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Home My WebLink About5351-zNO, 4 TOWN OF SOUTHOLD BUILIHNG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at B~ .V~...m~..A..V~.. .......... Street Map No. ~ ........ Block No. 1~I~ ...... Lot No.~...~..~, ........ c0nfo~s subst~tially to the Application for Bu~ding Pb~it heretofore ffl~ ~ this office dated .......... J~... ~..., 19. ~. p~su~t t0 which B~ldlng Pe~it No.. ~. dat~ ........... J~.. }~.., 19~.., wss issued, ~d confdrms to all of the requir~ ments of ~e applicable provisions of ~e law. The occhp~cy for which ~ certificate is ~sued is .. ~.. ~$t~. (S~r~. ~t~)..~ ....................... The certificate is issued to .~ .[~. ~S. ......... ~a~ .......................... (o~er, lessee or ten~t) of ~e ~ores&d building. S~olk Co~ty Deponent of He~ Approv& . N.~R, .............................. ..... ..../. ...:.-:,' ......... B~lding ~spec~or I FOR~Vt NO. 2 TOW~ OF $OUT~OLD BUILDING DEPART,~EN'I~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y, BUILDING PEP. MIT (THIS PERMIT MUST DE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5351 Z Permission is hereby granted to: ........ ~.,....~:......~.....~...~.....~..:.~. .... to ............ ~:~ .. ~.. ,,~ ~-'~t... 1 ~ ~. heue~,~..b~i~t~ .......................................... at premises located at ....... ]~'.~t.....~..A~ ................................................................................... ....................................................... aeu~l~ ........................... i ......................................................... pursuon¢ to application dated .......................... ~1[~ ............ ~J~ ........ , 19...~J., and approved by the Building Inspector. Fee $.~..,..0_0.. ............. muilaing respecter IPO~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ................... LTL..., Approved ....~.. ....................... '..!....., 19...~.'... Pemit No.......~..~......~.../.......~-~. ...... Disapproved a/c ......................................................... · ........................ ...................... Application No. ~' '~ ~' / APPLICATION FOR BUILDING 'PERMIT ~/~ · · _. · Date ..... ~ ....... ./..~.. .......... , 19...7..() INSTRUCTIONS 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 th s opp cat on 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 /v~kDE to the Building Department for the issuance of o Building Permit pursuant to the ! Building Zone Ordinance of the Town of Southold, Suffolk. County, New York, ond other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or o~terations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordi nonces, building cede, housing code, and regulations. ............. .......... ............................ (Signature of applicant, or name, if a corporation) .................... ...................................... (Address of applicant) State whether applicant is owner, lessee, agent, 9rchitect, engineer, general contractor, electrician, plumber or builder. Name of ow er of p em'ses .......~.~......~.~...,~.~. ......................................... ,.~ ............................................... .................. ......... - 1 , I,,ocation of land on which~0roposed work w be done. Map No ....... ....~.... .. Lot No ....~. / I ~7 - ~. ................... ,/~Street and Nu~goer ..~...~..O..U.~...~:../~.~.~... ............ ~.~.~.....7~'.~..O..~..~., ......................................................... ~' ' ~'- Municipality / 2. State existing use and occupancy of p~an~ed use and occupancy of proposed construction: b.a' IntendedExJsiting USeuse andand occupancy ...... .~z-~........~.....':~...~..z.....½~ ........................................................../,,-~.~ ~ ~ ~,.~ ............................ / 3. Nature of work (check which applicable): New Building '~ ............. Addition ........... . ...... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... ~..!...~..~..m ...................................... 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 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 altefatlons or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Nurrlber of Stories ................................ 8. ' ' /, ~ ~ ' D,mens,ons.?,entire new construction: Front ............. ~ .................. Rear ....... ~..~.. ............ Depth ..... .~....~.. Height ................... ~.... Number of Stories ....... A/.. ........................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate ap~ zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ......... ~.~..~...~. ............... Address~.~.~.~.U/.~....~..~'-hone No Name of ^rchJtect ..... ~, .................................. ,, .......... Address ............................................ Phone No ..................... Name of Contractor ........ mss ........ ~.~. ....'~.. Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whetherinteriororcornerlot. ~ff~..' STATE OF NEW YORK, ! S S COUNTY OF ................................ ~' ' ................................................................................................. being duly sworn, 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 fife 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, ~olicatiatt filed therewithm Sworn to before me this ........................ day of ............................................ ,19 ........ """~_J~"~ ~'~ g~na,~''~ ~ ' ~~ ~e~ Notary Public, . ........................................................... County