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Home My WebLink About4510-zFO~M NO. ~ TOWN OF $OUTHOLD BU/I,i~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z5~ ...... Date ............. ~a.y · · · 25 ....., 19.~(~ THIS CERTIFIES that the building located at ~eaeh' ~ive ................ Stree{ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 0/~t ....1 ~"" 19~0' pursuant to which Building Permit No. ~.~/~... dated ....... /)et ....l? ...... , 1970., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to.. ~chard 'H~a~,d ..... '(~,~i;~s;;' ;; 't~-~t') ......... of the aforesaid building. Suffolk County Department of Health Approval ..... pend~ ....................... ...... ....... Building Inspector ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N.o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4510 Z D~te ................... J~t,~e~3~ ..... ~. ......... , 19.J~.. Permission is hereby granted to: at premises located ot ................ ~.....~l~l~h..~jl~ll~ ......................................... : ............................... ............................................................ · .~e~..~ ....... ~I,~ ................................................. pursuc~t to application doted .................................. ~1~ .....~,~ ...... , 19...~i, and approved by the Building Inspector. Fee $..~.~.~...~,. .......... Building Inspector FO~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. " ', Approved ....................................... , 19 ........ Permit No ............................... Disapproved a/c ............ ~r ....... ~ .......... ......................... i'6'6 3 ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apphcahon must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giwng a detaded description of layout of propertymust be drawn on the d~agram which is part of th~s application c. The work covered by this opplicobon may not be commenced before tssuonce of Budding Permit. d. Upon approval of th~s application, the Building Inspector wdl issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e No budding 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 Budding Inspector. APPLICATION IS HEREBY MADE to the Budding 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 Regutahons, for the construction of buildings, addmons or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all apphcable laws, ordinances, budding code and regulations. ............. (Signature of applicant, or name, if a corporation) ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... >..... .......................................................................................................................... Name of owner of premises ...~.~...~..~..~..~.~.~.....,~...P..~...~'[.~ ............................................................................................. If applicant .s a corporate, signature of duly authorized officer ........ (Name and title of corporate officerf 1. Location of land on which proposed work will be done. Mep No: ............................................ Lot No: .................... Street and Number ..~.....~..~..~.J:/.../}.J/,,~..'. ...... .~..,U.TC .~..~..4:.O...,....~..ff..C.F:.~..~..,fC....~.~.~\U.,,',,,;.~ ....................................... Mumcipality 2. State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ~ b Intended use and occupancy . .".J .~.~..ff././~..~'].f.~.~ ............................................................................................. 3. Nature of work (check which applicable)' New Building ...... ..zf ........ Addition .................. Alteration ............... Repair .................... Removal .................... Demolition .................... Other Work (Describe) ................................... 4. Estimated Cost ..... .~...~....~...~..~...~..~.!..~.~. ....................... Fee .............. /..~.,..~?.~. .......................................................... (to be paid on filing th~s application) 5. , If dwelhng, number of dwelling units ..... ~..~.~. ........... Number of dwelling umts on each floor ........ ~ ................ If garage, number of cars ...................... ~ .............................................................................................................. 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use ~f 7. D~mens,ons of existing structures, if any: Front ....... ~: .......... Rear ...... ~( ............Depth .....~.~ ........... Height ......... ~ ........... Number of Stories ............................................................................................................ Dimensmns of same structure w~th alterations or additions Front ................. "-Z. .............. Rear ~ Depth ................ n.2 ......... Height ...... :.Z:..~ ................ Number of Stories if'- · 2~ , 8. D~mensions of ent,re new construction' Front ......... ¢.¢..~. .......... Rear ......... ,~..~..~ ........... Depth ..... ~ ............. Height .......... /..~.. ........... Number of Stones ...... .~...~'..~...~.~...~ 9 S,ze of lot. Front ..... .~..~¢..~. .......... Rear ....... .~...~.~..~ ........ Depth ......~..¢.~..i ................ 10 Date of Purchase ......~.....b.~. ...... ~.....~.. ........................ Name of Former Owner ;~.f..~......~.~.-......~.~..,~.~.,ff. ........... 11. Zone or use district m which premises are s~tuated ......... ./~.~.}.!..~.4:ZZ~..f;..C.~..~. ................................................... 12 Does proposed construction violate any zoning law, ordinance or regulatmon ...... ~..~ ...................................... 13 Name of Owner of prem,ses ./~....!.c.)~.~.fUl.~.~./~.t~.0. ..... Address .~.~.a.~.~,f.~...~.,...~.. ........ Phone No ................. ...................................................... Address ............................................ Phone No ................. Name of Architect ~ Name of Contractor ~..'~.~...~...~ZE~.~...~...~.O..~,/zz~t£~.~...Address ~..~.~...~.~.:....~..~.~./~.~..(~:~..qf},~Phone No. Z.~.~:2~.A PLOT DIAGRAM Locate clearly and dishnctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions property lines. ;ire street and block numbers or description according to deed, and show street names and indic, or corner lot. whether interio STATE OF N~ Y~R~, ~.~ ~ S.S. COUNT~ OF ~.~.:.'..:.% ........... ..~.~.. ..... ..~.....~.~. ~r~..~. ..... ~Z.~.Z~ .............................. be,rig du~y sworn, deposes and says that he ~s the appli (~ame of ind~wdual s~gni~g appl~ation) __ above n~med. He's the .... ~.~,~,..,~.,... ............................................................................................... / (Contractor, agent, corporate officer, etc.) of smd owner or owners, and is duly outhorlzed to perform or have performed the said work and to make and th~s application; that all statements contained m this application are t~e to the best of his knowledge and and that the work will be performed in the manner set forth m the opphcation filed therewith. Sworn to before me this ....... i.~..~ ......... day of ............................................ ~. - ~ , ,, ., :. ..... ..... ................... Nota~ Pubhc, ~,~~~ ~¢~ ~,~k County (S~gnature of applicant) ......... ~W~'' ~;T~:~'~ ................. _ II ' I F~.SH£RS ISLAND UTILITY CO., INC. FISHERS ISLAHD, HEW ¥OR~ 06390