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Home My WebLink About5383-zFOBM NO. 4, TOWN OF SOUTHOLD BU~,DING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...LiJMIF~. L&. & .~e~l ~9,~eet Map No..~ ....... Block No .... ~ .... Lot No...~...~..N.*~, ....... conforms substantially to the Application for Bufld~g Pemit heretofore filed ~ ~s office dated ............ J~....~., 19.~, p~u~t to which B~d~g Permit No..~. dated ............ J~ .... ~., 19. ~., was issued, and conforms to ~1 of the r~e- ments of ~e applicable provisions of the law. The occup~cy for which ~s ce~fficate is issued ~ . .. ~i~. ~. f~12..~$~g .................................... The certificate ~ issued to ... ~a ~ ..... ~ .......................... (owner, lessee or tenant) of ~e afores~d bulling. S~olk Co~ty Dep~tment of Health Approv& .. 9.~., .$.~.. ~...~. e t B~d~g I~p~tor FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5383 Z Dote ............................ J.~$ ....... 1 ......... , l~..~.l. Permission is hereby gronted to: .C,~. JIl~..~...;ta~....~/~..,llJJJJ[~ at premises located at .......~a,$.J~l~'~y,..J~l~.$'"~lr'~$~lll~l:l~"~b~&l~ ................................................. ................. (l~el~le~..llt~) ....... ~thel&...,....~;~. ..................................................................... pursuan~t to application dated .......................... ~1'~/' ....... "J ............... , 19,..~, and approved by the Building inspector. Fee $..~.0~1~. .......... Building qnspectorI Examined Approved ·OWN OF soU~"O~D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~<~-'~0~-"~ ;~ APPLICATION FOR BUILDING FIRMrI' Date ............. ./. .............. , 19...Z/...._ ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Buildin~r'~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premieee or public streets--~ areas, and giving a deeailed deecriptlon of layout of pmparty must be drawn on the diagram whlch c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this appllcatio?~ the Building Inspector will Issue o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the pragress of the work. e. No building shall be occupied or used in whole or in part for any purpese 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 pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable La~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein d~crlbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cnde, and regulations. ' ' (Sig ture of applicant, or name, If a corporation) .......... .......... ............ (Address of applicant) V State whether applicant is owner, lessee, agent, architect, engineer, genera~l contractor, electrician, plumber or builder. If appli~:~nt is a corpor,~ot~ ~gr~ature of duly~uthorized officer. ....... ......... ................... .................... (Hlame and title.of corporate officer) Location of land on whh;:h~ ~ 'd- c3~ ~1_0 , (~Pr°p°sed work will be done. Map No.:....~.....~.. ....... ..Y~.........~.. ................... ~~~t ~o.: ..~.~ ............ ........ State existing u~ and ~cu~ncy of p~mis~s and int.nded use and ~cupancy of p~ co~t~l~: ~ a. ~isti~ u, a~ ~cupancy ........... ~ .................. ~/L. ~.~ ............................................................................ b. Intended use and ~cupan: .......................... ~.~;.~;.-..~~ ................................................................ Locate clearly and distinctl property lines. Give street and whether interior or corner lot. 3. Nature of work (check which applicable): New Building ...... ...V~'... ...... Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost ....~..../..~..~t.~.~.~..~...~.. ............................... Fee (to be paid on fi~ing this application) 5. If dwelllng, 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 olterotions or additions: Front .................................... Rear ........................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... .~...~...~'.. .................. Rear ......~..~'....(('.. ........... Depth ......~.~. .............. Height ........ .~..'~... .... Number of Stories ............... ./. ..................................................................................................... / b~' ................................. Depth ......... ./..2... ~.. ............... 9. Size o~: lot: Front ........ .~ .................. Rear ... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........................................... ~ ..................................................... 12; Does proposed construction violate ony zoning law, ordinance or regulation? ....... ~. ............................................. 13. Name of Owner of premises ~...~ ....... Address .~..'~.-v~,/~/~.,~~ne No ..................... Nameof Architect ..................................................... .,~ ~~~ Addressil;i~,~ii~i~i~ilPh°neN° ........... i[ ....... V PLOT DIAGRAM all buildings, whether existing or proposed, and indicate all set-back dimensions from )lock number or description accordin~ to deed, and show street names and indicate IZ~. STATE OF NEW~/0~- ~ t~e . .............. ~~.~ ............................................ being duly sworn, d~oses and says t~ he is the applicant t~a~ o~ inaiviaual signing application) obove named. H~ i* the .............................................................. ' .......................................... (Contractor, ag~t, co,orate officer, etc.) of said owner or owners, and is duly authorized to perform or hove parroted the said work and to ~ke ond file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and tha~ the work will be performed~the manner set fo~h in the application filed ther~ith. Sworn to ~fore me this [ I ~ ~ ................. ....... .... ........................... NOTARY PUBLIC, ~te ~ New Yor~ No. 52-81258~, Suffolk Co~y Term Expires M~h ~, 19 8-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH SE,,,, !? 197'1 Date Bldg. P!ermit No. TO WHOM IT MAY CONCERN: at The sewage disposal faciliti;es for a structure located (GiYe deed /location) ~/ have been inspected by this department and found to be satisfactory.