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Home My WebLink About5336-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, BI. ¥. Certificate Of Occupnncy No.[l[~. ...... Date FeB 8 19.?~. THIS CERTIFIES that the building located atM~F~Llte .D~' ................. Street M~p No ............. Block No. ~ .Lot No. confor~ subst~ti~lly to the Application for Building Permit heretofore filed in tMs office dated ........... ~...7..., 19.~. p~su~t to which B~ld~ Pemit No. ~... dated ............. J~.. ~., 19~.., w~s issued, ~d conforms to ~11 of the r~ ments of the applicable pro~sions of issu~ ~ .~ate. ~a~a~e. (. ~ccea~c~. ~ ................................. The certificate is ~sued to (owner, lessee or ~n~t) of ~e ~ores&d b~l~g. S~o~ Cowry De~ment of He~th Approv~ . .~ ............................. B~d~g Insp~or FOKM NO. ~ ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT! TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMiS ~F-~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5336 Z Permission is hereby granted to: .......... ,~;~,..~....&/~:...~l~...l~ .... ................. ~,~1~:¢0~1, .............................. : ................. to ....... .b t~ j:][t2..~¢~e ;¢..~[~ t;~C F~Q...~0Zj;~ ~~ ..ga~,~.ge ......... ' .......................................................... at premises located at ........... ~¥'~.....j~,~,n~...~e. ............. ! ......................................................... .................................................. ~a.%~i%u~2~ ......... .N,~ ........... ! ......................................................... pursuan¢ to application dated .......................... ~r~%e ....... .~. ........ ~....., 19,..~.[, and approved by the Building Inspector. ,Fee $.~ ............. FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19...::... Pemit No .......~......~...~....~.....~... ..... Disapproved a/c .......... ~---~ ~ -~'"~'"-'~'"'"~ (Building In~ector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No ................................. 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 o 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 thi~ 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 Deportment 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 code, housing code, and regulations. ....... ............... .. ........ ( 'g o ~plicant,~r name//if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... Agent,...ef...C e,~.t,~. ~.¢.~.e~ ................................................................................................ Name of owner of premises ....... .~..~...e...s........~..e....]:~,...o..~... ............................................................................................................... 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.: .............. ~ ..................... Lot No.......:~:... .............. Street and Number .~J.J....~....~.......~/;~it~...~,~',,~;J~...~.~,T~. ............ ~...~.~.~.:~.~.~..c.~. ................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ..~l~.~J3~ ........................................................................................................... b. Intended use and occupancy sig~.e W~Lt, h ctetachect .q.z-iva~.e .l[~l~e 3. Nature of work (check which applicable): New Building ...~ ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolitio~ .................. Other Work (Describe) ........................................ 4. Estimated Cast ............... ..2.,~.~...0..0..._+ ........................... Fee ......~.......O~.. ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... l:1,~11,e ............. Number of dwelling units on each floor ............................ · If garage, number of cars .............. e~e ........................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each t~pe 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 ........... .1.~ .................... Rear ~1~ ............... Depth .....2.~ ............... Height .................... Number of Stories ..~t.-'~. ......................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 1~ Zone or use district in which premises are situated n , ........... ~.... Cl,:l,~t, ............................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~e ............................................ 13. Name of Owner of premises .T~e~...[ke~T~ ............ Address .......~...~.~..~..~...e...~. ................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .....~..q~11...~..e.~..e..z'.. ........................ Address .......... ~.~....l~...e...~. ................... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beak d mensions from property/ lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ),c c COUNTY OF ..~D.~;['.~:l,ir, ............. $~'~ ................................... ~.~..~]3~),,.~g~.~.~ .......................... being duly sworn, deposes and says that he is the applicant (Name of individual signlng application) above named. He is the ............. A~;ez~;...e:ff...C~D~t,~&C,.l;.~:~. .................................................. (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 a~d file this application; that all statements contoined in this application are true to the best of his knowledge and belief; and thru the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this day of ...... ....... ....... ' ' ' ' ' ELIZABETH ANN NEVILLE NOTARY PUBLIC, &t~la ef New York No, 52-B1258~, ~ givan~'~ Term Exldrle ~ ~ Jl~