The URL can be used to link to this page

Home My WebLink About5009-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..lt~l~ ..... Date ............. AIII':L1,..¶$..., 19. THIS CERTIFIES that the building located at ~k.' ~ ~' ~'~m' .I~ ..... Street Map No. 0~.. ~ .$~lock No ........... Lot No.. 8&. & .9~,. - · F~8~;. Mal'~,Ol~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 0~t; ....19..., 1970.. pursuant to which Building Permit No. dated .......... .~..~ ..... ]~..., 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 .. ]~I~S, VI~I~ .O~lt .flllt~. llllll),~.S.l~ ..................................... The certificate is issued to ~o~ Ma~. ~. ~olul. l~'osol~ ..... 0¥~, ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .II,R, ............................. UNDERWRITERS CERTIFICATE No... llell~ .......................................... HOUSE NUMBER...lh.~. ~lllllI.Street .......... ~ .{~, ............................... ................. .s.~.o. .................... ~.X .,~... 0.~. ............................. · .... Building Inspector FOI~M NO. ~ TOWN OF SOUTHOLD ~ BUtLDING DEI'At~TMEI~IT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREM'IS~ UNTIL FULL COMPLETION OF THE WOKK AUTHORIZED) N? 5009 Z Permission is hereby granted to: at premises located at .~ ' pursuar~t to application dated ....................... (~!j..,,..,..,.~j~.,...,,.,~,~t.,., 19,~., and approved by the Building Inspector. Fee $~.aO~ .............. BUILDING DEPARTMENT · TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ......... -' " - 'o0 Approved ............................... , 19 ........ Permit No ................... ~ ...... Di~approveda/c ................................................................. ; ............................ ,' ~/~T~ - _/,~'~,~-- ~ (Building Inspector) ~/ ~/~ ~~ / APPLI~TION FOR BUILDING Flbll ~/~ ~ ~/~ ~C~ ~te ............................ .Q~.~,....,1.~..,,., 19...~Q .... INSTRU~IONS a. ~is applicatJ~ must be c~pletely flll~ in by ~ewriter or in ink und submitted In ~pllca~ ~ the BuiJdi~ I~r. b. PI~ plan showing I~atJon of I~ a~ of bu~lding~ ~ premises, m~ationship to adjolnJ~ pmmim ar~s, a~ glvl~ a d~ail~ ~ri~l~ of I~t at p~ must ~ drawn on the di~mm whlch It ~ ~ ~ appllcat~ c. ~e ~ c~er~ by this applicati~ may not ~ commenced b~fore i~ua~e of Building ~rmlt. d. U ~all premiss ~llabJe for Jns~ction th~ghout the p~ress of the e. No building s~ll ~ ~¢upJ~ or u~d In whole or In part for any pu~e ~a~r until a Ce~lfl~ of ~c~ncy shall h~ been gmn~ by the Building In~r. APPLICATION IS HEREBY MADE to Se Building Department for the issuance of a Building Permit purduont to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York and other al:~llcoble Law8~ 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 of applicant, or name, If o ~orporatlon) Greenoort (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, elKtrlclan, plumber or builder. .............................................. .~o~t~c,to~. .......................................................................................................................... Name of owner of premises .... T.e~;)~.....~E~l~l~.g.~ ................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) /4~ ,.~ '~ ~ ~ ~ ~.~ 1. L~ation of land on which p~ed ~rk will ~ don~O Map No.: ......... ~ ....... ~..~.~..... Lot No.: ........................ ~ t an ~ ~ ~ ~ ~ S r~ d Number ...] ........... .~..g.t..~..~L~a~.~ ......... ~,..~ ......................................................... ~ ~unlcl~ll~ 2. State existing u~ and ~cu~ncy of p~mi~s and Intended use and ~cupancy of pmp~ c~ctl~: a. ~isting u~ and ~cuponcy ..... ~..~ .......................................................................................................... b. Intend~ use and ~cupan:', . .......... a~..~..~..~ ................................................................... 3. Nature of walk (check which applicable): New Building ~ ................. Addition ....... :/r,~... Alteration ............. Repair .................. Removal ..................Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost ..... $.~00 .......~ ................................. Fee ........ ~.~D.Q ................................................................... (to be paid on fi'.ing this application) 5. If dwelling, number of dwelling units ..... .o..~..e. ................ 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 .......... .1.1 ........ /.1.(~ ...... Rear ............................ Depth ~.0...~....1.~. ...... Height .................... Number of Stories ........ .1...&..2 ................................................................................................. 9. Size of lot: Front ............................ Rear ................................... Depth ................................ ]0. Dote of Purchase ........................................................ Nome of Former Owner ....................................................... ] 1. Zone or use district in which premises are s~tuated ......... ~.....~ .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ /10 .................. ......................... 13. Name of Owner of premises ..[,e,o/1..Zv~a.:~.t/~q ............ Address i~.'..,.,l~....~v~a,~o/1 ............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No .................... Nome of Contractor ....~...I~.1~ ............................... Address ........ .Gz'.ee~polt.t, ............. Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number orde.~cription according to deed, and show street names and indicate whether interior or corner Jot. L~Ov~7 STATE OF NEW' YORK, t S.S. COUNTY OF .... ~1//'1' O,]J~ .......... ............................................. · ]'os.....D~a.e~ ....... , ...................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ......................... ..C.~.~'.~.O..~..c:j~. ............................................. .. ........................................................ (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 application filed therewith. Swam to before me this .-.-.-..- ......... of ................ ............... . · · ..................... ./...4.~ ....................... No. 52.8125850, Suffolk Term Expires Moteh 30.