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Home My WebLink About5406-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy N Zg3~8 ~ulust ~5 .... o ............. Date ............................, 19 71 THIS CERTIFIES that the building located at .. P.e. qtlalih .A.~e ............. Street Map No .... ~ ..... Block No... ~ ..... Lot No...~ ...C~tCho~. ~,~, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... J~.~.. ~ .., 197~.. pursuant to which Building Permit No. ~.. dated .......... J~... J.~.., 19~., was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~.~"~..~a~.e~,?~. ~.~g. ~ .. [ ...... The certificate is issued to . ~.'..~d~..w. t~ ~8~,. ~r~ .~a~ ........ (owner, lessee or tenant) of the afores~d building. S~olk County Department of Health Approval .. ~ ............................. ... FORM NO. 2 TOWN OF SOUTNOLO BUILDING DEPARTMEN'I~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING P E P-JV. IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5~106 Z D~e ........... .~ ............. ~u:t,~, ....... .~ ......... , ~9..?.t. Permission is hereby granted to: ............... ~,,~ ..~.X~e~. ~zel.~a:. ................. .................. pe, q~sh..A-~e .................................... .................... ~ee~eg~ .................... ~ ................. to ... ~L~I~..~w.. ~A~a~a.. ~tt~X~l~.. ~X ............... .......................................................... at premises located at ....,~,,~J;~,..~J~..J~J~.~OJL.C~aGA .......... ; ......................................................... ......................................... ~¢jua,~h.-&ve ....... t~e~.....; ......................................................... pursuan~ to application dated ................................ ~T~. .......~6~....., 19.~.~,.., and approved by the Building Inspector. Fee $..~J.*O0. ............ IFO~Bf NO* I TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE o71 Examined ...................... , 1 .... ........................................ , ........ ,rmit No. Disapproved a/c ................................... : ............... (Building Inspector) Application No..-~.....~...~....~.. ............. APPLICATION FOR BUILDING PERMrT ~, Date ............ ~...~....~. ...... I.~ .................. , 19~.! ....... ~ ~ INSTRUCTIONS '~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building'~ Inspector. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or pub c streets or .'~ areas, and giving a dMailed description of layout of praperty must be drawn on the diagram which is part of thie 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 te 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 Perm t pursuant to the Building Zone Ordinance of the Town of Sou·hold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations~ or for removal or S:lm~ep, as here n described. The aPPlicant agrees to comply with all applicable laws, ordinances, building code, hov~ng cod~/and regulations. ....... k....W...-:..-. ............... (Signature cf applican~.~5 name, if a corporation) <---"T .... -- (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ..................................................................................................................... .-. ................................................ Name of owner of premises ....~...~..~..~.,..~....~.....~..~..~.;..~2. ........ &§...~'.. .................................. If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. Map No :'~./~..(~. .......... Lot No.: ........................ Street and ~-~ .~ ~ ~ ..~. ............................................................ /OgD _~' Municipality 2. State existing use and occupancy of Premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ................. .'....';~.. ........... b. , ~.~e , '"ntended use and occuponc~ ~. Nature of work (check which applicable): New Building ~ ................. Addition ................ F-,~lteration .................. Repair .................. Removal ...... Demolition .................. Other Work (Describe) ..~..~.~.~_~' -~e~ ~ -t .... .... 4. r.s matea L.ost .................. F. ...................... ~ ................. Fee ..................................................................................... i .... (to be paid on fi!lng 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 occupancyi 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 ............................ Depth ........................ Height .................... N~mber of Stories .............~ ....................................................................................................... 9. Size of lot: Front .........~?..!. ........... Rear ............ .~..~.'. ............... Depth ......... ..~·.~.?..'. ............ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction'violate, r.~.z,~_, - ,-~any zoning I~ ordinance or regulation? .............................. i ............................. 13. Name of Owner of prem ses .1~,?..:....~...~...~..~.?.~.~'-.'~..?.Address ........................................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..... : ............... 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 JndJcat'e whether interior or comer lot t~~ STATE OF NEW YO~4~,/~/, COUNTY Of :...~~'~' ............................................................ ~ ......... :.aelng duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 end file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this · ./.~. da of .. ~/~Z. 7 ~,.- , '~ ~ .................. y ....................................... , . to ,, -z ............. .................... No ry b 'c,~~.6~.,..~~ounty (Signature of applicant) ~otary ~[i~','S',~t~'of New York No. 52-0344963 5ufiCo/k Count~ Cornmis~ion Expires March 30~