The URL can be used to link to this page

Home My WebLink About5233-zFORM NO. & TOWN OF SOUTHOLD BUILDING DEPARTMI~.NT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No... ~..~.~ .... Date ............... .C,.c.t....1.~. .... , 19.. ?.1 THIS CERTIFIES that the building located at 'l~a~t~1er' 'Road ............. Street Map No.~.e.r.r. lr. i'(~.~.,e. Block No ........... Lot No..36 .... $ou. tho].c~ .... I~.,Y. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~pril' · '11~ 19. ~1' pursuant to which Building Permit No.. 5~3~. dated ...........~pr:EL-. '1'5', 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 · Pr~.va~;e 'ga~'age' '('acce'ssorF t~u$1d~.ug) ............................. The certificate is issued to .. '~horvetd. Re~ers~n ..... Owner ....................... (owner, lessee or tenant) of the aforesaid building. Smffolk County Department of Health Approval House ~ 1100 Building Inspect~/ FOKM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT CI'HI5 PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5233 Z Permission is hereby granted to: ................. l"~.....JJeie.~aJ~ .................. ............... ~ ...... 4~5~- ........................................ .................... 1~~ ......... I~]~.~ ..................... to :....lea~a..~aeae..~&vete..(aeeee~e~.)...~,tlle .............................................. : ............... at premises located at ........... ~It~J;---~-., ....... ~S~J~--~J~te~ ........................................................... ................ : ..... :' ................. : '" ttal13.:Li.~r ..t~m~ ...... :-'" J~Je-a~]r. ir~ ....... It-~.~ ...................................... pursucm[ to application dated .......... : ................. ~J~ltj,~ ....... ~J~ ....... , 19...~.1., and approved by the Building Inspector. ..... ~"~"';B'!ii'~ding Inspect~'r' ......................... Approved ....................................... , FO~ NO. 1 ~/.~ TOWN OF SOUTHOLD // / BUILDING DEPARTMENT-- TOWN CLERK'S OFFICE $OUTHOLD, Iq. Y. 19 ....... Pem~t No .................................. D~sapproved a/c ..................................... , ............ ~ APPLICATION FOR BUILDING PERMIT ....... .............. INSTRUCTIONS a Th~s application must be completely filled in by typewriter or in mk and submitted in duplicate to the Buildm Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubhc streets c areas, and giwng a detaded description of layout ofproperty must be drawn on the d~agram which ~s part of this applicat~or c The work covered by this application may not be commenced before ~ssuance of Building Permit. d Upon approval of this apphcat~on, the Building Inspector will ~ssue a Budding Permit to the applicant. Such perml shall be kept on the premises available for inspection throughout the progress of the work. e No building shah be occupied or used ~n whole or ~n part for any p'brpose whatever until a Certificate of Occuponc shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to th Budding Zone Ordinance 6f the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, addmons or alterat~G~, or ¢or removal or demohtion, as herein describe, The apphcant agrees to comply wfth-all opphcable lows, ordinances, building code, housing cede, and regulations. (Signature of applicant, or name, if a corporation) ........ : .................. ' .......................... State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budde~ If apphcant ~s a corporate, s~gnature of duly authorized officer (Name and title of corporate officer) 1 Location of land on wh,ch proposed work w,ll be done. Map No...'~.~..~.......~/...~.'~--~.~. Lot No ........ .'.~....~.. ....... Street and Number ............ ~./~....I~...~....L..~/~/~. ..... ~....~...~..~).. ................. ..~...~..~..O...L..~.. ............................ ~f -- / / 0 ~ Municipality 2. State ex~sting use and occupancy of premises and ~gtended use and occupancy of proposed construction: b Intended use and occupancy 3. Nature of work (check which applicable) New Budding .................. Addition .................. Alterahon .............. Repair .................. Rem~,a_l ................Demolmor .................. Other Work (Describe) ............................... 4. Estimated Cost ................ ~...~ ................................ Fee ........................................................................................ (to be paid on flhng th~s application) 5 I[ dwelling, number of dwelhng units ............................ Number of dwelhng umts on each floor ....................... If garage, number of cars ................ ~'......~ ................................................................................................. 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 D~mensions of existing structures, ~f any' Front ...... -~7 ............. Rear ................................ Depth .......~..T ......... Height ........................ Number of Storms ........... :.....~. ............. .~. ...................................................................... D~mens~ons of same structure with alterahons or additions: Front .................................... Rear ......................... Depth .............................. Hmght ....................... Number of Stones .............................. 8 Dimensions of enhre new construction Front ............. /...~. ............................................. ! Rear Iq ! Depth ..................... .2.~ ! Height ...... ---'.//..'. ...... Number of Stones ................ ? ........................................................... 9. Size of lot: Front ......... ././...~.. ......... Rear .............. ./~....O.. .......... Depth ........... ./...~...~.. ......... 10 Date of Purchase ...................................... ./...~...~ .~... Name of [ormer~Owner .................................................... 11 Zone or use &strict m which premises are s~tuated .......................z~ ....................................................................... 12. Does proposed construchon violate any zomng law, ordinance or regulahon? ............. ~ ................................ 13. Name of Owner of prem,ses~....~..~..~.. ..... ..~..~..~- .-~.-L~...^ddress -.~-..~.......-~.~...'~...~...~.f.~.t~.~...~4~. ¢~h'~o~ne~ No.~..~..7...-~...~. Name of Architect .................................................... Address ............................................ Phone No .................. Nome of Contractor .................................................... Address ............................................ Phone No ................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to d.epd~ and show street names and indica whether interior or corner lot LDI~ ~1.~ LoT' Il&, ~ STATE OF NEW~'O[~,~ COUNTY OF ~ ............ (Name of individual s~gmng applicahon) 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 fi this application; that all statements contained m th~s apphcation are true to the best of his knowledge and behef, tha~ the work will be performed in the manner set forth in the application filed therewith Sworn to before me this ...... ...... ....... ................ . (J[LIZABETH ANN NEVILLE NOTARY PUBLIC, State of New York fie 52-8125850, Suffolk Cou~h Ter~ ~xp~res