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Home My WebLink About5376-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPA.RTM~.NT Town Clerk's Office Southold, N. Y. Certificnte Of Occupency NoZ. 1~O7 ...... Date ............... .0.c.t. .... 6 .... , 19.7.~. THIS CERTIFIES that the building located at . Pa¢~.£ic..St. & .Sound .Ava Street Map No. ~ ......... Block No... ~ ..... Lot No...~ .... ~tt~tue~ · .N~Y.~ .... co~orms subst~ti~ly to ~e Application for Building Permit heretofore filed in this office dated ........... J~e.. 22., 19..~ p~suant ~ which B~lding Pe~it No. ~3.~.. dated ........... J~e.. 23.., 19.~., was issue, ~d conforms to ~l of the r~u~ merits of the appUcable provisions of the law. The occupancy for which this certificate is ~sued ~ .... ~C~0~ .b~. (. P~XYete..g~Ta~ ~ ......................... The ce~ificate ~ issued to ...North .Fer~ .E~ .&. ~.~st .Co ......... ~er ....... (owner, lessee or ten~t) of ~e ~oresaid buffing. S~olk Co~ty Department of He~th Approv& ....... H,~, ........................ ~ouse ~ 12~10 Sold ~ve // ....... ~ 7~0 ~aclfic ~t .......... ~./~ ~..,~...{ ?' ~ ... ' ...... FORM NO. ~ TOWN OF SOUTHOLD 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? 5376 Z at premises located at ~ ,.~.. ......... ~ ........... I~.......~.~ff'... ............ ..~.....~.. pursuant' ,o application dated .............. ..~. ....... ~...~...... 19..~...../, and approved by the Building Inspector. C,/ Building Inspector I~OR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ...................................... ]9 ........Pemit No. Disapproved APPLICATION FOR BUILDING PERMIT Date .................... , a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin Inspector. b. Plot plan showing location, of lot end of buildings on premises, relationship to adioinina premises or oublic Streets a oas, and g~wng a detaded description of layout ofproperty must be drawn on the diagram which is I:mrt of this application.i~') c. The work covered by this oPplicatlon 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 opp icant. Such permill., 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 Jn 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 nances, buildi0g code, ,housing code, and j'egulations. · .... .... (Signature of applicant, or name, if a corporation) ........... ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, 9eneral contractor, electrician, plumber or bui]der.~ a.T.. ....................................................... .: ...................... ............... Name of owner of premises ...~.?..q.Z~.....~?.a~...../J.a...a.~...~.......~.:..~L...~...'.- -- .......... q ............................................................ ~'1 If applicant is a corporate, signature of du[y 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 C4)R,I~j~.IC ~o'...'.N.~ Ru~L .~..~.C~...~.~/C :~.. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... ..~T...~../~..~....~.~ ............................................................................................ b. Intended use and occupancy ...... ..~..~....~....~....~.~. ........................................................... 3. Nature of work (check which applicable): New Building ."~. ........... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ~ ~O~ (~ 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 t~e 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 ..~..~..I ......... Number of Stories ......... I....~.. .............................................................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase .../~.].~.~.~.~.~. ........... .). ]. .?. . ]. ............ Name of Former Owner ...~..U.....~..~..~...~........~...~...Z....~.~.. ...... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation~ l~J o 13. Name of Owner of premises ,~.~l~r.~..~.e~T..~...~...~.~.i~ ......... Address ....~.~.~.)..~....u..c.~ ............. Phone No. ~..~..~..-..~-~..~. Name of Architect ....... ,~./..~.. .................................... Address ............................................ Phone No ..................... Name of Contractor ...... ..~../...~.. .................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or des~criptio~ according to ~eecl, and show street names and indicate whether interior or comer lot. ~ 0 L~ ~ c~ 1~ (/~ c~ O~ I STATE OF NEV¢ YORK, ~ S S ' /~ COUNTY OF ...... : ......................... ~ ' ......... ~.~..~..d..~.~...l..~.~. ....... ~...~/...~..~...~..o...~.. ............................ being duly sworn, deposes and (Name of individual signing application) says that he is the applicant 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 contained in this application .are true to the best of h s know~,dge and be el; and that the work will be performed in the manner set forth in the app Swor~ t~ before me this -- ~a, .... ,o,o ......... .................