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Home My WebLink About5430-zFOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk'~ Office Southold, N. Y. Certificate Of Occupancy No.Z~..801 ....... Date ............ .F.l.b. ...... .2~ .... , 19...~. THIS CERTIFIES that the building located at . .]~...~...~.. ~ .............. Street Map No. ~ .......... Block No....~c. ...... Lot No..~......~..t..t.~.t..~.k...~..~.Y.° ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... J~ .... 28.., 19.?¶. pursuant to which Building Permit No...~. 3.(~ dated w # 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 ~sued ~ .l~r~,Y. ate. acce~sorF..]~t~4~ng...(.storage..e.~c) ...................... The certificate is issued to ...~/$.1...l~....H.~ .... .0/~...e.r ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... .N. :.R: ........................... UNDERWRITERS CERTIFICATE No. ~..,.R.o ........................................ , ~n, ( . .~m. 1~&2..~.../,~..e ........................ HOUSE NUMBER .... , .-.:~ ..... Street ...... Building Inspector{ 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? 5~30 Z Permission is hereby granted to: .......... ~.~.~.~..~...~.l~k!r. ................. ~ ................. ............... ~,~..~.~.../~. .................... : ................. ................... .~.~.~.~,t,~ .................... + ................. to **.~** ~.~...~...~**c.~..~.~ ~:~..~.1~,~ ...................................................................................... pursuan¢ to application dated ....................... nT..~. .......28 .........i'"", 19...~.J., and approved by the Building Inspector. Fee $....~.?....~.. ............ Building Inspector Examined FOB,~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLE..'S OFF,C $OUTHOLD, N.Y. /,'/'/17~' *~..~,4/~ ~,~.~,, . ~ ........ Application No ................................. "19...~.~. Pemit No. ~..~...~/.....~...~.......~.... ......... ~"~7'er"r'~ ~ Approved 2-~7~ Disapproved a/c ................. ~. ~ ~ ~ /,z~ ............... · ....... ..................... :ii i (Building Inspector7 APPLICATION FOR BUILDING PERMIT (/~') /') ~ ~ Date ......... ~ ..................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building 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 ~art 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 pe ,trait' shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used Jn 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, Ordinanc..esm Regulations, for the construction of buildings, additions or alterations, or for removal or demolition~ as herein descn~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of apphcant, or name, ~f a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber oF buiIda ...................................................................... ...................................................................................................... Name of owner of premises ........................ ......~. .................................................................................................. ~ (~me and title o{ colorer* officer) l. L~ation of land on which~r~osed work will be done. Map No.: ............................... Lot No. ~ Street and Number ...... ........................ ~)~..~.Z.~.~.G.~......~. MuniciPali~ intended use and ~cupancy of p~d 2. State existing use a~ ~cu~ncy of pmmises and ~]]~]~]scon~,mct,~:]~]]~]~]~]]~ ~T~~]~]~]]]]]]] ~ a. ~isiting use a~ ~cupancy ........ ~.~.~.~ ..... b. Intended use and ~cupancv .................... ~.~'~.~.~ 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 c~rs .... ' .................................................................................................................... 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 ............................ /.2' Depth ...~. ................. ' Height ...... ~...'. ....... Number of Stories ............................................................................................... ..;~ .................... 9. Size of lot: Front ........./...~..?..:. ....... Rear ............ .~'..~..~ .............. Depth ......~....~....~...°....~ 10. Date of Purchase ........... .~..,~.....~.Z...Z. ...... ./...~.~..~.......Name of Former Owner ..~.~...~.~/.......~..~....~....~..~.~. ...... ............... 11. Zone or use district in which premises are situated ................ ~.. ...... ~.......Z~. ............ .j.. ........................ 12. Does proposed construction violate any zoning law, ordinance or regulation 13. Name of Owner of premises~.~.'....~../..~..4.~.~.. ............. Address .~.~..:~.~.....~....~../..~...~...~.~./..J'!~..g'Ph~e No~.~.:.~.:~'.~/.e.~.. Nome of Architect .~......E~... ,~....~.~..~.. ................ Address ~?~- ~H 3'7 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 Indicate whether interior or comer lot. - (Name of individual sic above named. He is the ............ ........... being duly swom, deposes and says that he i~ :the applicant (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 cont<~ined in this -application are true to the best of h s knowledge and belief; and tha~ the work will be per;ER~qed in the~manner set forth in the application filed therewith. Swam to,~j~[g~ me this/V~../· ..~'.,/...~ ~ '~/ ....... ~' ,,~/' /~.~.~.,~T ,7~¥ ~/I"']J ~ /~"~Z,~ ................. t .......': ........................ ~' ....................................... r~'otary ~'uD,c, .....~~'/../~.~:~'~...~K'f:~Eo59~ (Signature of applicant) ~ . _ ~o. 52-77994o3 ~k~,