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Home My WebLink About5212-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .Sth. & .W~g~.ns .5~; ........ Street Map No. ~ ........ Block N .o'~3~.. ........Lot No.m...Gx'senport .... N.oX, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Apltil...~.., 19 7.1.. pursuant to which Building Permit No. dated ........... April...~. , 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. one. family..dwe~3Ang ...................................... The certificate is issued to .. A.d.a~...J. 0.~..s.Q.~ ..... . .~..e.r. ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~,~, .............................. ..... ......... Building Inspector ~ l~O~ NO. ~ TC)WH OF SOUTHOLD BUILDING DEPARTMENT TOWN CL£RK'S OFFICE SOUTHOCD, N. V. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~t,...0~;~s~....~/~.....~,. at premises located at ...... ~ _~!~./.~.t..~..~;~l.~G~l~t..{~~. ....................................................................... ......................................................... Ik'~e~.~oz~ ........... ~.~ ........................................................... pursuarut to application dated ................................. &~.....~ ....... , 19..~., and approved by the Building Inspector. Fee $ ..... ~ ......... * ~ - Building Tnspector / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... ........... " " i & 7- Approved ........................................ , 19 ........ Permit No ............................. D~sapproved a/c .............................................................................................. L APPLICATION FOR BUILDING PERMrI' I NSTRUC'TIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buddin, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoEning premises or pubhc streets o areas, and g~ving a detailed description of layout of property must be drawn on the d~agram which ~s part of thEs applicat~or c. The work covered by th~s apphcotion may not be commenced before issuence of Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the apphcant. Such perm~ shall be kept on the premises avadable 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 untd a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perm,t pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe~ The applicant agrees to comply with all applicable laws, ordinances~ui, lc~ng code, hous,n~..code~ and regulations (Signature of applicant, or name, if o corporation) .............. :. 7' ........... (Add/~ss of applicant)~ State whether applicant is owner, less~ee, agen~t, architect, engineer, general contractor, electrician, plumber or builde If opplicant is a corparate, signature of duly authorized officer (Name and title of corporate officer) Location of land on w/~h proposed work will ~one Map No .......... :....~. ..................... Lot No ,] . :: ............. Street and Number J~/~,Z1¢~..~C... ..... ~... ........ ...~.....~.....~.~..:.~...~~ ................... /J u MunicipallY/ State existing use and occupancy of premises and intended use and occupancy of proposed construction Ex stin use an' occu anc ~ "~nJ~z~c~'~ " a. g a P Y .......... I.. ~ .................. t ..................................................................................... b. Intended use and occupancy ... ~ ........................... .&......~ ....................................... 3. Nature of work (check which applicable) New Building .................. Add~tion .................. Alteration Repair .................. Removal .................. Demohhon ................Other Work (Describe) .................................. 4 Estimated Cost ...~'~.......i~.....[...~ ............................... Fee ...... ~...Z...~C~. ......................................................... (to be pa~d on filing th~s application) 5 If dwelling, number of dwelhng units ........................... Number of dwelhng umts 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. D~mens~ons of ex~sting structures, if any: Front ...... ~.....~. .......... Rear .....~ ..................Depth .~.....O .......... Height ......~-..~,.'. ........ Number of Stories ...... ~....X.~,4~.? ........................................................................................ D~mens~ons of same structure with alterations or additions. Front ..... ~ .....................Rear ..~ ............. Depth .....~:~....~-7.....~. ........... Height ................. :. ......... Number of Statics ................................ 8. Dimensions of entire new construchon' Front ................................... Rear ............................ Depth ......... Height .................... Number of Stories ....................................................................... ? ............................. 9. Size of lot: Front ..... .~......l~.. ............ Rear ........... Z"..~....~. .......... Depth ...../....~-.....~. ......... 10. Date of Purchase ..............~....~.'....~...;.?...~ ................... Name of Former Owner ..~~~:.:.:. ............. 12 Does proposed construchon vialate any zonina law, ordinance or ~,e~ulahon~ .... .}'~.... ~ ....................................... 13 Name of Owner of premises ~..'~....~..Address .... ~.~...~y Phone No Name of Architect .......................................... .. ....... Address ....................................... Phone No .................. Name of Contractor ~..~~ :.~. ....... Address .....~.~qj~ ...... Phone No ............... PLOT DIAGRAM Locate clearly and distinctly all build,ngs, whether ex~sting or proposed, and mdmate all set-back dimensions fra~ property lines. G~ve street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot. STATE OF NE~/xOI~K~,r~i~ ~¢ cou (Name of indiv,dual s,gning application) . ( ~ - ~, above named He ~s the ................................................................................... ~~..'. ........................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and f th~s apphcation; that all statements contained in this application are t~e to the best of his knowledge and behef; a that the work will be performed m the manner set fo~h in the application filed therewi~ Swor~9 before me this ~ _ ~ ~ ......... ......... .... ............. ....................... ~/z~ N~ARY PUBLIC, State of New ~o 52 8125850, Suffolk ~erm Expires March 30,