The URL can be used to link to this page

Home My WebLink About5374-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy ............. Date ....... ...~ ..... 7.., 19.~3 THI~_CERTIFIES that the building located at . .~-...~/. ~.I/ /'g~ I .~ ...... Street Map No.~~:~.~ ....... Lot No. ~[.~,~. ~... ~ ~.~ ~ conforms su~t~ti~ly to the Application for Building Permit heretofore filed in this office dated ...~.~ -- .~] .... , 19~J. p~su~t to which Bulldog Permit No.~.~/.~ ,, . dated ......................., 1~).1.., was ~ssued, ~a conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is f ,~1 I :"' (owner, lessee or tenant) of the afores~d building. Suffolk Cowry Departmen~ of Health Approval ..~.: .l}., ........................... UNDERWRITERS CERTIFICATE No .... .~..'..f.~. ! ....... HOUSE NUMBER.. ~.3.~ ..... Street....~$..~..~.. '.k..:... / . .~..Ar,/.../.7-.-~.' .................... Building Inspector /' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5374 Z Permission is hereby granted to: ........ · e~mm ....... II.~ ~ ................................. to .tlgmJA..Jm..~aJ~..l:~t.~.~e.~..~.a~}...~a...t.~La.~n~..~m3J,~ ................. pursuant to application dated ....................... ,....~1.~L~..~..~ .............. , 19.~.~..., and approved by the Building Inspector. Fee $..,~ ............. "i~'~ii~ii1~g ,nspectoT TOWN OF SOUTHOLD ,~,~' BUILDING DEPARTMENT TOWN CLERK'S OFFICE / [xemined 19.....L. Application No...~.~...~...~[......~. ~proved ~ ........ remtr ~o..~.ff....&....~,..~ ..... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date June 21 ................................................ ....... a. This application must be completely filled in by typewriter or in ink and submitted in ,~Jl~e 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, as herein described. The applicant agrees to comply with all applicable laws, ordi nantes, b~ling code, housing code, an~14~lations. I1 H~tl'~R t~E ...... ~ ....... ~..~.~.... ....... (Address of ~'pplicant)//~'..~, .......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .............................................................................................. .... Name of owner of premises ....... ~.,e.~,e,.,~.....V,.?.,~,~,~,.~ 1~,.? ............................................... 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. Mop No.: ........................................Lot No ................ ' ., . :£asker ~-'ane Ureenport ......... Street and ~Numoer ........................... : ......... .................................. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy 1' ~a~ly gwelli~ b. Intended use and occupancy ....Attached ~al~e 3. Nature of work (check which applicable): New Building .................. Addition ......X. ......... Alterotion .................. Repair .................. Removal .................. Demolitio~ .................. Other Work (Describe) ........................................ 4. Estimated Cost ....?.~..0..0...0. ............................................ 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 2 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 ...2..~..'. ............... Number of Stories ..... .2. ......................................................................................................... Dimensions of same structure with olterations or additions: Front ....7.,~ ........................... Rear ~'.5 ....................... Depth 20 Height ....2.,~. .................... Number of Stories ................................ 8. Dimensions of entire new construction: Front .....2..0. ............................ Rear ...... ~.0 ................. Depth ..... .~.Q .............. Height :[3'6# Number of Stories 1 9. Size of lot: Front ...... 2.9..0. ............... Rear .....~...q.0. ......................... Depth ....... ;;],~) .................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ~o .................................................. ~,~<~e~er Verd~rame A~,~'a~ker ~'ane .................... 13. Name of Owner of ~ .................................................................................................... Phone No[ Name of Architect ...................................................... Address ............................................ Phone No ..................... High Style ¢orit.¢Oo Address 28[ North -~ark Dr, Phone No ..................... Name of Contractor ...................... ; ......................................................................... l~s sapequa 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 whether interior or corner lot. It-- STATE OF NEW YORK, tcc COUNTY OF ......... ,,_ ..................... )' ~'"" ' '.swre~oe ~o ~enny ................................................................................................. being duly sworn, deposes and says thor he is the applicant (Name of individual signing application) ~ent for ~Utlder 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 contoined in this application are true to the best of his knowledge and~:~dfe, f; and that the work will be performed in the manner set forth in the applicatic~, filed therewith. / J Sworn to before me this ............... o, ........ ................... , - ' ....... I4C)I'ARY I~UBLtC' sta i ~ 1'- ........ _-_~:_ ~4L' :l It DRAFTING SERVICES INC. 11 HALTER LANE, LEVITTOWN · PE 1-5506 CHKD BY, I