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Home My WebLink About5240-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z.~20g ..... Date ............. &~... 9 ....... , 19.?~.. THIS CERTIFIES that the building located at .S®und. P~a~ ............... Street Map No. ~ ......... Block No .... ~ ..... Lot No ....... ~...B~per~ .. ~.,~... conforms subst~ti&ly to the Application for Build~g Permit heretofore ffl~ in this office dated ........... Ap~.. ~ 19...71p~su~t to w~ch B~lding Pemit No .... dated ........... &pr~-. 16, 19.71., was issued, ~d conforms to ~1 of the ments of the applicable pro,ions of the law. The occup~cy for which ~s certificate is issu~ is . .Private..one. f~i~ .dwe~l~g ...................................... The certificate ~ issued to ~e~. A~Se~ ..... ~ ............................... (o~er, lessee or ten~t) of the ~ores&d b~g. S~o~ Cowry Dep~tment of He~ Approval .... N..R. ........................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MOST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5240 Z Permission is hereby granted to: at premises located at ........... ~O~l~l~..~U~h~- ....................................................................................... .............................................................. ~,z.~e~t:.: ......................................................................... pursuan~ to application dated ............................. il~l~L ....... .~ ...... , 19..,~, and approved by the Building Inspector. Fee $.....~.~...0~... .......... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............................. , 1 ........ Approved ~' 19....~.~... Pemit No. -~c:~ Z/O ~- Disapproved a/c .............................................................. ~ (Budding ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.....~....~.....~....0. ......... {. a. This application must be completely filled in by typewriter or jn ink and submitted in duplicate to the Building Inspector. ~o b. Plot plan showing location, of lot and of buildings on premises, relationship to adjoining premises or public streets r 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. ~t 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 Occupan 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, ordi nances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) Green~®rt (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................................... .................................. ............................................................ Name of owner of prem,ses ...~T.,~'L~..,~iLSe~. .........--~'"'~'"'"~;~'"'-~;'-'"'~'-~ ...... ..~..l..~ ........................................................ ,. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done Map No .:... z,]& ......... Lot No ~ St reet and N u mba r . Z .~..~f..;~...~,.t~_. ~?~ .~_.~1~ ~ ~' '~'~'['~ il~i ~'" ................. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... e]sze,].~;~i~ ........................................................................................................ b. Intended use and occupancy ............ S~Le. ....... ~Ll.[j~..a.13...~_~J,~;~e~ ............................................................ 3. Nature of work (check which applicable): New Building .................. Addition ..31:ZZ. .......Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..................... .c~oD ......... ..+....LL .............. Fee ...,~.,D.0 ............................................................................. (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 ................................ 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 ........... 1.3 ............. Depth .......... .~..~. ......... Height .................... Number of Stories ...................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ."~.". c~Lg~ 12. Does proposed construction violate any zoning law, ordinance or regulation? .... .~...~. .......................................... 13. Name of Owner of premises ..*,T~I~L..~i~. ........... Address ......... GZ'.e~p.~3~.~ ............. Phone No ..................... Name of Architect ...................................................... Address Phone No ..................... Richter H.I.Oe .. Gree~pert Name of Contractor .................................................... ~aaress ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from pr0perh/ lines. Give street and block number or description according to d~:~, and show street names and indicate whether interior or corner lot. I STATE OF NEW YORK, J S S COUNTY OF. ...... ~1~.~.~1.1~ ........ $ ' ..................................... ~ ............... '."i.~.~J~l~...JJ;J,~Jxt~l'....being duly sworn, deposes and says thot he is the applicant (Name of individuol signing application) above named. He is the .................. .g. ll~,~'~'.li~.td~'. .......................................................... (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 contoined 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~'~' ~ /~ ~') · ~/)~, ~' April 1;~1.~ ~ ~~..~,/~ ~~ .................. 16. day at ............................. :. ............ , .... Notary P u b I i c ,~~..~..,~..~,d~ ...... ELIZABETH ANN Nr-~ILLE NOTARY PUBLIC, State of New Yo~ No. §2-$125850, Suffolk Term Expires March 30, Z~