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Home My WebLink About7108-zFOBM NO. 4 TOWN OF SOIJIItOLD BUFr.~G DEPARTMEI~ Town Clerk's Office Southold, N. Y. Certificate Of Occupancy o ............. Date ... ..... ..... conforms substantial~ ~ ~e Appleton for B~g P~t h~e~fore B~d~ng P~t No.~ dated dat~ ............... ~/~l .~, 19YY.., was ~u~, ~d co~o~ men~ of ~e app~cable pro.iota of ~e hw. ~e occup~ for wM~ (o~, lessee or of ~e ~ores~d b~g. 8~o~ Co~t7 Dep~ent of ~e~ Approv~ aous~ m~.../.,.l~.~.., s~ .~. ~(~. ~ .... ~.~. Building Inspector / FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7108 Z Date .................... ~.TC~ ......... ~ ........... , 19.r~.. Permission is hereby granted to: t~eb.t~ ..~a.tt .....~/~. · ... ~.$.- ~1.. · ~ ............. .............. ~eu~h~l~l ............................................... to. l~o.~e...ex~. ,~ ~ iu &..u.t2. lite...huLld.tng. at premises located at ...~.....~.-¥~.eq/...A~S' .......................................................................... ................................................. ~.~hc.l~ ........... ~.^~.~ ...................................................................... pursuant to application dated ....................... F~.'Z' ....... ~ ............... , 19~..., and approved by the Building Inspector. Fee $...'J.O..O0 .......... FO~ NO. 1 "~?~'~. "~"~ TQ~WN OF SOUTHOLD . · BUILDING DEPARTMENT TO~N CLERK'S OFFICE SOUTHOLD, N. Y. ..... ........ .,,_2.7 ............................,, z ....... , I NSTRU~IONS e. This application m~t be completely fill~ in by Wpewriter or in ink end s~mitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to ~ole. Fee according to schedule. b. Plot plan showing Ioc~tion of lot end of buddings on prem,ses, retet,onsh,p to edlo,n,ng prem,ses or pubhc streets or areas, end givi~ e detailed description of layout ofprope~ must be drawn on the dicgmm which is pe~ of this application. c. The work covered by this ~pplicetion may not be comme~ed before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue e Building Permit to the applicant Such permit shall be kept on the premises available for inspection throughout the work. e. No building shell be ~cupied or used in whole or in part for any pu~ose whatever until e Ce~ificete of ~cupency shell have been granted by the Building Inspector. APPLICATION IS HEREBY ~ADE to the Building Department for the issuance of e Building Permit pumuent to the~ Building Zone Ordinance of the Town of ~uthold, Suffolk County, New York, ~nd other applicable Laws, Ordinances or Regulctions, for the constru~ion of buildings, additions or alterations, or for removal or demolition, ~s herein described. The applicant agrees to comply with ~11 applicable laws, ordinances, building c~e, housing c~e, end regulations, ond to admit authorized inspectors on premises and i~ ~ildings for n~esse~ i~p~tions. (Signature of applicant, or name, if a corporation) Southo ld N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ilder 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. Mop No.: .......... ~ ......................... Lot No.....X~... ................. Street and Number ~/.~....,qO33Z~d,..~LaW...A~.$ ............... S~u~hold.....N..Y.. .................................................... Municipality State existing use and occul~3ncy of premises and intended use and occupancy of proposed construction: e. Exisiting use and occupancy ....... .~LI3~q.t...].a. Ild. .............................................................................................. b. Intended use and occupancy ..........~.l;.$.~,l~:Z...b.p,..1..1..c!.~.Ag...(,~.~.o.~.~,.e....e.~g.) ........... 5.'?.... /3. Nature of work (check which applicable): New Building :.~ ............... Addition ..:~[;~ ........... eration ......... Demohhon .................... Other Work .........................................1~J[ Repair .................. Removal .................. '' relocate exist b (Description) 4. Estimated Cost ............................................................ Fao l~,~).e..~. .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units~ ...2 ...................... Number of dwelling units on each floor ............................ !f garage, number of c~rs ............................................................................................................................................. 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 ............. 8 ..................... Rear....8 ......................Depth ...2~ ................ Height .................... Number of Stories ......... Q33~ ...................................................................................................... 9. Size of lot: Front ........ .1.00. ........................................ Rear ................... .1.00.t~. ............. Depth .2~'O..'lt ..................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... ."...A..t!....d:..i...s..~. ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ J~g. .......................................... 13. Will lot be regraded,. ....... iZO ............... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...... ~:t....]JO'ld..J~.O, rp ............... Addressz.~.....n.~ .......... Phone No ....................... Name of Architect .............................................................. AddressC~,~fi~J~.'..~..:/r(...~'. P;,u,,~ tqu. ~..~....~...o.....~.. ...... Name of Contractor ..I~.....~.ILtt..TI10. ............................. Address ..J~g.l,1,.ll;~Q,].~ ........... 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 NEWYORK, ~,, COUNTY Of ....$....1~.~..6.;],,]f; ........... f~.~ ........................... ~.~.~..~.~..~.~ ................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. builder 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 conta,ined in this application are true to the best o~ his knowledge and belief; and that the work will be performed in the manner set fodh in the application filed therewith. Swam to before me this ................. · ~..... day of .................... ~ ........... , 19....~ ~~ ~ ~ , ~/~ Not w .............................. ..................... C .U ...t./ ...................