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Home My WebLink About5426-zFORM NO. 4 TOWN OF SOUTHOLD BUIIDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ~:l,$,h .l~,. I$.~th ......... Street Map No.~O~O .][~ Block No ..... ~...Lot No...1~.~.~1~ ..... 8~t~O~J[ ....... conforms substantially to the Application for Building Permit heretofore fried in this office dated ......... Jtl~.. ~.?. ·., 19 .~. pursuant to which Building Pemit No... ~ dated ............ Jl~... 2~.., 19. ~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... t~i, Va.~e - ~le. £~i,].y. ~lwetl~$ ................................... The certificate is issued to . .T]a~as. 0~.Nei,lJ, ..... 0~el, ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval aouse 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? 5426 Z Permission is hereby granted to: ................. 'them~...O.!ll:l,~ .............................. to .... ~ ..~,~e~ed~$e~e..& ..Im$~.~l..~z~. &d4,$t,t, em..em..ez~$~..~ ........... at premises located at ...... ~t,m....~.t.~Jt.~ ......... J~m...JJJlLJJ~..~.~ .......................................... ....................... 8,,~ t,k .l~Lve...a.~.ut, h .... ~e~t, lm3A ...... ]1.,~ .................................... pursuan¢ to application dated ................................. ~1,1,~r.....~. ....... , 19...~., and approved by the Building Inspector. Fee $...5eJO~ ........... Building Inspector TOWN OF SOUTHOLD~ ~ ~ BUILDIHG DEPARTMEHT~ ~ TOWN CLERK'S OFFICE~ ~ ~ SOUTHOLD, N. Y~ . ~ /_ .~ ~ ~-- - r/ Application NO...~..~..~ ............... Examined .........~....~.~..., ] V ~."~/C.O ~ APPLICATION FOR BUILDING F'ERMIT ........ ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot p on show ng [ocot on 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 o Building Permit to the applicant. Such permit shall be kept on the premises oYailable 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY /V~,DE 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 all applicable lows, ordi nonces, building code, housing code, and regulations. ...... ..................................... (Signature,of applicant, or no_me, if a.corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. ............. .............. ................................................................. i .................... Name of owner of premises .....~....~.....~.~ ....................................................................................... If applicant is a corporate, signature of duly authorized.,roffice. / (Name and title of corporate officer) ]. Location of land on whicl~pro.p__o, se~ ~rk will be do,ne, p,,~qo.: ...'-'RL~.~....~ ........................ Lot No..~..~.. ................. ' Street and Number .~,,~--~.~.....~.~. .............................................................. /~--/,,3 0 ~,x Municipality 2. State existing use and occupancy of premises and intende~J use and occupancy of proposed construction: (3. Exisiting use and occupancy ........ .~..~.~~~ ' ~ ' // ' ....... ~ .................................................... b. Intended use and occupancy ........ &~...~.~.J''..~..~..~~ ............... . 3. Nature of .wor/k' (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. ~g/,~Rem°val ..~( ...... ,: ..... Demolition .................. Other Work (Describe) ........................................ · aa ~ 4~ 4. Est,mated Cost .....~...sa.,..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 type of use ............................ 7. Dimensions of existing structures, if any: Front ././.~ ......~ ........... Rear ../../..~.....-x.. ................... Depth ..~F,>.......-: ...... Height ....~...O. .-5. . Number of Stories ./.. ,/./;~,,; ........................................................................................ Dimensions of same structure with alterations_~a/ o~ additions: Front ...,a~(-;.7/'-' ~)'' ......... Rear .~ ........ , Depth .~ ............... Height ......~:x.....'.. ............... Number of Stories ..f~......~....~....~....dr,eg~/ 8. Dimensions of entire new construction: Front ..,a~r. .................. Rear ...~ ....... Depth ..~ ..... · 2¢ . '/: Height .................... Number of Stortes ...... ./....'.~.. ......... ~ ......................................................................................... · . .So /~o aa 9. S~ze of lot. Front ..../. ...... : ....... .~ ...... Rear .................................... Depth ...~'... .......... 10. Date of Purchase ....... .//.~...~../~....2~.. ............................. N~L.o,2,o.r,me_r Owner .~...~....~..~ .......... 11. Zone or use district in which premises are situated ...~:.. ................................................................................... 12. Does proposed construction vio~Lqt, e~ny~.~v~,5_ ' ~r) ~ ~,~/ ~ -~ ~/ y -,.~z°nJ,~g law,,grdinance or,r~egulat~r!~ ..~..~..,.~, ................................. 13. Name of Owner of premises,~'.....~..(~......~..Address~~Y/k.:.~hone No. ~..~..~..~....~..~'./~ Name of Architect ..~7..~.~.5~.i.....~ ....................... Address ...... ~_.__~.,~. ................ Phone No ..................... . c,f ,.n~.a_c.t°r/~'~ .~..7.~ ............................ Address .~ .................... Phone No. ~..~.~....~..~..~.~ ~';~o~o ~?~"'" ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indiCate all set-bock dimensions from property lines. Give street and block number or description according to del}el? and show street names and indicate whether interior or comer lot. /t , ,--f~, /5'0' STATE OF NEV~_~/// .............. ,,~..,~.~,~,~'.....~.....,e~,,~,~. .............................. being duly ~orn, d~oses and says t~t he is the applicant (Name of individual signing application) above named. He is the ....... ~ ........................................................................................................................ (~ntmctor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e performed the ~id work and to ~e and file this application; that all statements contained in this appIJc~ion am t~ to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the ~plJc~i~ fil~ ther~ith. Swam tobefore me this ...... J ~, t,~F~ ~ ~ Z_ ~//~ .... ~...~.w~... ~ ...................................... NOTARY PUgLIC, State ~ New Yo~ No. 52-8125850, Suffolk Term E~