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Home My WebLink About5271-zFOBM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . ,.-~.~ ~ ............... Street Map No..~;]~ ....... Block No...~. .... Lot No .... . .~......Ma..~.t.$...t~,k.....~...~..* ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... . .M~.~ ..... 3.., 19.~.. pursuant to which Building Permit No. dated ........... M&~. ....3..., 19. ~.., 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 ... pl~Va~e. ~l'age · '(&oOUli~ 'l~l~l) .............................. The certificate is issued to...J.~..~...~.~..~ ...... · .07..er. ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Hm~me ~ 10~0 · li~.Re .............................. Building lnspecto~ FORM NO. ~ TO~N OF $OUTgOLD BUILDING DEPARTMENT TOWN CLEI~K'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5271 Z Permission is hereby granted to: ................ ~.~...s..~.~ ....................................... ................ ~,..~ ............................................... to .... Fs~.. ~4.. ~, ~v.. ~,z,-.t.~ ~.~...g e~'a~,~ .......... ~ &eces~z~..b3~l~') ............................................ at premises located at ................ li~/~.....K~t~t~....~i~ .................................................. ............................................................... b~a.t~t,.~.t, uei~ ....... ~-,~:~ .......................................................... pursuant to application dated .......................................... ]4~r ....... .~., 19..~.~.., and approved by the Building Inspector. tee $..~.,.~.0.. ............ ...... '~ Building Inspector NO. I ~N OF soUTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~.......~.. ~ 1 ~..~...~.. ........................................ , 19 ........ Permit No ............................. Disapproved a/c~......~..__ ~,.---.----'"~ ........... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot .pi.an showinfi location of lot and of bu.ildlngs on premises, relationship to adjoining premises or public streets or;~l~ areas, aha gtvlng a detaued description of layout of property must be drawn on the diagram which Is part of thl~ appllcation.~ 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold Suffolk County, New York, and other applicable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations,,~lr~for j',efnoval or demolition, al bereln described. The applicant agrees to comply with all applicable laws, ordin~.c~..e, i....t_. ~nd regulations. .... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ,, . ............................................... Name of owner of premises "~'"~'"~'"~'"'"' '~'"'~'~"'~'--~"~'"'"~'"'""~" "~'""~'"~'"X ............................................................. .-.~ If applicant Is a corporate, signature of duly authorized officer, i ................................................................................................(Name and title 'of corporate officer) ~ ~ /'~'~/'-c' ~ 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ~ ................................... ~ ........... ~...~.......~. ......... . .-~.........~..~... .......................... / Mu. c pa, -- 2. State existing use and occupancy of premises and intended use and occupancy of proposed comtmctlon: a. Existing use and occupancy ....... ~..~.., ..................................................................................... b. Intended use and occupan? . ........................................... . .. ~ ....................... ~ ................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ~.'.,~....~..~.~7-.~.. .......... 4. Estimated Cost ..~, .................................................. ~ee .......................................................................................... (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 ~ccupancy, 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. D~menslons of enhre new construction: Front ........ ~..~. .................... Rear ......... '~.~ ............. Depth 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 ~vhich premises are situated ....... ~ ........................................ ..;..~.! ........................................ 12. Does proposed construction violate any zoning law, ordinance or reaulation;~ /[/[/ ~,~ ..... ,~ ~-~, ";, "'~/~'~';r,~*~ ..............~ ...... ~ .... 13. Name of Owner of prem,ses ~..'.~.~.'.'.~/....~.. ......... Address ~ ......................... r.....: ...... Phone No .......~ ............. Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ................~~! ............ Address ............................................ Phone No .................... PLOT DIAGRAM Locat.e clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions from property hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF I.. OF _ - ............................. [./~....~..~~....~ing duly sworn, d~o~s and says t~t he is the applicant (Name ~ ind~ua~-igning applic~ J ~ / ~ a~ve named. He is th~ ........................ ~..~......~.~..: ................................................... (~ntractor, ag~t, calorie officer, ~c.) of said owner or owners, and is duly authorized to pe~orm or have perfo~ the said work a~ to ~ke ~d file this application; that alt statements contained in this application ar.~.~e ~is knowledge a~ belief; and that the work will ~ pe~ormed in the manner ~t fo~h in the a~lica~ ~ed ~i~. Swomto~fom~is~ ~~ 19..~ ~~ ................ ............................................. hloto~/Public, ~~~.... Coun~ ant) Ne. 52-8~2~, Suffolk Cou~