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Home My WebLink About5223-zFORM NO. 4 TO~FN OF SOUTHOLD BUll.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~ .I~Q~ ...... Date ....... THIS CERTIFIES that the building located at . .L.e~.g..C$.e.e.k...DR ........... Street Map No.~..e~...*. ..Pk.... Block No ........... Lot No....~.~ ....... ~..o~..t.h.o..l.d...N ...~.,. ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........Ma~... B ..... , 19..~J pursuant to which Building Permit No. ~2.~... dated ............al~l'~.l... 9', 19.71., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is p.~.~. ?.~.t.e...~g. ]p.o.e.~.. 4..a.~.~.e..~ .~.o..z~.. ~.~.e.). .......................... The certificate is issued to .. l~ellald. Bltlch .... 0~rzm~ ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...I~,~Lo ............................. .... '!:.('... ::i:'1 ............ :Building :h'mpectdr FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5223 Z. Pen~ssion is hereby granted to: ......... · ~ ...... tlem~,~.- Jj~l~ ',ir · ',it~e' ................ to ....... tm~&..Imm.~~..l/j~l..~£t~.. £m~ee.&. ~l~ee~m~ifj~ ................ ~[ai~..~..~..~~ ...................................................................................... at premises located at .......... :-.-~t-...-~-.-J.~ ..... ~J~$O~,~--J~J~JE .................................................. ............................................... ..~../~l....q.r...e..e.~...Pr$~. .............. ~.e~t~ ....... Ii.,I, ....................... pursuc~t to application dated .......................... JJl~Jl~ ....... j~ ............ , 19...~l~j., and approved by the Building Inspector. Building InspectorI so rrHOU), No ¥o APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoin ag pram ee$ or publ c streets or areas, and giving a dMofled description of I¢~o~1' of property must be drawn an the diagram which is part of thee application. 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 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 Build,ng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bud ng Permit pureuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app cable Laws, Ord nonces or Regulations, for the construction of buildings, additions or alterations, or for removal or demo t on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bui~ng cod.,~ cod~, and regulations. · TSIgnatu~e cf applicant, or name~.if a corporation) ...... ....... State whether applicant is owner, I~l~ee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name.of owner of prams.lees: ....................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) !. Location of land on which proposed work will be done. Map No.: ......~./....~'..Z .... Lot No.: ..../../.. ............. Street and Number ~ ...,~..~ ............. .~.~. " ' ' ,~- ~c)~ ~ _ · .......................... 2. State existing use a.nd occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ ................... b. Intended use and occupancy', ~... ....................................................................................................... 3. Nature of work (check which applicable): New Building ~ ................. Addi'~on .................. Alte~'ation .................. Repair ................. .~Eemoval ..................Demolition ............. ~,,~her Work (Describe).~.~. .................... Est,mated Cost ..... i .~.....~..~../~.... .................. ; ........ ~ ....... Fee .; ............. : .......................................................................... (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 ...... .~'...~... ............. Rear .....x~....~... .................. 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 ........ ../..~. ..................... Rear ....../.~. .................. Depth ...~.......~,~....~... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front .......................... Rear ........ ~ ..................... Depth ..../.. ......................... 10. Date of Purchase ............. ./...~'...~..., .............. Name of Former Owner--S.. ~'-'~ ~ ~ 11. Zone or use district in which premises are situated .... ~ ~ ...................................................... 12. Does proposed construct on va a~ any zon ng la~, ordnance or regulation:~ ~....~.~.~.. ~ -~ ,~'.Z.. ~(~c 13. Name of Owner of premises~...~ .~....~.'..~F~&ddres.~..~~-~-. Phone Name of Architect ................ ~ ..................... ~ ........... ;Address ........................................... Phone No ..................... ....... Name of Contractor PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or prOposed, and Ind cate a I setd~ack dimens ons fram p.rc~..erty lines. Give street and block number or description according to deed, and sh°w street names and lndicai-e whether interior or comer lot. STATE OF NEW' YORK, ! e e cou, OF ............ ............................. ; ............................................................... ~mg duly sworn, d~s and says t~ be is the applicant (Nome of individual signing appllcotl~) above named. He is the .... ~o~c~o~ .~' (~ntmctor, ag~t, co~omte officer, ~c.) of said owner or owners, and is duly authorized to peHorm or have perfo~ed the said work a~ to ~e ~d file ~is ~plica?on~..t~at al~ statements contained in 7his application am tree to the ~st of his ~owl~ge a~ ~lief; and nat the wor~ wm oe pertor~a in the manner ~t fo~h in the applicati~ f ~e~ith. N~a~ pu~i~ State of New Y~ N~ 52-34489~ Su~lk C~n~