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Home My WebLink About4917-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~)'~0 Date ~u.ly 27 1~.. THIS CERTIFIES that the building located at ............................ 212~ P±ne Tree ~;~ad Street Map No.N~..i~:~Block No ........... Lot No..~ .............................. confo~s subst~tially to the Application for B~ld~g Permit heretofore filed ~ t~s office ~te~ ~..~ ............ , ~97~.. p~u=~ to ~i~ B~i~ing Pe~it ~o~?~?.~... dated ~?.~ .~ ............ , 19 ~., was issued, ~d conforms to all of the req~ ments of the applicable provisions of the law. The occup~cy for which this certificate ~ ~,ea ~ ...~.~. ~. ~..~S ..................................... The certificate is issued to ~s. ~ter Fr2ed (owner, lessee or ten~t) of the afores~d build~g. S~o~ Co~ty Department of He~th Approv~ ......... ~? ....................... Pending UNDER~ITERS CERTIFICATE No ............................................. Building InspectorI FOEM NO. 2 TOWN O~ $O~TSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE ~ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~9~7 Z Permission is hereby granted to: ............ ~.~.~......~.. ~.~.~.~ ............................. pursuant to application dc~ed ............................ &t~jr..6 ......... i'", 19...~Q., and approved by the Building Inspector. Fee $.~0 .............. Building Inspector FORM NO. 1 TOWN OF soUTHOLD BUILDING Di~PAiiTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ....' ...... 3.~g..~..8,~....~.~. ............................ , m..7.9. ..... INSTRUCTION5 " o. This application must be completely filled in by typewriter or in ihk 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 giving o detailed description of layout of property must be drown 9n 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;o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progre~Ss of the work.. e. No building shall be occupied or used in whale or in part for any pu~'pose whatever until o Certificate of Occupancy shall hove 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 Y~ork, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code,~s[ng code, and r~De~gulations. ..... "i'gi¢~~e ~'~'~/~a~[, ~r n~;,'~ ~o~ordtion) ....... ' (Address at appticant) / / ~' State whether applicant is owner, lessee, agent, architect, engin~r, generaj contractor, electrician, plumber or builder. 0~e~ Name of owner of premises ...... J~.,...~e..~=~e~ ...............................; ......................................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which proposed work will be dane, Map No,: File ll7! Street and Number ..~.~...~.:Lae...~]z'.~.e...~L,.~...C~,,J~.~l~e~..,N, A$.~.~.A..~.~,~ ........ Lot No,: ~,~ ................... ) at; Co~y Clerk's afflce Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: Here o. Existing use and occupancy .....]).e.~n~,JJ,et~f~..J3,~e~ ............... ,'~ ......................................................................... b. Intended use and occupon~'y ...$e,o~d...be~..~e.m..<~...he~e.o ....................................................................... 3. Nature of work (check wI-~applicable): New Building ................. II~ddition .... ~ ........... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ~,~.,..0...O..0.... ...................................... Fee ..... ~, ......................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... ~ ............... Number of dwelling units on each floor ...1 ....................... 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 s?ructures, if any: Front. ........~.1~.1.....~..~'..1... Rear ........... ~.!.,...~.~.! ..... Depth .....!..~.~.....3.. Height...,........._....,....'18~ Number of Stories ...... I~lJl,Jl ................................. : .................................................................. Dimensions of some structure with alterations or additions: Front ....... ~'~..~. ...................... Rear ...... ~'~..~. ............... Dep/h ...... ~.~. ................... Height ........ '1~.t, ............. Number of Stories ...g.~ ...................... 8. Dimensions of entire new construction: Front ......... Rear ....... '12 ................ Depth ....'1.~.! ............. Height ..... ].~.~. ........ Number of Stories ..... .O.,IA~ ......................................................................................................... 9. Size of lot: Front ........ .~f) ............... Rear ............ ~.~,.~. ................. Depth ...... 2.O.O..~.....-...~..0..I. 10. Date of Purch,:se .....~.l~.~.,,.,~.~...,l~C~.l~.~ .................... Name of Former Owner A.o.Q.C.~.~...D~:Lcl~.~.~...i~.~a.v. lcl~ 11. Zone or use district in which premises are situated .~.~.~..~....~1~..~/..$.~..~.~..~.$~.~.~.~...~`~....~..~`~.~..1.~.~.~..~ 12. Does proposed construct'.on violate any zoning law, ordinance or regulation? .,q~lJ,~,,'1:LA~...o'l~.jt~,tm~j ............. 13. Name of Owner of premises ...A...~.~.m....~.~..1..~.~. ............. Address .~....[.J,.~.t.~...~.~.....1.~..c!: ...... Phone No?,~..bf..-...6.~...0.... Narr~e of Architect ...................... .-..,-..-. ......................... Address ............................................ Phone No ..................... Name of Contractor ...J~'.~.lJel..~].~l].~m:J..~,]o. .......... Address ~LvI~.zTL~...l:Jrt.,.,~.~t.b.~l~.. Phone No.~.~'.-..2.~.~.]... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and blocl¢ number or description according to deed, and show street names and indicate whether interior or corner Jot. STATE OF NEV~')YO~,K,~ (Name of individual signing application) above named~He is the .......................... ~ ........................ i ................................................................................. (Contractor, agent, corporate officer, etc.) of sakJ 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 that the work will be performed in the manner set forth in the application .fP~ed therewith. Sworn to before me this ELIZABETH ANN NF~I/LE · ,r , NOTARY PUBLIC, State of New York No. 52-812585B, SuffolkCou~]t Te~rn Expires March 30, 19