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Home My WebLink About5002-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy No.. z~28.~ ..... Date .. Jx~l.y. ~_~[ ................. , 19~.. THIS CERTIFIES that the building located at l~b.~nl~e.t .a~.e., .&. I~.~,ch..Rl~treet Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....0.c.t.o.b..e.r..~.6.'. ...... , lg ?.0.. pursuant to which Building Permit No...~.0.(~.2.Z. dated ...0C.t.c~bSr..],t~ ........ , 19.F.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 .... l~ll~:l~e~l, ll .&C.O.~III~OI~. (S.t.c~&go. Bll~3,dXr~g .) ......................... The certificate is issued to ...... Id.e~A'y. P.~,erc.~l ................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......... I~,R.o ....................... UNDERWRITERS CERTIFICATE No .................. .N.o.R.! ...................... HOUSE NUMBER ..... ~00 ...... Street .Beach .R01~I .&. F~.n. kanso.t. Building Inspector t 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) : 5002 Z Permission is hereby granted to: · -. ~¢~e ..~'a~t~...~z~..~ ...... ................. .......... ~,..]~ ................................. ~. ................ .......... G~n~,omt .......... ~-~- ........... i ................ to ...hG~,~t..~m~...(~,~}~s{mZ~)..~l~{~l,~ .bV~l~.td.~,Z{f~.!f~..b~l{~m~m~--~..~4). ~) ot premises {ocoted ot .........~....}~%t~..]{~Q~{~ ................... =[, ........................... ~ .............. ~ ............. .............................................................. G~'~I)~ ....... l~,~,,--:. ................. ~ ...................................... pursuan,t to application dated .................................... 0G~.....2..${~ '...., 19.,.~{~,' and approved by the Building Inspector. ( · ~e $.~.,~1 ............. i Building ihsPector ,{ · t ~ Approved ........................................ , 19 ........ Permit No ............................. BUILDING DEPARTMENT Application No ............................. Disapproved a/c .............................................................................................. (Buildin~ ........................... APPLICATION FOR BUILDING PERMI'I' Date ~ / ~ 19.7. ~ 0 INSTRUCTIONS ~ r~ a. This application must be completely filled in by typewriter or in ink und submitted Jn duplicate to the BuildinG-l- 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 drawn an the diagram wl'dch Is part of thle application. c. The work covered by this application may not be commenced before issuance of Building Permit. 7~ d. Upon approval of this application, the Building Inspector will 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 building shall be occupied at' used in whole or in part for any purpose whatever unti~ a Certificate of Occupancy~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY/v~DE to the Building Department for the issuance of o Building Permit punsuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ....... ...... (Signature cf applicant, or name, if a corporation) .... ................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... /.~..~..~.../../~... ~ ..~.../.44~..C../~.. If applicant~js/a corporote/-ei}gnatu,re of duly authorized officer. (Name~j~d title'of corporate officer) Location of land on which proposed work will be done. Map No.: ........................................Lot No.: ........................ ' Street and Number ...~.~(/./-'/.~../~..~...~....~...~.,~'....~.....~',~'.~/.~C/~...~..~.. ........................................................... .~ ~..~1 Municipality State existing use an~ occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~../g.~.......~.~,~'~......Z'...~.,,~. ............................................................. / 3. Nature of work (check which applicable): New Budding ................ Addition ................ Alteration ............. Repair .................. Remova~ ................. Demolition .................. Other Work (Describe) ................................. 4. Estimated Cost ......... ~..(~ ........................................... Fee .................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling umts ........................... 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: F,ont ........~...? ............... Rear .....~.;.O.. ..................... Depth ...~O ..... 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 .......... .r.~.: ...................... Rear....~..:.O. ................Depth ....~....O. ............. Height ....... ~....O..1. .... 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 ..... .~..Z'.~Z~ .'Z~......../~.~...~,~ .~'./~'...~.. ................................................. 12. Does proposed construct;on dolate any zoning law, ordinance or regulation? ..... ~/.~. .............................................. 13. Name of Owner of premises .x~.~(..~..~..........~,~C/~ddress/~,~.~..~...~..~....'E..~...~...~..~...~'...... Phone No.~..~'..~..~..../~..7'..~2 Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor .................................................... Address ............................................ Phone No .................... PLOT Locate clearly and distinctly all buildings, whether existing or proposed, and indicate dl set-b~ck dimensions from property ~ines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot, / ................................................................................................. being duly sworn, deposes and says thor he is the appJicant (Name of individual signing application) above named. He 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 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 applica}ion filed therewith. Sworn to before me this ~ _ . / ~ ..... ....... Notoe/ Public, ~~)~ Cou~,'~'"iSi~oture of ;;;~;;;;~ ............................ ~EUZABETH ANti NEVILLE ' ~ NO. 52-8125850, Suffolk Co~ Term Expires Msrch 30, [~