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Home My WebLink About5366-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~1+268 ...... Date ............... ~T~II~t. 2~ ...., 19.71. THIS CERTIFIES that the building located at .ll[/~ .li®¥. ~o~. ~.. · Street Map No...~ ........ Block No ..... ~ .... Lot No .... ~.. ~ .$~Ee~ ............ conforms subst~tially to the Application for Building Permit heretofore filed in this office dated ..............j~,. ~ 19. ~1 pursuant to which Building Permit No. ~3.~.. dated .......... J~e...21 ., 19.~1., was issued, and conforms to all oE the require- ments of the applicable prowsions of the law. The occup~cy for w~ch this certificate is issued is . '~iva~' ~cee~.$or~ .(. ~to~age ) · buil~ ~g ........................... The certificate is issued to . M,. ~r~ ...... ~ ............................. (owner, lessee or tenant) of the afores~d buildMg. Suffolk Co~ty Department of Health Approval ..... ~,R, .......................... ..... I'~~ .......... ~'~' ' "~: '1 ......... Building Inspee~or } FORM NO. · TOWN OF $OUTHOLD BUILDING DEPARTMENT 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? 5366 Z Dote ......................... ~T~'t~ ....... ~,1 ......... , 19...~. Permission is hereby granted to: .............. ....................... C~telte{~: ................................. at premises located at ................ ~;~,~(~....~-~...E~la~.:~,lr~../,~llll~ ....... (.~t,~.~.~) ............................. pursuant to application dated ................................... ~l~e.....~l ...... , 19..?/.~., and approved by the Building Inspector. Fee $....4.,..P~i ............ Building Inspector / ' l~OR~ NO. 1 Town OF SOUT OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19...~?:. Pemit No. ,~.....~......~....~.....~ .... Disapproved a/c ............~ ........... / ~ m Application No ................................. /~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildir~j~-~ Inspector. c~ ~, b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets 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 o 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, ordl nances, building code, housing code, and regulations. (S'gna ure of applic~ant, or no, ne, if a corporatj~n) · / (Ad~ of applicant) / ~' / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. .................. ......... t, n flan n h, h 1. L~a'o o do w 'c~p~sedworkwil~ed~ ~.~ ........ ~.~ ............. Street and Number ...... ~L....~ ....... ~~~......~.~...~~ 2. State existing use and occupancy of p~mises and intended use and ~cupancy of proposed construction: · ~ P Y ................. t ........... ~ ................ ~"t ................... '~ ..................................................... ....... ...... ~ "7- 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...................,/...~...~...'. ........................... 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 ............................................................................................................................................. or mixed occupancy, specify nature and extent of each type of use ....t~...~....cT.~/. ........ 6. If business, commercial 7. Dimensions of existing structures, if any: Front ........... ~ .C) Rear (. O Depth ( O 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 ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... Does proposed construct on via ate any zon na Jaw, ordnance or reaulation;~ 13. Nameof Owner of premise~Acldress~~~.-.~.:... Phone N~.....~'..:.¥~.~...~. Name of Architect ......................................................~ Address iii~iiiiiiiiii Phone No ..................... Name of Contractor ...~....__~ ....... Address Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer I,~ot~ ~- STATE OF NEW..~ORI~./j/~, t. r COUNTY Of .~~;..J*'~** ~ /~ · .... ,-:~ ........ ¥~~;,~.~¥~_~:..;;;,~~....~', duly --rn, d~es ~nd says t~t he is the applicant a~ove named~ ~ ~~He S the'~ ~ (~ntmctor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e performed the said work and to ~ke and file this application; that all statements contained in this ~plic~i~ am t~ to the best of his knowledge and belief; and tha~ the work will be performed in,he manner set fo~h in the ~plic~i~ fil~ th~ith.__ Sworn to~.L day ofbef°re me this ~C~ ,19 ~:/ /' // ' ............. ............ .......... ...... ........................ ............................. ..... ............... .............................