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Home My WebLink About5364-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at l~i~l~gl~ }/&~r ................ Street Map No. Nlalaekei. Ig. tX, Block No ........... Lot No.. ~[ ....... 8olltJaold,..N,~., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ,Ililae...18.., 19.?1. pursuant to which Building Permit No. dated ............ ,l~lla®.-18., 19.?~1., 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 -Prl~a~;e. olle. £~11.t~ .dl/e.~.lillg ....................................... The certificate is issued to MeJ. V..~. 1401'1'~.8 ..... O'~®l' ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 'NOV · '23' '¶97¶' ' '1~' R',' 'V~.'~.'~'a ..... House t# 22~ // ~ ' FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥, BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5364 Z Permission is hereby granted to: .......... .Gae+..,~¥,,l~,:~...J~.tld. oz**..luc.....~t~(1. P, e2.'fJ~ )lel'~tl ............... g~i~,~ ........... I1~, ..................... to .aull~.~.~...me...~.emt,~,7...~.v. el~,~ .................................................................................. at premises located at .......... ~:~.2.....~f~JilZa..~&te~l ............................................................. ................................................... J~a,~mm.. ~ .,'~7 .......... ..... ~m~t~m~l.... ~.,~. .................................... pursuon¢ to application dated ........................... .~..I~D.IR,.....~.~, ............. , 19..~..~.., and approved by the Building Inspector. Fee $..I~,~,.~ .......... SCHD SUFFOLK COUNTY DEPARTMENT MAY Date Bldg. OF HEALTH :,11- vi ,ermit No. TO WHOM IT CONCERN: ~ ~ j' The sewage disposal facilities for a structure (Give deed ~ocati'dn) ' located have been inspected by this department and f~und to be satisfactory. Chief of Geseral ~ngineering Servio~e Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PIRMrT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premisee or public streets or areas, and giving a dMailed description of layout of property must be drawn on the diagram whlch II part of thll 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 port for any purpose whatever until a Ctrtlflcate 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 puniuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other applicable I.ov~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, Il herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ......... ..... ........ .............. of opp,c ;.;i ......... ~ ........... State whether applicant is owner, lessee, agent, a/~h~#r,! general contractor, ellctrl¢lan, plurt~er or builder. Name of owner of premises ..................... ~ .............. ~ ........................................................................... If applicant is a corporate, signature of,d~ly authorized officer. 1. Location of land on which proposed work will be done. Map No.: ................................... Lot N~: ...... Street and Number .............. ~.r~.j~..u...~l. ........... ~ ............................. ..~...~ ......... M,,nic pali / ....... 2. State existing use a.nd occupancy of premises and intended use and occupancy of proposed conltructlon: a. Existing use and occupancy ..................................... ~ ................................................................... b. Intended use and occupant', . ................................................... (~ ................................................................... 3. Nature of work (check which applicable): New Building,................J Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ............. ..~.~.~.~..~j?..:..c~.~. ....................... Fee .......................................................................................... (to be paid on fi~ing this application) 5. If dweIHng, 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 ....~..~... ................ Depth ....~..~ .............. Height ........ ./....~... .... Number of Stories 9. Size of lot: Front ....... ~.q.~.~. ............. Rear ........ ./...~.~G ................... Depth ......~....3....~.. .......... : .... }0. Date of Purchase ........................................................ Name of Former Owner ..... ~..n..~.......~...~...~.?...~ ! 1. Zone or use district in which premises are situated .................... ~.. ............................................................................ ~ 12. Does proposed construction vi01~te any zoning law, ordinance or regulation? ...... ..'f~'.~. ................................................ 13. Name of Owner of premises ..,~..e../Y/.~.....~'..~.~¢.~.ll. ............. Address .~.'...C~..~./....~..r.....~....~.~/..n4 .~..n... Phone No. ~..9.~.....~.~..~. Name of Architect ................................................... Address ............................................ Phone No ..................... Nome of Contractor ,-~.......~...J~..~..~/~.Address ...~..~.....~..x...~..~......~....~... ...... Phone No. PLOT DIAGRAM Loca~e 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 ~hether interior or comer lot. 0 STATE OF NEW ~K//_,~' tS.S countY_OF.,...~c~lfd~dB~__7~ ...... I ' , .......... ~~.:L~...; ........................................ being duly sworn, d~es and says tMt he is the ~pp cant --'~;'of ,nd,v,dual S,gn,ng ~plication) ~ ~ above n~med. He is the ................................................................. ~.~ ........................ '~ ........................................................ (~ntractor, agar, co~orate officer, etc.) of said owner or owners, a~d is duly authorized to perform or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this application are tree to the ~st of his knowledge and belief; thav the wore will be performed in the manner set fo~h in the application filed ther~ith. Swom~ore me this _ ...... ...... ...... .............................. Term Ex~i?s ~rc~ ~.l~