The URL can be used to link to this page

Home My WebLink About5275-zFORM NO. ~ TOWN OF SOUTHOLD BUff,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.. Z)~:~:0 ..... Date ............ 0c~,. · 21 ........ , ~1.. THIS CERTIFIES that the building located at ,. p.$r~e.. ?~.e.~.g..R.~ ........... Street Map No...XX ..... Block No. ~ ....... Lot No.. ~ .~0~ ~ol~l..~ ,~..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ l~a¥.. )+ ......., 19.~.~. pursuant to which Building Permit No. dated ........... .~.~Y...~. .... , 19.~.~.., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... P~.ivate .acces~o~.~. (. ,~tor. a~e.)..bui~li~g ........................ The certificate is issued to..V, era..~ie£~.b~cher ...... ~mer. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approval .... .~;;~. ............................ llouse ?;' 920 ........ ?]:¥,.: ,~ .... Building Inspector FOItM NO. ~ TOWN O~ $OUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5275 Z Permission is hereby granted to: ............ .V..~.:.i.,~ ........ ~.L L['..!:..~.~..c....~!.~.h~.... SOU]- ~1¢~ L g pursuant to application dated .................................. ,.£..! ....... ..~.~..A...'.f.., 19...--J....J., and approved by the Building Inspector. Fee $ ...... =~ .............. Building Inspector 2.30. l~'olt~ ~i'o. 1 TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ..... ~....~...~.. ............ ~ ......................... ...................... ........................ / (Building Inspector) APPLICATION FOR BUILDING PERMIT ~ °ate ........................ 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 a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The w~k 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. Building Department for the issuance of a Building Permit pursuant to the APPLICATION IS HEREBY MADE to the Building Zone Ordinonce of the Town of Southold, Suffolk County, New York, ond other applicable Lows, 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, ond regulations. (S'g a re of applicant, or name, if a corporation) ........... .9.20....~;ne....liee~:....licu~l. ........................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) l. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ..................... Street and Number .... ~..~.O......~.9....~g~ ..~..~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ......... 9,~,t~..~?...~....~..~_t._n.~......?......~.. ............................................................ Intended use and occupancy 3. Nature of work (check which applicable): New Building ....... ~[. ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Ot~hej' Work (Describe) ........................................ 4. Estimated Cost .~..~O~00 ............................................. Fee ~-'- (to be parc1 on filing this applicatiOn) 5.~f e~lling, number of dW~l-ling-'~,,,,~..~ ................... NumbeF'~f dwelling units on ect~h floor ............................ g~c~ege, number or cars ......... ~.)..t'. .............................. 7..;.-:~ ......................... .; .................................................... 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 ~.0 ................................ ear ...... J~ .................... Depth ..].(~.! ?. ........... Height ....... .6.l, ........ Number of Stories ................... ~ ............................................................................................ Size of lot: Front ............................ Rear .................................... Depth ................................ Date of Purchase ........................................................ Nome of Former Owner ............................~ ....................... Zone or use district in which premises are situated ..~ ............ Does proposed construction violate any zoning law, ordinance or regulation? 1~ ............................. Name of Owner of premises .~ez'~.~,..11I.e~eetl~lz~ddress ....... .~20..~..llee~.,E~e.. Phone No..?~,~...~.6... Name of Architect ................~ ............................. Address ............................................ Phone No ..................... Name of Contractor .............. J~t(tae ............................. Address ............................................ Phone No ..................... 10. 11. 12. 13. PLOT DIAGRAM Locate ~learly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or descriptiOn according to deed, and show street names and indicate whether interior or corner lot. COUN~ OF .~ ............. ~ ' .......................................... · ~. ........ ~ ........................ ~mg duly ~orn, d~es and soys t~t he is t~ applicant (Name of individual signing a~lication) above named. He is the ............................................ ~.~.~,~. .......................................................................................... (~tmctor, agar, co,rate officer, etc.) of said owner or o~e~s, ~d'le ~y authorized to perform or h~e perfo~ed the said work and to ~,ke and file this application; that all statements contoined in this applic~ion am t~ tothe best of His ~owledge and belief; and that the ~rk will be performed in the manner sef fo~H in the ~pllc~i~ fil~ therewith. Nota~ Public~~~ ......... Coun~ (Signot~ of applicant) ....... [LI~BETH A~ NEVILLE NOTARY PU~LIC,'~ 0f N~w Yor~ Term Excro ~rch