.. ..................................... Name of Former Owner ........................................................ ] 1. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation? ....~..¢~. .................................... ~,.;~... Name of Architect ........................ ,~,,-....~ ............... Address ....... ~ ............... ; .................. Phone No ..................... Name of Contractor PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from number or des ript'on cording o deed, and show street names and indicate whether interior or corner lot. STATE OF NE~~ ~ [SS ...... ; ..................... ~. ........... ~-~...;~..5~.....~... ....................... being duly sworn, deposes and says that he is the applicant (Name of individual signing applicotion~.~_~.~ ~ / ~-~ ~ . ~ -- above named. He is the ~ (Contractor, agent, corporate officer, et~i of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicatio~ filed therewith. Swam to before me this ............ of ................... . ............. , Notary Public, . ........................................................... County ~ (Signature ................................................ of applicant)