The URL can be used to link to this page

Home My WebLink About5776-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy No. 1~93~ ........ Date ............... DOC .... (Hay ~at~rs THIS CERTIFIES that the building loca~d at F~e~$. ~each .E~. (~et Map N~9~.*..~a~.*..~ock No ........... Lot No. ~....~0~9...N rY.* ........ conforms subst~tially to ~e Applica~on for B~g Pe~it heretofore fil~ in ~is office dat~ ........... ~.... ~.., 19.7~. p~su~t to which Bu~ng Permit No..~.. dated ........ ~.. ~Q ...... , 19. ~., was issued, ~d confo~s to &l of the r~ ments of ~e applicable pro,iota of ~e law. The occup~cy for which ~ ce~ificate is issued ~ . ~9..9~9. f~ .~.~g ....................................... The certificate is ~su~ to ... 9r..~ ~. ~&Z.&. ~$f~ ...... ~r~ ................ (o~er, lessee or tenant) of ~e afores&d b~ding. Suffolk Cowry Dep~tment of He~th Approv~ .~,~.* ............................... UNDERWRITERS CERTIFICATE No ~ .......................................... HOUSE NUMBER.. J.~5 ....... Street... ~hg~. ~.~. ~.~ ..................... Building Inspector FOr~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. N? 5776 Z BUILDING PERMIT '(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL OMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: ........... 5./..~.......~......~......:....~::.,.~...~.~..~ s to et premises located at ................ ~ ................................................................. ~.......<~ ....................... pu suo t o opp icotion dot~ ................................. ' .................. ~...., ]9 ........ , ~nd opproved by Jhe Buildin; Inspector. ' Building In~ector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ ~ ~ Approved .................... .~... ....... ~....., 19.7.....~'Pemif No ..................................... Applicotion No. 5 77~, Disapproved a/c ........... ~ ............................ (Building Inspector) APPLICATION FOR BUILDING PERMIT 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, and'~ 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 nspect on 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. 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, Suffo/k County, New York, and other applicable Laws, Ordinances or Ragulatio,=, for the construction of~ buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with al! applicable laws. ordinances, building code, housing code, and ragulations, and to admit authorized inspectors on premises and in buildings for necessary inspections (Signature of al~olicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ Name of owner of rem ses ..... -7'- , ...~.....~...~.~.....~.....~'~..~-~' ~ ~A/! 7'/-t- .~'~°r/~/ U ~-Z.~' If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) N~].: 7°C~ ' ot No ~ '~' -~ . 1. Location of land on which proposed work will be done, Map o.: .................... ~. ............................................ Strut and Numar .......................................................................................... ~ .......................... ......... , .................... ~ ~ ~ d ~ ~-- MunicipaliW 2. State exi~ing u~ and occupancy of premiss and intended u~ and ~cupancy ~ propo~d con,ruction: Exi~in u~andoccu anc ...... E~.~ ...... ~ IH IL~ a. g p y .............. ~ ....................................................................................... b. Intended u~ and occupancy .................................................................................................... ~ .......................... 3. Nature of work (check which applicable): New Building ....................... 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 type of use ..................................... 7. Dimensions of existing ~ructures, if any: F~ont ..................... Rear ........... ~..[ ............ Depth ................................... Height .................................................. ; ........ -Numbe~ of Stories ............................................................................. Dimensions of same structure with altei~atiohs dr additions: Front. ..................... Rear ......................................... 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 .............. i.lv ............................... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase .............................. ~ ...... Name of Former Owner/t....: ..................................................................... 11. Zone or use district in which premises are situated ................................................... ,.. ........ .. ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ : ............................. ~ ......... : .... 13. Will lot be regreded ............. ~ .......... , ........... Will,excess fi,II be removed from premises: [ ] Yes [ ~jJ~lo 14. Name of Owner of premises ::.' ........ :...' ....... : .......... :: ......... .....:...:::..: ............... ,......~....~...~./.. ....... .~..0..?. ,~.. .................. (Address) (Phone No.) Name of Architect .......................... ...._.,.~ ..................................................................................................................... Name of Contractor ............................................................................................. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimens, ions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner Int. / STATE OF ~ YORK, ~) COUNTY (- ='.......~ ....................... ~ ...................... ) .................. ~ ...................... ~ .............................................................. being duly sworn, deposes and says that he is the applicant above named. He is the ................................................. ~....).....~ ....... ,*'. ................. ; ........................................................................................................................ (Contractor, a~ent, corporate ojjqcer, 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 thi~ application are true to the best Of his kdowfiedge and b~l'ief; and that the work will be performed in the manner set forth in the application filed therewith. ...................................... .................................................. ,, ............. Notar~ Public ...................................................................... County ........................................................................................................... (Signature of applicant)