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Home My WebLink About5402-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..~!~3.$8 ..... Date ............... &~ .... 9..., 19.7.1. THIS CERTIFIES that the building located at .~//8.8tal'e .Rea~ .......... Street Map No. ~ ......... Block No... ~ ..... Lot No .... ~ ·-~aSt .~i~...N,~.. .... conforms subst~ti~ly to the Application for Building Permit heretofore filed ~ t~s office dated .......... j~7... ~, 19. ~.1. p~su~t to which B~ding Permit No.. ~. dated ........... j~y .... l~, 19.7~, was issued, ~d conforms to ~1 of the require- ments of ihe applicable pro~sions of the law. The occup~cy for which ~is ce~ificate is issued ~ .. ~ivate. ~e. f~ily. ~ell.~ ..................................... ~e certificate ~ issued to ~P~l~p..& .~a. F~ent~ .... ~ers ................ (owner, lessee or ten~t) of ~e Mores~d b~ding. Suffolk Co~ty Dep~tment of Health Approval .. N. tR ~ ............................. .// Hous~ FOF, M 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? 5402 Z Permission is hereby granted to: ............... ~.... I~'mml~l,..~ ..w~,,"m ......... at premises located at ........... .W61t~J..JJ~/~ll..~J~lJ, .............................................................................. pursuan¢ to application dated .......................... ~ .......... ~J~ ......... , 19.~..., and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...................... , I ........ ........................................ , 19 ........ Pemit No ..................................... Application No. .~.....c~...~. APPLICATION FOR BUILDING PERMIT ,ate..i ...... 2.a .......... INSTRUCTIONS a. This application must be completely filled in by typewriter or ir~ ink. and subrnLt~ed in duplicate to the Building Inspector. '--- ....... b. Plat 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, os herein described. The applicant agrees to comply with oil applicable lows, ordinances, 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 of owner of premises ..... ~..~.....~.....~...~..~.~~" ~" ~ ......................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ]. Location of land on'which p~,se~d .w~rk~y. jJL~ done. Mop No.: ........................................ Eat No ......................... Street and Number ..... ~'"~-~"~"~'""38 ~.~-~ ...................................................................................................... Municipality 2. State existing use and occupancy of/~es and intended use and occup~ancy of proposed construction: a. Exisiting use and occupancy ....~~~ .................................. 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 ..................... .~,~..~.. ............................. 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: Frant ........... .~,.~.. .......... Rear .......... Z,~. ................. Depth ..c~.~c~,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: ,fl~"~...~... ............... Rear ....... ~..~. .............. Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ......... /.~.~.. ....... Rear ......... /. ........................ Depth ....... ~./.~..~ ........ 10. Date of Purchase ................ /..~..~.~. .......................... Nome of Former Owner ~...~'T.. 11. Zone or use:district in which premises are situated ..................................................................................................... 12. Does proposed construct on vjs~te any zoni~ aw, etd nonce or renu at on? ..~ .................... 13. Name of Owner of premise . ress ... ne No.~-.,....~..~...--.~- Nome of Architect ..... ~ v ............... ~;.Address ............................................ Phone No ..................... // Nome of Contractor Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or descriptic~ according to de~d, and show street names and indicate whether interior or comer lot. STATE OF N E~ YO, RI~,_, ~¢ tS S COUNTY O~ ....... }' ' . -,. ............. ~..~..~.~........~...~ ..................... being duly sworn, deposes and says that he is the applicon, Nom. o,.'n ividuo, above named. He is the ........ ~m;..,.~-~r~. ................................................................................................................ ', , (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 Jn this applicati°n are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the applicat]~ filed therew~h. Swam ,to b,~re me this ........ o, ................. ............ ...................... , o~ote of New York No. 52-0344963 Commission ~ . . oI~ ~p~res March 30,