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Home My WebLink About5034-zNO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ....~/~...JJOJ'.t~..J)J'~.~'~. ............................. Street Map No. ~..J~...&.~... Block No .......................Lot No..J~..JJ..&..~, ............................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................... (~Ot~ .............. 28 ................. , 19...~.0. pursuant to which Building Permit No...~.0~.~.. dated ...................... (~j. ......... ~ ............ , 19....~(~ was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .......... P.r. Sva.t~.. erie...f~t,t.y..d~e.l.t.i, ng ....................................................................................... The certificate is issued to ....~/~l,:~il.e..ROl[lllll'icks~llt .............. OI~IO~. ............................................. (owner, lessee or tenat~t) of the aforesaid building. House ~ lC)0 1~o Dr BUILDING·, PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE~ISr~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5034 Z Permission is hereby granted to: at premises located at ..... ;~....~.&.4 pursuon~ to oppficofion d~tod ~. ................ ....;..,:.~ Building Inspector. ' ; and approved by the Examined ........................................ , 19 ........ I~B~ NO. I · TOWN OF SOuTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved L! ~ 19 t l ~JO ../...~ ........................................ , ........ Permit No .......................... Applicotion No. ~ 0 ,~ ~' -~ Disapproved a/c .............................................................................................. ..... ...................... .......................... (Building Inspector) / APPLICATION FOR BUILDING PERMIT Si ~ Bt. .............. ................... , ,9.z ..... INSTRUCTIONS ~ ~ o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoinino premises or public streets or /~ areas, and giving a detailed description of layout of property must be drawn on the diagram wh~c'h is part of ~his application.') c. The work cOVered by this application may not be commenced before issuance of Building Permit. ~I d. Up6n 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 or used Jn whole or Jn part for any purpose whatever until a Certificate 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 pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Count, New york, qnd other applicable Laws, Ordinances o~ 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, building code, housj,ng~ code, and regulations. (Signatu~Jof applicant, or n;'~;] if a co.~¥i;;')' ........ .............. "~"'":~"q ..... (Addr;;;~ of a'l~'l~licant) ~/ .............. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner ............................ ~ ......... ~...~ of premises ................. ~ .~i./~... ;~.i ~; ............................ If appli~,~nt is a corpora, taft signature of c~ly authorized officer. ....... ...... ............... ......... ~*~-r~e and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No.: .~.....(~<~,~'.~ ......... LotN~: .....~...~.. ~.~., ....... · Street and Number ../.. ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Ex stn use n'occu an ~..~ o. g a a p cy ..................................... ..~ ........................................... ~ ............................................... b. Intended 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...~,e.(.~...~'...~'. .................. 4. EStimated Cost .......................... ,~.c~..~.~. .................... 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, 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............ ..~.~. ................. Rear .....~,...~.. ................ Depth ....Z...a/(.. .............. Height ........ ~/...~ ..... Number of Stories ............./. ........................................................................................................ 9. Size of lot: Front ...... .2:....O?.....~.. .......... Rear ...... .~...~..?. .................... Depth .......... ~.~...~....~.. ......... 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. Name of Owner of premises .~...!!..¢.....~.....~..~!..~..~'.~.c.,.Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~'...e.~..../l,~z{~f.~, .......................... Address ..2,3;~...Cep.~..~..(~.¢~..~ ....... Phone No..~..~.~.....~..~,./.0. 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 or description according to deed, and shew street names and indicate whether interior or corner lot. 7~7 /r L! STATE OF NEW "~K,~' .-,,/ ........... ..~......--...~.....:'. ................................. being duly sworn deposes and says that he is the aoalicant (Na~le of individual signing application) ~.~' ~ff~-.&~ ~,..~ jj/x~ - -- 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 moke and file this application; that all statements conta;ined in this application are true to the best of his knowledge and belief; and that the work will be perform~.d in the manner set forth in the application, filed therewith. Swam tcL~e~,fore me this ~1 .-.~-~ o,f ........ .;..., ............................. EL ZABETR ANN tlEV, .LL NOTARY PUBL C, 5r~e No. 52.8125850, Suffolk Term Expires M~rch