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Home My WebLink About6121-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .1~.8..l~..~.~..1~..! .~t., ]~d .... Street Map No... ~ ....... Block No..~ ...... Lot No...~.....N~..~.t$...t~k.....~.t~. ? ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ 8eP.~...~ ~., 19.. ?~ pursuant to which Building Permit No...~.! .2~..Z. dated ........ ~ei~...¶~ ..... , 19. ~A, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. & .ece~sozT. bu~,lxl~J~g..-..~fl;ora$e~ .e~;g ............................... The certificate is issued to .A]~.e.e .&..D.~H;~.t,~'..H~. l~e.~ ..... . .0~ke...l'.l. ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... .~.e..l'.e .......................... UNDERWRITERS CERTIFICATE No ...... I1',1~ ....................................... HOUSE NUMBER .... 31,3~. ....Street ...... 1~$~1~,8J.::1.8..1~1 ......... Building Inspector I~'ORM NO. 2 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) 6121 Permission is hereby granted to: , / /~ / ** ~ .... ~.~.....~~.~~....~z ..... ~.ZZi;~_-~_.~...~._.~...~....... ,o ................ ~~....~.~..~~~.~..~ ........... pursuant to application dated ...... ~, ......~....../.~.. .................... , approved by the Building Inspector. Building Inspector Disapproved a/c ............................................................................................ (Building Inspector) Applicotion No ............................ APPLICATION FOR BUILDING PERMIT -.,C, ' o /.5-- Dine ..... ~ ............................ 19. ,7_,°9......~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with'~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an giving a detailed description of layout of property must be drawn on 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 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. O rd~nP;nLIJoAf'r~hOeNT IcSwnHoEfR EseBulYho~ldA, I~uEffto°j~hceouBnUtily,di~egwD;Poarrkt, r~t~l~re;~;~lSiS~a[ ~2L~s~ OBrl~liilnd~nngcesPeorTl~tegP~ioar~st' ~o°r tth~ ~ cBoUnil,~dt~igctiZo~no~ 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (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~ ................................................... ........... ................ ........ ..... .......... 5'7" ........ .' ................ Name of owner of premises ...~.......'~...: ........ .r.~......~...~......~ .......... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~ 1. Location of land on which proposed work will be done. Map No.:; ................... Lot No ........~.. ................................. Street and Number ...,~....zi(-t~..~......-~~ ....... ~....:....} ......... ~.~.~,~ ................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~~...~.. Intended use and occupancy .~~,~~,,-//' "----- . . ~c~c~.~ ..... 3. Nature of work (che~,k whicJ~ applicable): New Building ......... ..v~_. ........ Addition ..................... Alteration..;...:... ...... Repair ......................... Removal ......................... Demolition ........................ Other Work ................................. ~... ~'~ (Description) 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 Wpe of use ........ ~ ...................... 7. Dimensions of existing structures, if any: Front ...... Zj~...; ..... Rear ....... ~....z~....~...., Depth ..... ~...~...." ............... / Number of Stories Dimensions of same structure with alterations or additions: Front ........... ~ ........ Rear .......... ~ ....................... 8. Dimensions of entire new construction: Front ........ ~...../. ......... Rear 9 ...................................................... R ......................................... p ................................................ Height 11. Zone or use d str ct n wh ch prem ses are s tuated ....................:; ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ Will lot be regraded ~ - · Will excess filL, be removed from prem ses' [ ], Yes [~]~N_9 - 14. Name of Owner or premises .,;,,,,: ............................ ;;.; ........ ; ................................. ~ ................................................... (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 indicate wheth- er interior or corner lot. , = COUNTY OF ....~ ................. ) .......................................................................................................... being duly sworn, depos~ and says that he is the applicant above named. {Name of individual signing contract} 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 and file this application; that all statements contained in this application are true '~o the best of J~ll~r~hnd belief; and that the work will be performed in the rnanm~r t%ta Pubhc Sta~e of New set forth in the application filed therewith. / W ' . · ~ ~ ' ",2.034~963 Suffolk C. ounh~5 ..................... of ............... Notary P u bi ,c~,/~..~..~o u n tY ......... ~--... ~..-.....~.~.. ~ .......................... (Signature of applicant) \ \ \ \ \