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Home My WebLink About6029-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 7--.,50 O o Date ....: ....................... , 19 .... ............ ~z:.~ ~,~.>,o'~ ~[ THIS CERTIFIES that the building located at ............................ Street Map No..~ ~! .~,.).0~ Block No ........... Lot No. ' conforms substantially to the Application for Building Permit heretofore filed in this office dated ...~ ..... .~..-:.., 19. f.. pursuant to which Building Permit No. ~.OA dated .......... : ............ , 19 ...., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occup~cy fqr which this certificate is ~ssue~ ~s ...~ .......... : ....~ .... ~ ...... ~ .:~: ................ ~ ................. The certificate is issued to../¢}'~' :.~'~.. ~~ .... ~~ ............ (owner, lessee or tenant) of the afores~d building. Suffolk County Departmen~ of He~th Approv~ ................................... ,,/ ~ ~ o 7" ~ /~ UNDErWRITeRS C~RTI61C~TE No... {. ~ ~ . . .~ .......... ~ ..... ' b ..................... .... . ..... . .................... Building Inspector leO~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~, Y. BUILDING PER/vIIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°· 602L9 Permission is hereby granted to: ,o..~g,~....k. ....... ~=~..~.~ ...... .~.~s.........~.~~,,.~:~ ............ ..................... ~.,,,,~ .......... ~-.:/....: ................................................................... ,... · . ...... .~...~ .~..~?.. 19~..~... and a roved b the pursuant to application dated ........ ~..:..~ ................. , .... . PP Y Building Inspector. FOBBf NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Fxamined ........ 19 ........ Approved ............................... 19 ........ Pemit No .................................. Disapproved a/c .................................................. Application No. ~0 'L..~ . APPLICATION FOR BUILDING PERMIT ~, Date ....... .r~. ..................................... ,19...-.~.....~...~ ~ · INSTRUCTIONS ' ~ a, This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit 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, aha% 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 orl~ 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 bee~ 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 buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lawsk~ ordinances, building code, housing code, and regulations, and to ad mit authorized inspectors on premises and in buildings for necessary inspections.tv ~of applicant, or name, if a corporation) .................... s OT apgJi, ~ State whether applicant is owner, lessee, a n~rchitect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. I. Location of land on which proposed work will be done. Map__No.: ..................................................... Lot No ............. Street and Number ..... ~ .~.x~.....~..../~......~...~,~.......~..~.~.. ~ ................................... ...~....~...~.......~....~...~'...~...0..4... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... i .............................................................................................. Intended use and occupancy . ..................... ~j 3: Na~'ure of work (check which applicable): New Building .~.~...~..~,.~,~,. Addition ..................... Alteration.'. ......... ;:.. Repair ......................... Removal ~.~.. Demolition ........................ Other Work .................................... ~ Description) 4. E~ima~d ~ ~.~ ....................... {to ~ paid on filing this appli~tion) 5. If d~lling, number of dwelling units ................. Numar of d~lling uni~ on. each floor ............. : ........................... If ,r~, numar of ,rs .~ ~......~.~..~~..~~ ......................... 6. If busine~, ~mmemial or mix~ ~cu~ncy, s~i~ nature and extent of e~h wpe of u~ ..................................... 7. Dimensions of exi~ing ~ructures, if any: Front ..................... Rear ........................... Depth .................... ; .............. Height ........................................................... Numar of Stories ............................................................................. Dimensions of ~me ~ructure with al~rations or additions: Front ................... ~ ...... Rear ......................................... Depth ............................................. Height ......................................... Numar of Stories ........................................ 8. Dimensions of entire new con,ruction: Fret ....... ~..~. .......Rear ........ ~,~ .......... ~ O Depth ................................. Height .............. x..~. ........................... Numar o S ones .......... ........................................................................... 9. Sizeoflot: Front ...................................... Rear ........... ~. ........................... Depth .................................................. 10~ Date of Purcha~ ..;; ................ ; ................ Name of Former Owner ............................................................................ 11. Zone or u~ di~rict in which premiss are sleeted ..................................................................................................... 12. D~s propo~d con,ruction violate any zoning law, ordinance or regulation: ...~ ................................................. 13. Will lot be m~aded ................................Willex~fill~mmo~dfrompremi~s: [ ] Yes [~ N~ 14. Name of O~er of ,.m,~ .~ ........................... ,.....~..~. ...... (Address) /. (Phone No.) NameofArch~t~t ...................................................................................................................... / ~ , ~ ~ ~ ~ , ~'~'"~:~ ............... Name of ~ntra~or .................... ~....~.~.~X..~, ~ ......... ~ .......... ~;~~. .......... ~z.....~x.(~ .... (~ddress) (Phone No.) PLOT DIAGRAM E~ clearly and di~inctly all building, whether exi~ing or propomd, and indicate all ~t-back dimensions from ~o~ lin~. Gi~ ~met and bilk numar or d~ription ~cording to d~d, and show ~met names and indicate whe~- er interior or corner lot. STATE OF NEW YORK, ~. ) SS COUNTY OF ............... ..~......(~f~ ............. ) / ............ V~...~--.-.~/- ./~.. ......... ~.-~...~-..0.~../~. .............. ~,ng duly ,.rn, d.~., and says that he ', the a~li~nt (N~ o~ i~i~ si~ing con~act) ' ' He is the ........... ~.~ .......................................................................................................................................................................... ' / (Con~ctor, ~t, coyote o~r, etc.) of sa~ owner or owners, and is duly authorized to ~rform:or havq ~or~d the.said work and to make and file this appli~tion; that all .~,m~.~ ~on,in~ i. ~hi..,,,.,on .. tru. to t~ ~t6~I~'~.~ an~ ~.f; ,n~ th.t t~. work w,~ ~ ,,or~ ~t fo~h in the agpli~tion~, filed themwith~ · ..,.~ya~a POBtIC, STATE OF ~EW ~0~ . ....... ~.2 .................... ~,~of ........................ ~,tt~ ~ .~" . .... ...................