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Home My WebLink About5209-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ~2.07 ...... Date ........... Apr~J.... 22 ..... , lg. ?~. THIS CERTIFIES that the building located at .. Wells. AVe ............... Street Map No. ~ ......... Block No... ~ ..... Lot No. ~... 3.outt-.o14 .... N ,Y.. ....... conforms subst~ti~ly to the Application for Buil~g Permit heretofore filed M this office dated ........ A~rll .... 5.. , 19 .~. p~su~t ~ which Buil~g Pemit No. ~9~.. dated ........... ~Pr$~.. ~.., 19.~., was issue, ~d conforms to ~ of the req~e- ments of the applicable provisions of ~e law. The occup~cy for which tMs certificate is issued ~ . .~l~ate. acces.so~. ~ng. (~.tabla .~agrtc~.tur~, 1..la~). ..... ~e certifica~ ~ ~sued to g~. ~VY. ~$g9~$$. 9W~.. ~ .~.~9~. (o~er, lessee or tenet of ~e ~ores~d building. Suffolk Co~ty Dep~tment of Health Approval .......... ~.'~ ~ ..................... Heuse ~ 3000 4P3) /~ ~' .../ ............. Bmldmg Insp~or 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? 5209 Z Permission is hereby granted to: ..:. ......................... ..................... a,mt~mM ........... ~I~ ..................................................................... ~_pursuar~ _ -~- to application~. ~ · · dated ..................... ~...., ..... ~1~ ....... ~ ...... , 19...~.~, and approved by the ~' ~ ..... "~' Bi~lding [n'spector., FOBM NO. I TOWN OF sOUTHOLD BUiLDiNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... . ~i~pp~ ~/c ......... ~ ......................................................................... Application No ....................... i APPLICATION FOR BUILDING FERMI'[ ~,,~, .............. ..(-~.....Z...~7.. ........................ , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Buddi, Inspector. b. Plot plan showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets areas, end giving a detailed description of layout of property must be drawn on the diagram which il part of this applicati.~ c The work covered by this application may not be commenced bo(ore issuance of Buildir~g Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such per~ shall be kept on the premises available for inspechon 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 Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~nd other appllcc~ble Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein describ- The applicant agrees to comply with all applicable laws, ordi~g code, housing code, and regulations. ........ ', ..................... (Signature cf applicant, or name, if a corporation) ...... (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ~t If ~=pphcant is a corporate, signature of duly authorize~d officer (Name and title of corporate officer) Location of land a~ which proposed work w'lbe don, nap No..' ... State existing use a~d occu~ncy of pre~is~ende~,use and occupan~ ~mp~ construction: o. ~isting use and ~cupancy ..... ~~ ............. ~.~ .......... ~'~~...[.~ ..................... b Inte ded use deco p ;- ...~....~ ........ .~..~ ............. ~. .................... 3 Nature of wo~k (check which apphcable). New Budding . ..~. Addmon ....~.... .... Alteration .... Repair ................. ,~,Remova~ ................. Demolmon .................. Other Work (Describe) ................. 4 Est,mated Cost ......... ~' ..~....~.....~. .................................... Fee ........................................................................ (to be pa~d on f(mg th~s apphcat~on) .5 ~f dwelhng, number of dwelhng un,ts,,2.~.~....~.. ....... Number of dwelling units on each floor If garage, number of cars ...................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 Dimens,ons of e>.ist,~,z~tructures,~:~ if any: Front ..... /'....~. ............... Rear ......... /..~. ..............Depth .. ,/ 2_.., ..... Height ............. /...~...Number of Stories ........ Dimensions of somerstructu,e w,th alteratlo~qsjor~.~ additions: Front ....... ~....~.. ................Rear .. ~..~7 Depth ...... ~..~.. .................. Height .... .7.-~ ......... Number of Stones ......... ? ............. 8. Dimensions of entire new construction:--WFront ........ ~..~ ....................Rear .......,~"'-'7 ...........Depth ..... ?....2m.. ........ Height ..... ..~ .........Number of Stories ......... ~'. ......................................................... 9. Size of lot: Front ............................ Rear ..................................Depth 10 Date of Purchase ...................................................... Name of Former Owner ................................................ I 1. Zone or use district in which premises are situated ............................................................................................. 12 Does proposed construction ~ol~te any zoning law, ordinance or regulation .... Z~..~.. ................................... 13 Name of Owner of premlse~/'~/.,~....~.~-~....'7.~dress ~.~..~:... Phone No .............. Name of Architect .................................................... Address ............................................ Phone No ................. Name of Contractor .................................................. Address .......................................... Phone No ............... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether ex~st,ng or proposed, and md~cQte all set-b~3ck d~mens~ons fro property lines. Give street and block number or descript,on according to deed, and show street names and indica whether interior or corner Jot. STAT.E~F NEW' ~.-~RI~,/ ~~~S.S ................. being duly sworn, d~ose~a~ays~ ~ that he is the app,ic. - (Name of i~widual ~gmng application) above named. He ~s the .................................................................................................................................................. (Contractor, agent, co~orate officer, etc.) of sa~d owner or o~ners, and is duly authorized to perform or have performed the sa~d work and to ~ke and th~s application; that all statements contained m th~s apphcation are true to the best of his knowledge and belief' . tha~ the work will be performed in the manner set forth in the apphcation filed therewith Swam tp before me this ...... o, ...... ~ ~: _ l,~ / I'_ .' y [ -~_ ,~...K.~-~....~L.t,,.f..f..,[(Sia ............................................. Not~rt Publi~~.~~ ..... Cou~ ~~ (S'gnature of applicant) ~OTARY PUBLI0, No 52.8125850, Sutlol~ Term Expires March 30, . J- Iv'd'..! ~ t t /: 1 / ?LooE Pt.4rJ: ' r ® PLAN- · F'IbL~D ,~lf~,D'~S .SH/&LL[~E' FILED ,'AT COO.4f~.D-'rlIOMOF E~L)ILO~MC.~L., , ~ EF,j E ~ A L M O-T ~~ ,7 ,6,LL ~.,i,A_,..~Dt.J~. V,C/fl. Li.~ .~j,4~LL Egr~ L/&.i~) iM C::~ MOi_P.T~,~ i~ ~ M i~ OAK 5TR, IP FLoOr~ltq~ /-/-" V~"/'L Cove J , 'I , iI LL ; \ : \ \ \ \ \ \ , . rI · r ? ! ' f