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Home My WebLink About5032-zFOBM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at l~,O.,l~, of.f .Iladiall. l(eal,..J'.aStreet Map No..Z$ ......... Block No .... ~ .....Lot N . .oX~.. .... P~e.~!C....ll~.,. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. 0et...27., 19 .~. pursuant to which Building Permit No...~.0.~..~.. dated ...........OCt.. 27..., 19.?0., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ...PT.i.ya..t.e..e.n.e..f..a~i...ly..4.¥.e.1.1..~.g ...................................... The certificate is issued to . ~re~l. F.l~oher .... Ownz~' .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... .N.;R. e .......................... HIu...?I~O Ind. l~Ik. La ~..:,~.... ! ~ Buildin~ Inspector - FORll{ NO, ~ TOWN OF $OUTHOLD BUILDING DEP~RTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF: THE WORK AUTHORIZED) N? 5032 Z Permission is hereby granted to: at premis*$ ~oted at ............... ll,O,l,l,.,~,..~/l~..~,.leet~.:l~.: ................ ......................... .................................................... ~e,,tte ......... ~-~.;.: ........... i ...... : ........ :. ............................. ;-..--;.,. pursuon,t to application dated .................... ;..jJ~. .......~,~...L.....I~..,, 19. ';~ and approved by the Building Inspector. Examined ......................... J~.....~......., ........ ¢, Approved r ~ 19 ........ Permit No. .' BUILDING DEFAITMINT -- -- TOWNCLERK'SOFFI~'E ,~fF ~'~'~ ~ : '1"( ./~ ~. ~ Sou'moLD, N.Y. Appllcatlon No. ~"O-~.~- APPLICATION FOR BUILDING PIRMr/ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premlees ar _public st.reets or areas, and giving a detailed description of layout of property must be drown on the dlngmm whl~h II part of fllli application. c. The work covered by this application may nat be commenced bafore issuance of Building Permit. 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 progre~ of the work. e. No building shall be occupied or used in whole or in part for any purp(xe whatever until a Certlfleate of Occupancy/'~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit PUnmant to the~ Building Zone Ordinance of the Town of Southold, Suffolk County New York, Grid other applicable Law~ Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, a~ hem. In dllcrlbed. The applicant agrees to comply with all applicable laws, ordinances, building code, houslngAcade, and regulations. .(SignSture..(~..... ~ appllcaDt, or name, if a carpamtlon) (Address of applicant) Stat~~i~/t~_L~nt, architect, engineer, general contractor, electrician, plumber or builder. I~lame ol' owner o1' premises ......i(~,c~....~.....~! ............................................................................................... If applicant is a 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.: ........................................ Lot No~: ....................... .~ .... Street and Number ........................................................ ~ ................................................ .., ........................... Municipality 2. State existing use and occupancy of premises and Intended use and occupancy of pmpeeed coml~uctlon: o. Existing use and occupancy ............................................................................ , .............. , ...................................... b. Intended use and occupant-, .......~...A...I~..E. ........ ..~...!..?..~ ............. ~...~...~.j...?..[..o...k( ......... : ....................................... 3, Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other ~ork (Describe) ..................................... 4. Est mated Cost J J~, 0.0. 0 · Fee /D-- ~ (to be paid on f'~'ng this application) 5. If dwelllng, number of dwelling units ....... ~[~ ....... Number of dwelling units on ~ch flor ........................ If garage, number of cars ....................................................................................... ~ ..................................................... 6. If business, commercial or mixed ~cupanc~, speci~ nature and extent of each ~e of use ............................ 7. Dimensions of existing s~ructures, if any: Front ...........~.~.:.~ .....Rear ................................ Depth ..~ D ........ Height ...... ~.~ ..........Number of Stori~ ............ ~..~..~..~.~ .................................................... Dimensions of same structure wi~ alterations or additions: Front ........... ~.~..~ ............Rear ~ ....... Depth .......... ~.~ He ght ~ ............ Number of Stories ...... I ~ ........... ' ........................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ D~th ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ..... ~ .................... Rear ..... / / O Depth ........ ~..~ ........... 10. Date of Purchase ........................ ~.~. .................. Nome of Fo~er ~ner ...... ~.~..~(~ ......... 11. Zone or use district in which premises are situated .... ~.~.~..~ ............................... 12. Does pr~osed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises .~¢~......~.~...Address ....... ~,.~...~ .................... Phone No ..................... Name of Archit~t ...................................................... A~ress ............................................ Phone No ..................... Name of Contractor .................................................... ~ress ............................................ Phone .................... PLOT DIAG~M L~ate clearly and distinctly oll buildings, whether existing or proposed, a~ indicate all set~ck dimensions from prope~ lines. Give street and bilk number or descri~rding to d~ and ~ street nam~ and indicate whether interior or corner lot. . ~ ~ ~ ' x ~ .-. fo o STATE OF NE~oY~xIA !..' --r-,. - COUNTY OF .'~..w~el~-. ............ fa.a. .................................................................................. I., Demg au~y sworn, deposes and says tl'~,t he is the applicant (Name of individual signing application) above named. He is the .~...~../N...."~.....~......~.....~:.....'~....O....'~.. 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. Sworn to before me this .... of ....... o /,, _ .-/ .oran ....... ...................................... ~m'Jl"~'~-~,~cw~.~-..~*-~ .......... ~u . ~:~ignature or applicant) No. 52.8125850, Suffolk Term ~pJres March 30,