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Home My WebLink About6647-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. THIS,CERTIFIES that the building located at ~J.~ . .~. f.o~...~....~..~... Street conforms~ntially to the Application for B~lding Permit heretofore filed in t~ office dated .. dated ....................... , 19.. ~, was issued, and conforms to all of ~e r~uire- meats of ~h~lie~ble prov~~l, aw. The oeeup~e, for ~ certificate is ) ~ed ~.. (owner. lessee or ten,t) of the afores~d building. Suffolk Cowry Depa~ment of He~th Approval .... .o~s~ ~. ?,. ~.0 .... ~Z.'.'.'.~Si~Z.'.'~.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'" Building Inspector l~O]~ NO. ~. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, 1'4. Y. BUILDING PERMIT CI'H1S PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 66~17 Z Dote ............................. .~...~...~...L, Permission is hereby granted to: pursuant to application dated ............................~. ..~....., 1Z..~....., and approved by the Building Inspector. ii Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERRRRRRRRRRRRRRRRRR~C'S OFFICE SOUTHOLD, N. Y. Examined ................. , , , '/" / proved ................... ...... .............................. Disapproved a/c . ~;.~ ~.. ..... ..................... .~<3,~.,';//~. t..... _~... ...... ../~ ..-t....~ .................... / (Building Irr'~ecfor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS p,,cat,on No.., ........... /.. ........... Date ................................................ , 19 .... a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building~ Inspector, with 3 sate of plans, accurate plot plan to scale, Fee according to schedule. b. Plot plan sho~. lng location of lot and of buildings on premises relationship to adjoining prem ses or pub c streets areas, aha giving a aetailed description of layout ofpraperty 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 work. e. No building shall be occupied or used in whole or in pa rt 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 Perm t 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of ap~ica'~, ~ r~r~e, i~'~a-~'~c~poratlon) (Address of applicant) / / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ........................................ ; If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......................... ~ .................... Plumber's License No. ................................................ Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Ntap No.: ... ......... /'-*' '~'.-"1. ........... Lot No .................. ..~ Street and Number ~,:.'~.1'~..,~.'*?.../.'~ ......... ¥.~...../~ ............................ ~../..~..'"Z~.,..~,..~..~.~. ....... State existing use and ~cu~ncy of premiss and intended use and ~cuponcy of pried constmcti~: a. ~isiting u~ a~ ~cupancy ............... ~.....~..; .............. ~ .................. b. Intend~ use and ~cu~ncy ~ ~ ' ~ r . 3. Nature of work (check which applicable): New Building ....... J~.Z.~.... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ................... ,~ ................................... Fee ......... .x..r.....~.. ..................... : .............................................. ~ -~ ~' '(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 I~u~i ~'.r~s~., commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Din~n~ons of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or 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 ..... j...~...~. ............ Depth ....... Z.,~,..~. ............ 10. Date of Purchase ............. '.~"~"X"~' ............................. Name of Former Owner ...... .~.~.C..,.-.e ......... ~ ....... ~.~ ............ ! I. Zone or use district in which premises are situated ........................ ~ ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .................... ;~.;,..~m. ........................ 13. W~:iI~ lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ~ 14. Name of Owner of premises .~.:;..~/..~-~e.~,~t..t ....... fl.....4a.~Address ................................ Phone No.~..:...[.~..~..7 Name of Architect ........................................................... .t.. Address ................................Phone No ....................... Nome 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 corner lot. ~ STATE OF NEW YORK, C(/'~ ~u, COUNTY OF ......................... ,2....;.~ '"" ..........................(No;~-"~/' ;;'~/~vld'~u~l:'''t''7 '"':s~gning_contrac~:"f'"'"'~ ...... "~:" ....... being duly sworn, deposes and says that he is the applicant above ~amed. He is the ............................... v.~T.,....lug.,~..t.,, .......................................................................................................................... ~ (~ontl~or, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perforrr~e~ the said work and to meke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this 19....7..~ ........................ of .................................... _ .,.. / // Notary Public, .:;:/. ...... .~..,..~. ............ ,...,..~,.,, ........ 'C~ounty.., . .............. .z.:--.,,..~--.,,..,.....~..~f..~....,..,,~..~,.~.....~.... ........... ~.~/~.~,', , ~/, / ~ .... JUDITH T. BOKEN Notary Public, Stale of New York No. 52-0344963 Suffolk Count)~