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Home My WebLink About5288-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z.~FI~. ..... Date ....... 0~t, obel~..10, ........ , 19. THIS CERTIFIES that the building located at ~'ookg~" Ol'e~k-.l)l~,v® ...... Street Map No ...... XX ..... Block No...~ ...... Lot No.. ~... 80~l~hol~ ................ conforms substantially to the Application for Building Permit heretofore filed in this office ~.,~d~.~ .. AI~:L~. ~! .......... , 19 .?1. pursuant to which Building Permit No.. ~88Z. _.i~~d .. ,~.,~. l~ ........... , 19.7~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... l~v~;e. ~ .poo~ .&. £~ .................................. The certificate is issued to ... Jo~31. ~,..0!~e. IIX ............................ . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...1~. .............................. UNDERWRITERS CERTIFICATE No.. ~ ........................... ~ ............. ttOUSI~ NUMBER ..... ~1.8~0.. ,Street ....~lMltke~'. l~l'~lll[. ,DI*~'~ ....................... ............................................... 8o~t, hol~ ......................... Building Inspector FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5288 Z Dote ........................ ~ ......... .J.~. ......... , 19.~'.'J... Permission is hereby granted to: at premises located at ....................... JJ/~..~:~k$~..OJJ..J)~ .............................................................. ....................................................................... ~e~t, ho.~l .............. J~,~, .............................................. pursuan~ to application dated ........................... ~j~J~ ....... J ........... , 19..~.$., and approved by the Building Inspector. Fee $"~a~ ............ TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, No ¥o INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink -,nd submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premialt or public streets or areas, and giving a detailed description of layout of property must be drawn on'the diagram which 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 a~nt. Such permit shall be Bept 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 I'~REBY MADE to the Building Department for the issuance of a Bulldlng Permit I~nluant to the Building Zone~Ordi.nan,~e of the Town of Southold, Suffolk County, New York, and other applicable I.awl, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al homln deecrlbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and r~lulatl~s. ..................... ~'"'"~ ~'~ ~ (Sigddture cf applicant, or name, If/6 ~l~ratlon) ,' , K~) ' ~. ~-~ / -- ~ (Address 6~ appllcant)~ State wheeler applicant is owner, Lessee, agent, architect, engineer, general contr~tor, electrician, plumber or builder. Name of owner of preml' ..... ~,~.: .... ..~..,.Z.L'~..,~, ..... ~ ..... ~ .......... i ..... If applicant is a corporate, signature of duly authorized officer. .................. "-';;;fi,;i;':;;i';;;;;;';;';";';,;;;';; ........... ' ....... 2. State existing use and occupancy of prem~es and intended use and occupancy of propaeed comtmctlan: a. Existing' use and occupancy ............ ~. ......................................................................... b. Intended use and occupon? , ........ ~ ............................................................................ 3. Nature of walk (check whi pplicable): New Building ..................Addition .................. Alteration ............. Repair .................. Rem.~al .................. Demalifian .................. Other Work (D~cribe} (to be paid on fi~ing 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 occupancy, specify nature and extent of each type of use ..: ......................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ............ Height ........................ Number of S~ories ....................... ; ............... ... ............................................... . ......... Dimensions of same structure wULh alterations or additions: Front .................................... Rear ........................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 10. Date of Purchase ............................. ~. .......................... Nome of Former owner ........................................................ 11. Zone or use district in which premises are situated ........ ~.......~ ......................................... 12. Does propos~ construction violate ar~'/~'aning law, ordinance ar regulation? ......... .L~u~:.~...:..~ ........... j ............. 13. Name of owner of premise~/:.~./.~.~Z~...Address~ ............... %hone N~'~.(iLt.~ ............ Name of Architect ............................ ~ ......................... Address ............................................ Phone No ..... ~:.: ........... PLOT DIAGRAM Locate Clearly and ~JstinCtly 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 whetl~er interior or comer lot. STATE OF Nb'W ~I~ORK, i / .~ t COUNTY OF .,~.~-,-~-~..~;,:...J' ~ - ~<~-~.,~.-L~.~,CL~:::iL~---~./....4/~f..c....~ .......... being duly sworn, deposes and Says that he is the applicant / (Nome of ,ndividual signing applic~ion)~2.~'~"~ ~r----~. above named. He is the .." ................................................................. ~, ~,. ....... .:. ............................................. (Contractor, agent; corporate officer, etc.) 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 hil~.J~nowledge and belief; and that the work will be performed in the manner set forfl~ n the;app cat on f led therewith, Swom to before me this ~ ' ~ ~ ~'' ' ....... ..... ............. (S,gn reofop ,co ...... N ADELE PAY