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Home My WebLink About5234-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. 21~9 ...... Date .............. Oct .... ~'~ ..... , lg..?~ THIS CERTIFIES that the building located at .,,est..~ho~e .Dx' ............ Street Map No~eydon. ~h.. Block No. G ......... Lot No. 4-3' &~ ........ ~outhotd. ~.,~ .. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... a_~r*t. · .~1+., 19. '7'~' pursuant to which Building Pemit No... dated ........ Apr$t. · 1 .~...., 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 ...Priva. te · orre · family, dwe.~.l-in~ ..................................... The certificate is issued to .. o'~n~('owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ~ ~i;. ........................... i~ouse ~- 675 Building InspectorI F~IIM NO. 2 TOWN OF $OUTHOLD BUILDING DEPART/~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5234 Z Permission is hereby granted to: J, ]ll~ A/~..;ll[,..~eme~e;~ ............................................... .......... ~tla~l~ .................................................. to ...... ~.~3,~,...~..14~t~,t~L~...~..ed~.t~n~...~w.el:Lf~ ........................................................ at premises loceted et ....... ~..~..~.~ ..... see..C....a~1~4~a~..i~l:eel ....................................... .............................................. ~e~.- ~:b.e~e.-~.~e .............. t~e~t~e~ .......................................... pursucmt to cpplication dated ................... Jt,~il~ ....... .1.~ ................ , 19.7.[.., end apprc~_ed by the ~uilding Inspector. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ~. ...... (....~......., 19..?..(. ........................................ , 19 ........ Pemit No ................................. ............ . .......... ; ................................. ','"':;m; ........................ : ........... .. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. ~ ,L-.~ ~' a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building'~ 'Inspector. , · ' . . b. Plot plan showing location of lot ~nd of buildings on premises, relationship to adjoining'premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. In 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 Building Inspector. ~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition; as herein described. The applicant agrees to comply with all applicable laws, ordinances, building cede, housing code, and regulations. /X~/(Signatu re. of. ~, ~',"~-' '~' ~or~;;~tio~i'"'"~--~ Store wh~ther opplicont is ~wner, I~*see, ooentr ~it~, engineer, Oenor~l ~ontroct~ electrici~, ~umb~r or builder. ~me o{ If applicant is a co~orate, signature of duly author/zed officer, .................. ....... 1. L~atio o land'onwhchpr~osedworkw hedge. MapNo' . Street and Number ..~..~...~x ............. ~.....~'~~~'['"[ ............ ~f -- ~ ~ , / MunicipalJ~ ~ ..... ~' ............... 2. State existing use and ~cupancy of premises and intended use and ~cu~ncy of proposed const~ction: a. Exisiting use a~ ~cupancy ....... ~~ ............................................................................ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .................. Addition ......~'. ....... Alteration ................. Repair ................. .~Removal ..................Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .... e'~...~.~_~ - ~ 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 ~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, speci~ nature and extent of each ~pe of use ............................ 7. D~mensmns of ~shng structures, ~f any: Front ....~....~. ........... Rear ..... ~...~. ................ Depth ~...~. ....... Height ....~.~. ............. Number of Stori~ ........ ~ ...................................................................................................... Dimensions of same structure with alterations or additions: Front ....~....~ ................ Rear Depth .....~..~.~.~ ...........Height ............................ Number of Stories ...........~ ................. 8. Dimensions of entire new construction: Front ......... Height ...... ~ ........ Number of Stories ....~. .............................................................................................................. 9. Size of lot: Front ............................ Rear .................................... ~pth ................................ 10. Date of Purchase ........................................................ N~e of Fo~er ~ner ......... ~.~..~. ............. 11: Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning aw, ordinance or r~au at on> ............. 13. Name of ~ner of premises~.~~..~ress~.~t~.~ Name of Architect ...................................................... A~re~ ............................................ P~ne No ..................... Contractor .~.~.~...A~ress~..~ ........... P~ne No.~Z~.~.~ Name of PLOT DIAG~ Locate clearly and distinctly all buildings, whether existing or pr~d, a~ indicate all ~t~ck dimensions from prope~ lin~s. Give street and bl~k number or description acco~ing to d~, and show street nam~ and indicate whether interior or corner lot. ri i~O' ' STATE OF NEW ~{~'J~Rl~.t,,,~ ~J ~ S.S ..C.~ ........... being duly swam, deposes and says he is the applicant ttmt above named. ~.d..u..a.i~ ................................................................................................. {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 Jn 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 appIicatior~ filed therewith. Swam to before me this ~ · .... ....... 0_x,.~ , ~ 7) , _ l _--/1,~ /// ; Y I. . . //E .......~?~z.~...~.l..../.~...; ...................... ,oto ...... Coun , opp.co. ....................... (J ELIZABETH ANN ~E~ILLE ~ F/- '! ' ~ NOTARY PUBLIC, ,State of New Yerk lie. 52-8125850, SIIffoJk Tam Exl~ires ~rcJ~ 30, !