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Home My WebLink About5403-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. ~ ..... Date ........... ~I*~L~.. · ~ ...... , 19~3. THIS CERTIFIES that the building located at ...¥/8..Statism. ~ ....... Street Map No. ~ ........ Block No...~1~ .... Lot No. ~gl~. · kilt. ~la~:Lm..]1,~. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~ .... ¶3 ...., 19.7~, pursuant to which Building Permit No..~ll4)~. dated ........... ,TII~...~.~.., 197.~.., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . ~$.~l~e .~. (aeees e , . Im l ltz ) ............................. The certificate is issued to 1~I~,3~l~. l~lle~i .&. W~8 ...... 0#~.1 ................. of the aforesaid building. Suffolk County Department of Health 'Approval (owner, lessee or tenant) · ............................. UNDERWRITERS CERTIFICATE No ..... ]le~., ........................................ HOUSE NUMBER.. ~. ..... Street .......~Mt~.~ .~IMI~ .............................. Building Inspector gOlkM 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? 5 03 Z Permission is hereby granted to: ................. Je~st,"'F,a,~l, en .................................... at premises located at .........~/J.-Jtl~J..J~ ................................................................................ ............................................................ · ~"~'t~ii~11~ ........................................................................... pursuan.t to application dated .................................... ~ll~'"'J'~'"', 19 ...... I?,Jand approved by the Building Inspector. Fee $....~eJ~J .......... Approved FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, 19..*..(.... Pemit No~~ .................. Application rqo ................................. "APPLICATION FOR BUILDING PERMIT Date .................. ~.,, 19 ...... INSTRUCTIONS a. This applicotion 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 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 permitJ,~ 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 nances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name o{ owner of premises ........ ~ .................................... If applicant is a corporate, signature of c~ly authorized officer. (Name and title of corporate officer) --'~'.~ ~- ~ 2.-- Street and Number ........ ~--e/~'~'l / ~ ...................................................................... ~'~ ~ ~ .2. ~' Municipality ......... ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~, o. Exisitin§ use ond occupancy ..... ., ......................................... b. Intended use and occupancy .......... ~.~.....~.~ ..................................................... t'"' / 3. Nature of work (check which applicable): New Buiiding "'...~...... ...... Addition .................. Alteration .................. Repair .................. Rerooval ................. ~ Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........ ...~.~.....~....~.. ....... ii .................... 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 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 ..;:..~.X:~ ............... Depth .~.....~... .............. Height .................... Number of Stories ../. ........................................................................ 9. Size of lot: Front .......~.~.~...!. ....... Rear ...... ~....c~. ...................... Depth ..~'~'..~..~... 10. Date of Purchase .......... /.~..~..~.. ............................... Name of Former Owner .~..~,~..~.~~ ..... 11.. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction ,vj~l~e~a.ny z~ging law, ordinance or regulation.> .~ ; .................................... 13. Name of Owner of premise .. ress .. Phone No. ~.~../,~. Name of Architect ...................................................... Address / Phone No. Name of Contractor .................................................... Address ............................................ Phone No. // PLOT DIAGRAM Locote cleorly and distinctly all buildings, whether existing or proposed, and indicate all set~ck 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. STATE OF NEW V~)RI~,/ ~/ t. ~ COUNTY OF~~.~...~.. _ ........... ~'~ . ................. '~l~lame of incrlvidual ,igning/.g~pplicationj)': ............... ~'~ duly ~rn, d~s and says t~t he ,s the applicant above named He Js the .......... ~.~....... ..................................................................................................... (~ntmctor, agar, co~rate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e peffo~ed the said work and to ~e and file this application; that all statements c~toined in this applic~i~ am t~ ~ ~e best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the ~plic~i~ fll~ ther~ith. · S' · '::' ':' 't' ':~ d;;th°;s~~ ~~_~'"':-..~., 19.r/.' ....... ~~ ....... ~ Suffolk covnt~ No. 52.0344963 Ma~ch 30, 19~ Commission Expires