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Home My WebLink About5327-zFOBM NO. 4 TOWN OF $OUTHOLD BUILI~ING DEPARTMENT' Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .. l~C~C. ~ .B].~ ...... Street Map No..'.XX ........ Block No. 1~ ....... Lot No... ~XX...La~il'o],t .N,]E, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... l~f-. 2.~. .... , 19.~[. pursuant to'which Building Pemit No.~2~... dated .......... p,~,.. ~ .... , 19.Fl., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this c~rtificate is issued is . .Pl'~,~ate. ~o- f~ai~y. ,dw®.l. tZng ...................................... The certificate is issued to Lest~-l, -l,~v- -~u~l~ · · · 0~ner ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approvai . I~,R,~ ............................. l~ouse ........ ........... FORi~ NO. 2 BUILDING DEPARTM EN'I' 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? 5327 Z Dote ...................... ~. ....... ~ .............. ,19..2..t. Permission is hereby granted to: ............ /~ee.t,~:~.. ,T~e.~J.a~ e~ ............. : ................. ..... :~x..l~e ....... ~.~..~ ....... ~att~ta~k ......... ........ ~.e.e..e~a~.~...~.~.~...~.],'~L...k~.~m.~ .............. to ...'J~,~,~ ~....~...~.~ ~.~.~.0~...~.J~...e~v~, ~.~;~.K'~,~...~..~.~ ~ ~-.~J .!. ......................................................... ct premises located at ........... .~J .~..:.....~..~.~..~]~L.~...:J~..J~]~.~ .............................................................. .............................................................. ~,e~,l,.....Ck~.t...1.JI .............................................................. pursua~]¢ to application dated ............................... ~ .......... ~..i....., 19.~.1..., and approved by the Building Inspector. Fee $ ....................... Building Inspector \ FO'~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo Disapproved a/c ........................................................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No ..... Date ........................... ~ ,~'~, 19....~,..! .... 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 and 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. 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, os herein described. The applicant agrees to comply with oll applicable lows, ordinances, buildihg code, housing code, and regu!ot!o_ns. (Signatu.re of applicant, or no, me, if a corporation) ...................... /....l.,.I ..... :.[..%,'.1.. l'. t. I...~.. Z}~..../...?.:.../.., ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~~.~~ ........................ ' ................ j . If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which aroposP.~Lwork will be dene. Map No.: ........................................ Lot Nn ..... ; __ ~ Street and Number~., ~. ~/. iC?..,~,.,~,.f. ~ ~.:~.~.~.~ .~ ~/~ ~~' "~"~ r - .......... / ........... .......................... 'r' 2. State existing use and occu~ncy of premises and intended use and ~cupancy of pr~osed constmcti~: a. Exisiting use and occupancy . b. Intended use and occupancy ~-~/..J... ................................................................ 3. Nature of work (check which applicable): New Building .................. Addition..................V ^Iteration .................. Repair .................. Removal .................. Demolitiar .................. Other Work (Describe) ........................................ 4. Estimated Cost ....?....~..~.-~ ................................. Fee .......................................................................................... (to be paid on filing this application) /~ I~- Number of dwelling 5. If dwelling, number of dwelling units .....(~. ..................... 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. D mens ons of x st n structures f an · F -~ ~ ~ ~ ~ ~r g ' y. rant ......... Rear ................... Depth ...,..~r../-~.. ........ Height ..,/.~....~.. ........... Number of Stories ...... : ............................. : ....... : ................................... Dimensions of same structure with alterations or additions: Front.........~........................., ~ ~ Rear ............................ Depth .....~....~.. .................... Height ....... .~. .............. Number of Stories ................................ /5-' -'~ ~ 8. Dimensions of entire new construction: Front .................................... Rear ..... ~!..~. ................ Depth ..... ./.....'~.. .......... Height .................Number of Stories ............................ ~ .................................. ~ .................................................... Size of at: Front ........~.....~'... ............ Rear ......... .~ ~.. .......... Depth ......... .~.~ ......... Date of Purchase ...........]....~....~.....O. ............................. Name of Farmer Owner ..~...~..~.~...~. ~...~_~ Zone or use d~stnct m which premises are s~tuated .............. /~ ................................................................... Does proposed construction violate any zonina aw, ordnance or renu at on~ ~ O z -. · ' ................. ....................................... Name of Owner of premises ..: .~..~.~.~.~...~z~. Addr .r...~... , .. hone No?.. ... .. ..~ Name of Architect ...................... ~ ............................... Addrees-:~ ............ ~ ........................... Phone No ..................... Name of Contractor : ./.~-/~..~.~(. Add c~..~.~, hone N ~: "~ PLOT DIAGRAM Locate clearly and d st ncr y a I buildings, whether ex sting or proposed, and indicate all set-back dimensions from property line~. :Give street and block number or description according to deed, and show street names and indicate whether interior or c~mer lot. 11. 12. 13. Sworn to before me this _ NOTARY PUBLIC, State of New York ,o. 52.8,25850, Suffoll~ Cou,t,. Term Expil~ STATE OF NEW,Y-ORJ~- ~, ~SS COUNTY ~ ...,~..~.',,~.,,~...~..J' · ..................................................................................... ~emg duly swam, 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 all 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 applicatio~ filed therewith. Count~o~' "~,'~,j ~ (Signature of applicant)