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Home My WebLink About5431-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No..~.~.~.2 ...... Date ............ F~b ...... I~ ....., 19. THIS CERTIFIES that the building located at . 1($1~.. ¢~eek- l)rSv® ....... Street Map No. ~1; ......... Block No...~[~ ...... Lot No..~... 80~tt,~O],d'~' -N,][', ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~e' · '28- ', 19 ?]. pursuant to which Building Permit No .... dated ........... JUl~y .... ~O, 19.?l., 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 . .Pr~vat®. ~e. famX~.y .dw®.~.l:img ...................................... The certificate is issued to . ttarold-Mah®r ..... O~ner ............................. (owner, lessee er tenant) of the aforesaid building. NOTEI ~tpproved b~, Bd ~ppea].~ Suffolk County Department of Health Approval · .~I,R., .............................. // Building Inspector FORi~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE!S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5431 Z Permission is hereby granted to: at premises located at ....~..~e~,..t~.~..&..~ee~e~...~*,(.~,~,..~&.) ...................................... .................................................. ~e~.~ho -~- ~ ~ ~'~ ............................ pursuan¢ to application doted ............................... ~t~llle ........ ~.~....., 19...~,]., and approved by the Building Inspector. Fee $ ...~//.. ,~. ........... Building ~[nspector I l~Ol~M I~0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~/ App'cotion No. Approved ............. :t, ......... .~.....O.. ........ , ]9.,,~,.(,. Pemit No.....~.,~...r,~,,J ...~.... ........ Disapproved a/c ...... ~.~...~...~...~...~ .... .... ~ ~ ................ + ....... :'"'f~a~;~T~t~;;i ................................. ~'~ ~ APPLICATION FOR BUILDING PERMIT ,,~ ~ ............... 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 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, Ordinan~s or Regulations, for the conetruction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (^ddrc:~ of opplicont)' 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) L~ot No. ,. Location of ~l;dm~en ~c~.(gsed work will be don~ Map No ~ ~) ~' /~ ~5~ Municipali~ 2. State existing use and ~cupancy of premises and intended use and ~cupancy of pr~osed construction: a. ~isiting use a~ ~cupancy ...~.~..z. ..................................................................... 1 3. Nature of work (check whic~pplicable): New Building .................. ~clition ....~... ......... 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: Front .........~....O. ........... Rear ..... ..~...0. .................... Depth .~...~.. ......... Height ~ ~. I ...... Number of Stories ......... ~,, .................................................................................................. Dimensions of same structure with alterations or additions: Front ......... .-~....~ ................... Rear ......~.....O.. ............... Depth ......;..~..~..~. ............ Height ......~...~?. ............ Number of Stories ......... ./.....~.... ........... 8. Dimensions of entire new construction: FrOnt .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ................................................................................................. 9. Size of lot: Front ....... .,~,~ ....... .~. ...... Rear ........ .~....~. .................... Depth .....~ ...................... - ,~ 10. Date of Purchase ...,L.~,../.~....-...~.~...(~...~.. ............... Nc,:,:,:,:,:,:,:,:,~e,of Former Own_er ...~..~.~ .................. 11: ' Zone or use disfrict in which premises are situated ...... ,~.~.~:.:..-~..'.;..:.~.-~. ............................................................ 12. Does proposed construction violate any zoo ng aw, ordnance or regu at on? . .~.....-~.. Name of Architect ...................................................... Address ..:..~ ........ .~r.. ..... Phone No ..................... Name of ...~.....(,~..-T~'......Acldress ....~.~....~ Phone No ..................... Contractor 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 corner lot. ~(Name of individual signing application) ~ ~ ' above named. He is the .................................................................... ~.~... ............................................................. (~ntmctor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or 'h~e perfo~ed the said work and to ~ke 'and file this application; t~t all state~ents ~ont~ined in this application amt~e tb the best of his knowl~ge and belief; and tha~ the work will be performed in the manner ~t fo~h in the ~pllc~i~. fil~ ther~ith. Sworn to ~f~re me this NOTAry ~o. 52-8~2585o. Surf6,: c~~