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Home My WebLink About7052-zFORM NO. ~ TOWN OF SOUTHOLD BUH.BING DEPARTMENT Town Clerk's Office Southold, N. ¥. Certificnle Of Occupnncy .o Z5'? 3~' ...~.~m~... ............. Date .... ~ ./.~. ...... , 19~. ~. THIS CERTIFIES that the b~d~g located at ~ .~.~ ........ S~eet Map No .....~ ...... Block No...~ ...... Lot No. ~...~~ ....... eo~orms m~ti~ to ~e Application for B~d~g Permit heretofore filed ~ t~s office dated .. ~... [~..., 19~.ff. p~su~t to w~eh B~ld~g Pemit No.~o~ .~ dated ... ~...? ...... <~ .... , l~ff.., was issued, ~d confo~s to ~ of the r~e- ments of ~ ~~ro~siom of ~e law. The occup~cy for whi~ ~ ee~ificate ~ ......... ..... The certificate ~ issued to~..~ .~ ....... ~~ ......... ~ (o~er, lessee or ten,t) of the Mores~d b~ld~g. S~olk Co~ty Department of He~ Approv~ . ~.~.: .......................... No. ............................... HOUSE NUmaR ~. ~ .~.f ..... Street. ~..~.~ ..................... Building Inspector / IrOBM NO. ~ TOWN OF SOUTHOLD BUILDING DE~AltTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING IXERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 7052 Z m,, ....... ..~...~...../....c/. ....... , ,~..~..y Permission is hereby granted ~ //~ .....~...~'~ ..... U....,O.....!~ ......................... ('"?~'Z'~ .............. ,o ~.t...~ ....... ..... ..~~~.~! ...... ~~.~...~...~.t..~.~ ....................... .......................................................................... ................................................ ~:....:...i ....................................................... ............ ........... ~nd ~pp~ by the Buildin~ In--or. Building Inspector ( TOWN OF SOUTHOLD BUll. DINS DEPARTMENT TOWN CLERKqJ OFFICE SOUTHOLD, N. Y. · .. Examined / ......]~...'~.. ~ Application No ............~. ................... Approved ~.. .............. !: ........ .~.! ........ , 19 ........ Permit No.~..~......~.....~....~...... ..... Disapproved a/c .................................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ..~..: ................................. ,19..~......~. .... a. This application must be completely filled in by typewriter oe 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 o~ 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 nat 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. 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, admit authorized inspectors on premises and in buildings for neces~ ¥ (Si~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ? .............................................................................................. Name of owner of re ' p m~ses ....................................... ;. ......................................... 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 ............................................... and on whcL prop ~ work be done AAroN - -~ Lot Location of .~.~.~.. ~-4~ y ....................................... No ......................... ' Street and Number ~ ~- ~'-~ Municipality State existing use and occupancy q~pre~nJs_~.gnd ir,:tnded usegnd occupancy of proposed construction: a Exstnguseaedoccu anc. ..~._~~ · p Y ...................................... ~ .......................................................... b. Intended useandoccupancy ....~ ~*-~ ~ ~--~ ~il ~'..: 3. Nature of work (check which applicable): New Building ...:./~ ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (Description) 4. ~timoted Cost ............................................................ Fee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units O .......... Number of dwe ng 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 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 .......... i...~..%,- .............. Rear ...... .qL.'~- .............. Depth .~...../..']. ....... Height ...... ~.~...~,T,.. Number of Stories ....... - ............................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ .,Name o,.f Fo~er ~...e~...i..~ ................................................. 11. Zone or use district in which premises are situated "'~"'~r~Z'!,dir~nce ......... .~t~*..~.~_V~.regulation: ~ I~,. [~/'J~'~ ............ 12. Does proposed construction violate any zoning law, o or ...~-/~'..J]..,.~.-t....,~4..~-/.~.~' 13. V~ill lot be regraded . .........,~ ........... Will/e~cess f~ll be removed from pr,~ise~: ( ) Yes (/~No 14. Name of Owner of 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 properb/ lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF I~LEW,Y-ORI~,j /~ [c¢ ................. ..,C~...~....( .~.,C~.~;.Z..;~ .................................. being duly sworn, deposes and says that he is the applicon! ~me c~/indiv~dual signing controcf) above named. 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 to the best of his knowledge and belief; and thor the work will be performed i,~the manner set forth in the application filed therewith. Sworn to before me this I I ................ ......... ....... t ......... ........ Notary Pubh .~f'~,~.~ounty ... '~,~, · ......... 1 ~o~ul~ican~')' ........................... JUDITH T. BOKEN Notary Public, Stale of New Yo~ No. 52-0344963 Suffolk County b