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Home My WebLink About5703-zFORM NO. 4 TOWN OF SOUTHOLD BUrr.BI]NO DEPARTMENT Town Clerk's Office $outhold, N. Y. Cerlificnte O[ Occupnncy No..Z.~35.5. ..... Date ..............Y~g~s.Z. ?.s .... , 19.~.3. THIS CERTIFIES that the building located at .6.17~.0...l.~;I~. lt0.~d ........ Street Map No .......XX ..... Block No....X~.. ..... Lot No. ~ .......~.o.~.h.o.~.d.~..N.,.Y.: ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............J.a~..~. 2~.t, 19. ?2. pursuant to which Building Permit No... ~?.0.~ dated .............J~r~,. 2?$., 1972.., 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 .B.~l-t~.e~.~ .]~t.~d~g-.~al,~ .&. R~m{~[I'..l{hOl~ ........................... The certificate is issued to ... Y/i,Ct~O~, .J,. ~Ol~l,i{ ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No...P..~!.~ ................................... HOUSE NUMBER .~.1.?~.0. ....... Street . .8/.8.. ¥~..~.n...R.o..ed. ......................... ..................................................... .SV .......... Building Inspector FOrM NO. 2 TOWN OF $OUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N.Y. : BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5703 Z D,~e ............................ ~ ...... ~. ........ , Permission is hereby gronted to: at premises located at ...... ~'~"~i1~ ...................................... ~ ......................................................... pursuant to application dated ....................... ~a~l~.".~ ................... , 19. L~., and approved by the Building Inspector. ~ee $...:P,5,~0 ......... ~ ¥ - , Building [nsp~:tor { FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Examined ...~....~.~Z, 19..Z.~. Approved ........................................ , 19 ........ Pemit No ........ Disapproved a/c ........................................................................................... .~ 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 commer~ed 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, Ordinances or Regulations, for the construction 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. ~(c~r~ature of apl~n~jt, o)' name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ......... ............... ................................. ; ............................................................................ ~'x X ~ ~)n r f I auth°~zed fficer ~\'~- If applicant is a corporate, sig atu e o du y ' o ' · (Name and title of corporate officer) 1. Location of land on whici'T~roposed work will be done. MaR No.: ..... ,. ................................. Lot No ......................... Street and Number ..... I.~'.~....~..~...~......~...~ ............... ..~..?. ~ .) ...LY~.....u. ! ..~ ........... ...~....~ ...... Municipd~il~ ............................... 2. State existing use and occupancy of ,premises and intended use and occupancy of proposed construction: ' 5 £ a. Exisiting use and occupancy ...... ~~....~. ..!~ ......... ..'~.. ........ ~. t ........................ b. Intended use and occupancy ....... ..~.....~..92.~ ...... .~.....¢~..;....!..~..~ ....... ..0...t ...... ..~....Lff.~..~.~..O...'.TL?...t..~ ...... 3. Nature of work (check which applicable): New Building .................. ,~clition / Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) 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 ~...!....~....~...~....O~ r. 7. Dimensions of existing structures, if any: Front ....... ./...Q.c~ ........... ~. Rear ........ .?...~.. ................. Depth .~.....~. ....... ....~ Height ........ ~..? ........... Number of Stories ........ ! ........................................................................................................ Dimensions of same structure with alterations or additions: Front ........... ./...~..~.."..=. .......... Rear .......... /...~.ff.. ........ Depth ............. ,~...~. .......... Height ........... .~. .............. Number of Stories ............/.......~ .......... 8. Dimensions of entire new construction: Front / b~ Rear / '~ Depth .......... ~.~.. Height ......... ~.J ........ Number of Stories ......... ~ ........................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 1 1. Zone or use district in which premises are situated .............. 12. Does proposed construction ~iolote any zoning la_w, ordinance or regal, lotion? ...... .._.~...?......-....-_...._~.Phone N° ._.. 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 whether interior or comer lot. ~)~.~_~ ~_ ~ $ STATE OF Nb'W~.RI~',~,( tee .... ~..,~.~~...~...L.I.~ ................................ b*infl duly ~worn, d~me~ ond soy~ t~t h~ i~ t~ opplicon~ a~ve nmed. He i~e .......... 0~ ....................................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to perform or hove performed the said work and to ~ke and file this application; that all statements contoin~ in this application are true to the best of his knowledge and belief; and tha~ the work will ~ performed in the manner ~t fo~h in the applicati~ filed therewith. Swam to before me this ~ / t ..... : ;: .......... . ....... ........... ~*m [xpir~ ~*h ~0, 1~~