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Home My WebLink About8459-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z?~.] ..... Date .............. .l~l'.~h .... 21.., 19. THIS CERTIFIES that the building located at . .~. ~ .~ ......... r. Street Map No. ~ ......... Block No. ~ ........ Lot No, .~ ...~$~ .............. conforms substantially to the Application Eot Building Permit heretofore filed inthis office dated . ~/]7~. &. 3/30 .... , 19~.. pursuant to which Building Permit No. 7~ dated ~!7/~ .&. 3.~0/..~., 19 .... , was issued, ~d conforms to ~1 o~ t~e requ~ ments of the applicable provisions oE the law. The occupancy Eot which this ce~ificale is issued is . ~$~. d~.~g .~/~.~h. P~.~ .~.~..~ .~0~ .~0~ The certificate is issued to . Ph~.P..~. {~ .... ~!~ ............... ............ (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval .. ~:~* .............. .. :. ........... UNDERWRITERS CERTIFICATE No. l~.,.tt~ ........................ ~. ;~ ............ HOUSE NUMBER .... .~0 ...... Street ...~p~.~. P~i~. ~i~.'... ~. ~.~k.. B~lding,~ Inspector FOI~H NO. ~ TOWN OF SQUTHO~D 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? S459 Z ' "PermiSsion is hereby grante~d to: ': ise ed a ' : ' :' Approved ~ t -~'~ <~) I . Permit ,~u~/.,.~ ................................ APPLICATION FOP. BUILDING PEI~MIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in i~k and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproper~ must be drawn on the diagram which is pa~ of this application. c. The work covered by tgis application may not be commenced before issuance of Building Permit. d, Upon approval of this application, the Building Inspector will issue 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 Ce~ificate of ~cupancy 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 th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construmion 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 c~e, and regulations, and to admit authorized inspectors on premises and in buildings for n~essaw inmections. ......... {gf~nature of~plic~nt, ~r name, .... (Address of applicont) p/A'777 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. ................................................................................................................................... ,=m, of ...... ....... 'e7 ....................................................................... If epplicant 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 Trode's License No ............................................... Location of land on which proposed work will be done Map No.:=...,.~.,./......~....7....'"'~ ......... L~ot No ..... d~.....6..~. ......... Street and Number . ..~...~.~......~....~...?..~ .Z7..¢../.?.....~..~.,~./.~-...~........./?. '~' "~.-~....t......Z'~'/~''~''''~''''~''/'''(':')''~:-''/''~':''''''''~'~''''' '/''~' Municipality State existing use and occupancy of p~nd intended use and occupancy of proposed construction: a. ExJsiting use and occupancy ........................ ~ ......... .~.....:.....~ ............................................................................... ,, . b. Intended use and occupancy ............................. 7-" ........ '~* .............. "~:z~"'"M ............................................ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... ~00, '~ ~ ...~....~.~....._~... (Description) 4. Estimated Cost ...... · ..................................................... ~ee ............................................. (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 ............................ 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 ....... Z.~.. ...................... Rear ..... ~..~.,,.~. ............ Depth ...../.,...'~'.. ............ Height .................... Number of Stories ................................................... ; ...................................................... 2' .......... 9. Size of lot: Front ........ ~..~...../. .................................... Rear ...... /.~.~...~.. ........................ Depth ...... .?....~.,~.. ........... ,... ................................... Name ...................... 10. Date of Purchase af Farmer Owner ..~.....~..~...,7~...~'../~.,, 11. Zone or use district in which premises are situated ..................................................................................................... i2. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~j~..~,. ....................................... 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No of remises P.~..,I j~l/) .~.../~....~...~..,~ - 14. Nome of Owner p ' . ........................................... ~,./j'j-j~ddress ..... ~.,,('.,~..~..~,.~.~.~hone No..~...~...T...~..~.~:~ 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 +,'bother interior or corner lot. I ou6' % pyr Tl STATE OF NEW YORK ~ ~ S S COUNTY OF ........ ~.¢.[.z..O...~.~ ....... f . ..................................... · .,~..~..~.~./../.'..~.........~...-~..~.....~....~......~.../~eing duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ....................................... ~,l~'Ze~. ............................................................................................................................. (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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ ............ dayof ........ .................... , Notary Public ................ ._~££o~ ..................County .......... ~ .~..,...'~..~..~..~.. ......................... v, ..~"~'~... .................... , ' oture of app~/~~ ELIZABETH ANN NEVILLE NOTARY PUBLIC, State of New York