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Home My WebLink About5295-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Cerlificnte Occupnncy No. ~1~ ...... Date ............. V.~.b....1~ ........ , 19.~.. THIS CERTIFIES that the building located at II/~1~ .(~'~k. 9~ .w$~ ...... Street Map No. ~ ......... Block No.. ~ ...... Lot No..~ .$~ .... ~,~, ....... co~orms subst~tially to ~e Application for B~ding Pemit heretofore filed ~ ~ office dated .......... ~ ...... ~., 19~.. p~s~t to which B~lding Pemit No.. ~. dated ........... ~..~..., 19.~., was issued, ~d conforms to ~I of the requir~ ments of ~e applicable pro~sions of ~e law. The occup~cy for which this ce~ificate is issued is .... ~$~ .~ .f~y. ~1~ ................................... The eer~icate is ~su~ to . ~,~~ ..... ~ ............................. (owner, lessee or tenant) of ~e Mores~d b~d~g. S~o~ Co~ty Deponent of He~ Approv~ ...N~, ............................ ........ -" ........ FORM 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? 5295 Z Permission is hereby granted to: ................... G~.~h~u~ ....................................... to .. ~3,~ ..a~..ee[dA~.em..e~.. ex,l, st,~,n~. &~e3~ ~1 ............................................................ at premises located at ..... ~..'[. ~..~Z'....;~e~ .......................... .................................................... ~e~t,~t ........... ~-¥, ................................................................... pursuonl' to opplicotion d~ted ............................ '~1~ ......... ~ ............ , 19...~., and opprov~d by the Building Inspector. Fee $.~.&~{~ ............. IPOBif NO. I TOWN OF soUTHOI. D EUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, No ¥. APPLICATION FOR BUILDING FERMI'[ U0 19...~/. Date INSTRUCTIONS o. ~rhjs application must be c~mpletely filled in by typewriter'~r in ink u~d"~ubmitted in duplicate to the Building~ Inspector. . . ~ b. Plat plan showing location of lot and of buddings on premises, relationship to adjoining premi~al or public streets or areas, and giving a detailed description of layout of property must be drawn on the dlngram whlch it pert of ~hl~ application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Bulldin~ ln~ec~or will ~ a Building Permit to the applicant. Such permit~'' shall be kept on the premises clvallable for inspectio~n~'t'Th, mughout the progress of' the work. e. No building shall be oc~:upied or used in whole or in port for any purpose whatever until a Certificate of Occupancy'~_. shall have been granted by th6 Building Inspector. ~'~ APPLICATION IS htEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other appllaable I.awl, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein described. The applicant agrees to comply with all applicable laws, ordlna?~ces, '~uilding code, ho~u~ng code, and regu~ptlons. "'66;;'6~"~¥';'~ii',:;~;~.7;7';6~;;'iT~'~;'~.'~,'~,'~' ........ ;~ ~"o C~ .... ~ ............ (Address of applicant) State whether applicant is owne~','~lessea, agent, architect, englnallr, general contractor, electrician, plumber or builder. ................................................................. '.::z.:'. ...... Name of owner of premises ..i......~.....~... ....... ~ ........................ i .............................................................. .~, If applicant Is a corpoKa~e, signature of duly authorized officer. (Name and title 'of corporate, officer) 1. Locat on of and on wh ch proposed work , be d~ne Map.INa.: ..~..~..q.f.....~..?!..~..~.~. ........... kat,l~O. _O....'l~.. 6p....e~....~.. Streat and Number ............. ~.....~...~:~........~....~.~.... ....... P~.........................,...:: ................ Municipality State existing use apd occupancy of premises and intended us~e~and occupancy of proposed comtructlon: · g ana ac p cy ........ -~..._:.~ ........................................................................ b Intended use and occupan--, , .... ~ ................................................................... 3. Nature of work (check which applicable): New Building .................. Addition ......... ~.. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost .............. ~.....6~..,...~... ............................. Fee ......................................................................................... (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, speci,fY6nature and extent of each type of use ............................ 7. Dimensions of existing s~ructures, if any: Front ........~.~.. ............... Rear ...... .3.2..?. ................. Depth ..~.7 (' ........ Height ......... ./..~'... ....... Number of Stories ............./. ............................................................................. Dimensions of same structure with alterations or additions: Front ......... ~.~..~..~ .................. Rear ...~...~...6..i ....... iiiiii Depth ......... ~,.~..,6. ............... Height ........... /...~.. .......... Number of Stories ...... ./. ........................ 8. Dimensions of entire new construction: Front ............. t.~.. .................. Rear ...... ./..~.. ................ Depth ..../...~.. .............. Height ......... ~...'~'... .... Number of Stories ............... ./. ..................................................................................................... 9, Size o~: lot: Front ......... ~.~..~.. .......... Pear ........... ./...Z...~.. ................ Depth ........ ~.~...~. ................ 10. Date of Purchase ........................................................ Nome of Former Owner ......................................................... 1 1. Zone or use district in whic~ p, ,r~rnises are situated ............ ~. ..................................................................................... 121 Does proposed constrUcfio~ vi01ote any zoning law, ordinance or regulation? .....~... .................................................... 13. Name of Owner of premis'~s .~./..~..¢~.....~..x~L~..~..~..Address .~.f~'../...~..~.e..~.....~..~.....~.~.~.....~Phone No..~..~....~'..../..~....~... Name of Architect ............................... ; ...................... Address ............................................ Phone No ..................... Name of Contractor ...~'...~........~..~...~.........~..~!.~..~..~..f. ........ Address ...~.§~.R...~..~.~...~.~,..C..~...~...o.~.¥..c. Phone No..Z.~.~....6.?/..~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and b~ock number or description according to deed, and show street names and indicate whether interior or corner Jot. COUN~,~ ..~..a...:f' · ' , .............. ~'~ ......... ~,~...~.,J ......... ~..,~..~bei~ .~ sworn, d~oses and says t~ he ,s the app,,cant (Na~ of individual signing application) ~ ~.. ~ above named. He is the ......................................... ~ .............................. ~ ....................................................... (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly autho~d ~o~ ~rm~r h~e perfo~ed the said work and to ~ke and file this application; that all statements containe8 In~t~is op~cation are tree to ~e ~st of his knowledge and belief; and that the work will be performed in the manner.~tf~ ~Be application filed ther~ith. Swam to ~fore me this ___ ~ __ ...... o, ....... ........ : ....... . .......... ................... ..................................