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Home My WebLink About8129-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icate O[ Occupancy THIS CERTIFIES that the building located at .. A~ex'.a .Road ........... Street Map No...XX ....... Block No, . ~ ...... Lot No, ;~...Gr~.~.!~Dor.~...N.,.~.,. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ~ku~.. t., 19.7.~. pursuant to which Building Permit No.. dated .............. .~.~.g.. 7.., 19 .~. ~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...P.r~W..t.e..o.~..e. f .z~..~,1~..d. Fe.~.~..t~.g' .w~.h.. ,~i..~.~.o.~... .................... The certificate is issued to .~/~ll:L~m. P.z. ll .... .0t~e~. ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Healih Approval ~:.R., ............................... UNDERWRITERS CERTIFICATE No..~elFl(lSnl~ ................................... HOUSE NUMBER ..... ~).0. ..... Street ... ~g.l~.r.Z...R.~. ·. ........................ Bmld~ng Inspector 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? 8129 Z Permission is hereby granted to: C~s.,...~,I~.....~..~...~l~l;La~,..~. ~ ................... ....... ~,~n~o~ ................................................... to ~.tt;~J,t~...~kU..~.C~r~ ~J;f~.o~...~..exi~l;~m &..c~g ................................................................ at premises located at ....~.~,..,~:~.®~...B~a~[ ................................................................................... ................................................................... E,~ee~_~o~% ...... :~, ....................................................... pursuant to application dated ............................~.~.~. ........ .~ ............. , 19...~..~, and approved by the Building Inspector. TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ............ .~. ......... :.~. ............. , 19.....o~.'./ Permit No .......... ~...~...~-.;': ........ ^pp,,cof,on .............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter ox 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 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 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 perm 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 them 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 aJterations, 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. 'q~Signature of applicant, or name, if a corporation) ~(/(ddress at app~ican~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... ~~/~.. '~.'~.t~........~.~ ................................................. ; ............................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......... .~...~..~....,'~. -~.~- ................ Plumber's License No ................................................. Electricion's License No .............. ' ............................... Other Trode's License No ............................................... /~ ~ I. Location of land on which proposed work will be done. Map No.: .............. ./.......~. .............. Lot No. :....j ................. Street and Number ...~..~.1~. ........ ~../:~j~.....~..~ ......................................... .~-.~-..~-~t..~.... ..... ~' ' Mu~tfcipallty 2. State existing use and occupancy of premises and intended use and occupancy of proposed constru~ction: / ......... ..¥.. .... /.. b. Intended use and occupancy ............. f~'"'"'l ....................................................................... ~'~ Nature of work (check which applicable): New Building,. ................. Addition ....~. ........Alteration ................. Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... ¢/~/ .-~-~-.~ ~,~/~ (Description) 4. Estimated Cost ............. ~.~.~ ............................... Fee ..................... ~ ........................................................... (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 ................... , ................ Rear ............................ Depth ........................ ; Height .................... Number of Stories .... ........ ...... ... ............................... / ................................................................. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ]1. Zone or use district in which premises are situated .............. ~~ .......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~ .................................... ~3. Will lot be regraded ..... ~..~... Will excess fill be removed from Eremises: (~ Yes ( ) No 14. Nome of Owner of premises ..~~..,~;:~... .......... Address ..... Phone No.-F..H..~..z~Z.~.~ Name of Architect .............................................. ~~ ~ ~ ............. Address ................................ ~ Phone No ....................... Name of Contractor .~~...~-~.~ .......... Address .¢~.~......... Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from prope~y lines. Give street and block number or description according to deed, and show ~treet names and indicate whether interior or corner lot. / (Name of individual signing contract) above named. Pie 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 th;s 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 Jn the manner set fo~h Jn the application filed therewith. Sworn to before me4his ~ ~ ............ Z ......... ....... , ,o,o, ' .... ............................ ~ ~¢~ PUBUC OF ~ YUH~ J~ (Signature or app.canf)