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Home My WebLink About4926-zFO~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMR. NT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z~2.7.1 ...... Date .............Jan ....30 .... ,19. ?.~. THIS CERTIFIES that the building located at .. P~Q~a~h .&- ~illo~ -St-.. Street Map No ....xx .......Block No. ZX .....~.Lot No..x~ ... gutchog~.. N. Jr.. ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated ...........~ug.. ~7", 19.~0. pursuant to which Building Permit No. tl,926Z.. dated ........~ .... Aug...27.., 19.7.0., 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~'ivete. one. famil~r, dweL],lng · · w~t, th. aclcl~.~;:Lon ..................... The certificate is issued to . .l~dwa-r<l · A,..D~m~ ...... Owner. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · .l~,Tt, ............................. UNDERWRITERS CERTIFICATE No..N,R, ....................................... HOUSE NUMBER ..... l ~3~ .... Street .... .Peqnash. A~e ........................ 30 Willow st ...... ........... Building Inspecto{ 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? 926 Z Permission is hereby granted to: ........... ellJeimlm ......... .11~,.~, ............................ at premises located at ............... ~'~JJ~'JJ ' 'Jg~J;J~ ...................................................................... ............................................................. ~ ....... I','l,, ............................................................. pursuar~t to application dated .............................. j~jjj~ ......... j~., 19....e~ and approved by the Building Inspector. Building Inspector BUILDING DEPARTMENT .~'~. ' "~ ' .~'-,-~/-,~-.' '-~ ...................... ~omin~ ........ : ................. , ...... Appli~tion No. q ~ ~ .... ~ ~ 19...~.~.. Permit No ..................... ~~ ~ ~ ~ A~roved ........................................ , ~ ~&~ ~ ~ _ ~ 3/5~ Di~pp~ a/c .....~_.~ ........... ~ -- .............................. : ............................. ;';'"'7 .................. ....-. z .................. ,A¢¢- ~7~~ ......... ........................................ cz ' (Building In, actor) APPLICATION FOR BUILDING PERMIT ......... ..................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Buildin~ I nsp~tor. areas,~Nl~a'~il~ ~'~i~ti ~o~ !,~ O~ '6f; ~ e m -~t; ~nt~ a w~ h c. ~ I ne WOrK covered by this appllcahon may not be commenced before issuance of Bulldiftg d. Up~ ~proval of this application, the Building Ins~ctor will issue a Building Permit to the applicant. Such ~rmit shall b kept on the premises available for inspection throughout the profess of the work. e. No building s~ll ~ occupied or used in whole or in part for any pu~ose whatever until a Ce~iflc~e of ~cupancy shall h~e been gmnt~ by the Building Inspector. Building De~rtment for the issuance of a Building Permit pgmuant to the APPLI~TION IS ~REBY ~DE to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, O~i~nces or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, The applicant agrees to comply with all applicable laws, ordinance, building code, housing c~and regulations , ........... (Signature cf applicant, or n~me, if a co~mtlon) ............................. of QpPlico~ State wh~,J~er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builderi~-: ........... ~..~ .......................................................................................... :' ,.,: .............. . Nome of owner of premises ./~........4~.~(~,,/.~ ................ ,/¢ .~. ~ ........ .~...~. ........... /-'~ ,'~"~ ........................................................ ' ' If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) Location of land on which prop0se~work will be done. Map No.: ........................................Lot No.: ...................... Street a~:d N~b~er ...i...i..i...'.Z'.~..'~'~'~.,~..~.~.~..'i'......~......~....'~i.....'.....:.~~..~.~.~.~-..'.., ..~...,~ ~ /T .- /,2..,:~_% ..,/ ~) ,E',~-..~O .,,¢¢~ ,,.~,,-- Municipality (J-; ' ...... 7'"' State existing use' t~.nd occupancy o~ premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... -:~ ................................................................................ .................... b. Intended use and occupan:, . ........................ ,~...~........~.....~...........~,.'~'". ~ .......................................... 3. Nature of work (check which applicable): New Building ~ ................. Addition................../' Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........... ~..~..~..O...o. ..................... ; ....... Fee .......................................................................................... (to be paid on fi!ing this application) S. 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 ~..~.....'w.~...~../~. ~. ......... 11. Zone or use district in which premises are situated .......................................... ~ .............................................. 12. oes proposed con&~'u~;t on v olg~l;e~any zon~3a law, ordnance or reau at on;~ ~..~.. 13. Name of Owner of premises~..~...~..;, dress ~ .~ ....... Phone Nc~...~..~T'.././~. Name of Architect ...................................................... Address ............................................ ~'/ Phone No ..................... Name of Cootractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ack 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 NEW YORK, ! ee .~.~.. 4~.~w.r.~.... ~,,er~...~/.~ .............. being duly sworn, deposes and says that he is the appl cant ~ame of indivi~l signing a~licat~) above name. He is the .....................................~~~ ..................................... ~; ........................ ~ ................ (Contractor, ~t, co~omte officer, ~c.) of said owner or owners, and is duly authorized to peHorm or have perfo~e~ the said work and to ~ke and file this application; that all statements contained in this application am tree to the ~st of his ~owl~ge and ~lief; and tha~ the work will ~ perfo~ed in the manner ~t fo~h in the applicati~ fll~ ther~ith. Swam to ~fom ~ Noto~ "ublic,~~...~ ............ ~ ~ (Slgna~re of applicant) NOTARY PUBLIC, ~A~ ~ ~ T, NO. 52.274412~ OUALIFIEO ~ 5~ C~NTY TEAM EXPIRES M~CH 30, 197/