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Home My WebLink About5031-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupnncy No. E~.7.1~ ...... Date ..... ~.el~;.el~be~. ~.0., ....... , 19~. THIS CERTIFIES that the building located at . .Voggs. l;01~. ~c~a.d ............ Street Map No. l~as:~o,U .Pt~, Block No.. ~ ...... Lot No .... 3~1, ... CBt;cho~ ............ c~nforms substantially to the Application for Building Permit heretofore filed in this office ted ........ 0cto.b. er. 2.~.~., 19. ~.O pursuant to which Building Permit No..~03~;fi.. dated ........ 0ct~her. 2.~.~.., 19 ~.Q., 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.r~V.a.~;~. 0~e..f.~..,.~ly..~t~..~$~ ...................................... The certificate is issued to . ~.~.~..u?..B..~. d.w~..n' ...................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... Jto~t. ............................ UNDERWRITERS C~RTIFICAT£ No..P.?n..d.~..n.g. ........................................ HOUSE NUMBER...176.~ ..... Street....~.~rlston .itd, ................................. 15OO I ters .................................................. Outchogue .................... Building Inspector FOI~M NO. 2 TOWN OF SO~THOLD I~UILDING DEPART.'~AENT 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? 5031 Z Permission is hereby granted to: i ............... ................. l~e~t~t~; ........................ ; ............... i premises located Ot J:ee · .~,,~00 pursuam to application doted....,................JJ~J~,.....~j~ ~i 19..~, and approved bY the Building Inspector. i, ! BUilding TOWN OF SOUTHOLD RUILDING DEPARTMENT TOWN CLERK'S OFFICE ~THOLD, N. Y. APPLICATION FOR BUILDING PERMIT ~, Date ....~.~--~...~......~,...~.. ......................... , 192~1 ..... INSTRUCTIONS .~ a. .This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildingl~ inspector. / b. Plot pi.an showing location of. lot and of buildings on premises, relationship to adjo n ng prem ses or pUD C streets areas, and giwng a detailed descriptibn of layout of property must be drawn on the diagram which is part of this application.~ c. The work covered by this application may not be commenced before issuance of Building Permit. &' UPon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit .sh'all b~ kept on the promises available for inspect on throughout the progress of the work. ~'e' No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancv'~J. shall have been granted by the Building Inspector. . APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bud ng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app cable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bu~J, ing,-cede, housing code, ancJ~egulations. L ........ ........ ...................................... ~ ....... i .............. : .......... . ....................... .L...[.-.... .......... .;i ..................................................... Name of owner of premises ......... ..~....LL.~.O......~.. ...... ~...~........~...~.L.I~/. .................................... If applicant is a corporate, signature of duly authorized officer .................. i~;;;;;;';;;;;i';;;;"J;;;;;ii;;;;;'~;~;;;'"'T'Z'2,~ _ 1. Location of land on which Proposed w~?r~ will /be~doUne7 Cp_No.: ................. : ................ Lot No .~-'/ Street and Number .'-~.....~..~.~J~ ....... ~.~.z~.~r~..e..,......B.~..'.~.@...'.~o'~ ~'~o) /1/,¢-,.¢,~c~'- -~- -- : "~-- '"~'"'"'"'"'"'"'"'"'"~ ~O//br/~' · Munici.,~ality //,6t_,~_-~'7'~9~' '"~) 2. State eXisting use and occupancy of premises and intended use and occupancy of p-/ro/pos~/~o~n"~mct'~an: o. ,r,e.,.....-.~ b. Intended use and occupancy ......... ~[. ~ .'}~. l[~ ..~[[ 3. Nature of work.(check which applicable): New Building .................. Addition .... ~... Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..... ,~.~..~.....~.......'~... ............................. Fee .......................................................................................... (to be paid on filing this application) 5. 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, speci~¢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 ...... . .~.......~t..~ .................. Rear ..'.~....~.. ................. Depth ........ .~.~. ................ Height ............................ Number of Stor~es ....... ~ .............. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number o/f Stories .................................................................................................................. 9. Size of lot: Front .......~'..w~..~.~.'~...'.. ..... Rear ......... ~.~..../.. ............. Depth ,~,..O..~...~....2--7 ~' 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... .~...~. .......................................... 13. Nome of Owner of premises~./.4~4~....~.....~..~.~.~.Address ~...,~...d'.~..~.... ,.~../.x~. ,.~.,... Phone No ..................... Name of Architect ............................................ ~. ........ Address ............................................ Phone No ..................... Name of Contractor .'.~..,'/..~...~.'.~J~.J.'....::~/'~F~r/.~/...~.....~.....Address ~-~.~~,,~'~,...... Phone No.~....~...~...~../.0./ PLOT DIAGRAM locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-b~ck dimensions from proper~y 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, ~ e e ..~-~D'~.~.~.~-~.....~...~...~..~ ............................. being duly sworn, deposes and says that he is the applicant (Narfie of in~.~iduo I sig nin~ ication~~ . · above named. He is the .................."~') ~ ~'*~"~'-~.~.~Z-~~..~... ......................................................... ; ............................. (C6ntractor, 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 oil statements contained in this application are true to the best of his knowledge and belief; and tharsworn to before me this /~'~ ~ ,c~.~the work ..... ~,-~,- ~-~ ,x~~- --willdaybe of Perf°rmed.~,~in the manner .................. set ........ forth, l~n~~~~''in the application filed therewith. Notary Publi o~ i~c ELIZABETH ANN N£VILLE NOTARY PUBLIC, State of New York NO. 52-8125850, Suffolk Coun,,~,~ Te[rn Expires March 30.