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Home My WebLink About5296-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .C&r~.~g.~.~. &..l~..~.. ~.0... Street Map No~.. ~,.. Block No ........... Lot No..~8~....~~.. ~Y, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ ..... ]~ .., 197.].. p~su~t to which Building Permit No.. ~. dated .......... ~... ]~..., 19~]., was issued, and conforms to all of the req~re- ments of the applicable provisions of ~e law. The occupancy for which this certificate is issued is ...~a~. ~aoalo~. ~ ...................................... The certificate is issued to . R .&. ~. ~gt~ ....... ~r~ ..................... (owner, lessee or tenant) of the aforesaid building. S~olk County Department of He~th Approval ...[~: ............................ ~.., ~ ~.~er. ~r~ ~ ~... FOR~I NO. 2 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? 5296 Z Permission is hereby granted to: ..... A,...ileiZl~...&..~na..I~.....A/g...K,...ae~'rin~n ........ ¥~a ¢,I~ t.t,-~e,k ................................ .................. to . t~l,td,, ali..~£t £o~..e~..exial~la ~..ac~ea~...blflg .............................................. ....................................................... ~;'a; .................................... : ......................................................... ot premises located at .......... ]~t~.~ ....... L...::.:.~.'g...}?£..!~ ........................................................ ....................................... liey,~aCe~..~... ,~,~iag. t ~..~:~-..; ........ {~t~hes~e ........................... pursuan,t to application dated ........................... ~y .........:l~,........., 19..~,1.., and approved by the Building Inspector. Fee $ ..~.e.f~. ............ APPLICATION FOR BUILDING PERMI'f INSTRUCTIONS ~ a, This application must be completely filled in by typewriter ar in ink und submitted in duplicate to the Buildin~ Inspector. . . ~j b. Plot plan showing location of lot and of bu.ildings on premises, relationship to adjoining pmm~ses or public streets oW areas, ana g vlng a detailed description of layout ot property must be drawn an the diagram whlch Is part of ~ie eppllcation.~ 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 permiL~1/ 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 a Building Permit punmant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York ond other appllcoble Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant ngrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ......... ........ (Addres~ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................. .................................................................................................................... Name of owner of premise~ ....... ~. .......................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. ~, (Name and title 'of corporate officer) ~.~ ~o~ 1, Location of land on which proposed work will be dane, Map No,: ~...~.~-.~.,.~...~..,, ..~,.,?.~...,d(../~... Lot No.:~ .......... Stree and Number ~ ~ ~ ~ C~/~ ~ ~ ~ Municl~ll~ 2. State existing u~ and ~cu~ncy of premises and intended use and occupancy of pmp~ co,traction: a. Existing u~ a~ ~cupancy ................................................................................................................................... b. Intended use and ~cupan? ~eC~ ~.~ ~o o~ 3. Nature of work (cheCk which applicable): New Building ~ ................. Addition ................. Alteration ............... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ...~.....~....~. o ~, 0 8 - . ~ .o...o... (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 occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front .........,~....o. .............. Rear ......... e~..o. ................. Depth ..~..Q ........... Height ......... ~...~ ......... Number of Stories ....... ~ ....................................................................................................... Dimensions of same structure with alterations or additions: Front ...... ~..~.....'. .................. Rear Depth ......... .~..0. .................. Height .: ........ ~.. ............. Number of Stories .............. ./. ............... 8. Dimensions of entire new construction: Front .......... /~.. ................... Rear ............................ Depth ..~....O. ............... Height ......... ~....~.. Number of Stories ........ ../. ........................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................ .~ .............. 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ] 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ -~ 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly 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 comer lot. /ou STATE OF NEVi YORK, 'lee COUNW ................ ................. · /[4'...'....x..~....7~.4cJ:4~......~'7....c.../.('..~../.......47..~. ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 alt statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this NotoryPublic,( tLz .. ...... da.y of ........ ............. : ........ ' ........ ........................ NOTARY PUBLIC. State of New Yo~k No, 52-81.25850, Suffolk County Term Expires M~rch