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Home My WebLink About5042-zFOBM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.I*.~I~ ...... Date ......... F. eb .....8 ......... , 19. ~.. THIS CERTIFIES that the building located at .~'.~ .&.~ ................. Street Map No. ~,I,T~l$,h;~iL~lock No ........... Lot No.. ~;~2~p.~'t~ ..... /~el.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ lioV...~ .., 1970. pursuant to which Building Permit No.. dated .......... No.v. ....h..., 19.~.0., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. -Pl,~.v~te. gal, age · ( · ~,cees~ol~' .l~u~..~d~.ng ........................... The certificate is issued to .. Phllltp. Failer ..... ~zne~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... I~.R. .......................... ........ Building Inspector l~O~ NO. ~ TOWN OF SOU~HOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREM SE$ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5042 Z Permission is hereby granted to: .................. ~.1. .......... ~ ................... ~ ................ to ..... ~]~1:,~]~.. a~, · ~2.t ~l.O,~ ..ott..-e;~b%~;tl~g-'* &~t~l S~ .~* :. ~ .......................................... at premises located et .......... ~J~..5~..~J~,-.~.,..~:....~a-I.~li~.~[;~: ...................................... ............................................ ~a;~..~-~e ....... .~u~l ....... ~,.~Y.~,* ....................................................... .... , 19.~;, and approved by the pursuant to application 'da~ed J .......................... ~J ........ .~. ........ Building Inspector. Fee $..~ ............ . . i:Building ID~pector f' rGli ' NO. ! 'tOWN MU'mOLD BUILDING DEPA~TMEHT TOWN CLERK'S OFFICE SOUTHOLD, No ¥o Disapproved a/c .......................................................... " ........................... ........................ APPLIGATION FOR BUILDING PERMIT Date ............................................................ , !9 ............ INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot .pi.an showin~ I.oc.ation of lot and of buildings on premiSes, relationship to adjoining premitee ~r public streets or ~ areas, ana giving a de~auea aescriptiorl of layout or property must be drawn on the diagram whlch it part of ~hit al~llcation, t% c. The work covered by this application may not be commenced before iuuanca 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 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 Occupancy shall have been granted by the Building Inspector. B .A.P..PLI_CATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuont to the ~u,a~ng Lone, OrfJinonce of the Town of Southold, Suffolk County, New York, and other applicable I.aw~, Oeclinances or .~.l~u~atlons, tar the construction of buildings, additions or alterations, or for removal ar demolition, aI hlmln deIcr bed · applicant agrees to comply with all applicable laws, ordinances, building cede, housing code, and regulatlom. ¢. ....... ~' .......................... (Address of appllcant)~" ....................... ~ ~'('~';'"~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premi, ......~-.~.......G......~ ................................... If applicant Is a corporate, signature of duly authorized officer. .................. ::::::::::::::::::::::::::::::::::::: ................... . ,,, 1. Location of land on whlch proposed work will be done, Map No.; ..,.~.. ...... ...~,?. ...................... LotNo,: .~.,.¢~...~...~.~.,~....~ 2. State existing use a~d occupancy of premises and intended use and occupancy of pmpaeed c°mtmctlon. a. Existing use and occupancy /~4,'~'~' ~,/c/.~¢,e ~' b. ~ntended use and occupan:', . ....................................... ~ .......................................... 3. Nature of wink (check which applicable): New Building .................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ................................. -. .......................... Fee ........................................................................................ (to be paid on fi!lng this application) S. 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 .... ~- t~. ....... Height ......... ~...i .......... Number of Stories .............../. .................................................................................. Dimensions of same structure with alterations or additions: Front ~ ~ Rear 2,- ~-- Depth ~'/' Height ............ ~ ............ Number of Stories / 8. Dimensions of entire new construction: Front .................................... Rear ~' ~" Depth /~' Height ......~ ........... Number of Stories ............../. ....................................................................................................... 9. Size o~: lot: Front ............. .?..~'.. ......... Rear I--~(*o Depth 10. Date of Purchase ...................................................... ·.Nome of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction viol~.te any zoning law, ordinance or regulation? 13. Name of Owner of premises ...~..~./.~t4..C.:../-.u././..~...~. ........... Address .~....~......~..&.4.~......~..& .......... Phone No..~...?..~.:...~...~.7'.~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone~lNo .................... 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 show street names and indicate whether interior or comer Jot. OF r-, o. ........~ ....................... J/..~....~..X..~.~! ........ [.~_....being duly sworn, deposes and says that he is the applicant (Name of individual signid'g application) above named. He is the ........................... ~...? ......... ~:~ ......... i~. ........................................................ (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; end that the work will be performed in the manner set forth in the application filed therewith. Swam to ~ere me this .............. .......... .............. ........... ............................ Notor'/ Publi~~[.~l~, ~,s~'~'~l~/~L~'°rk ...... Cou,~~ i~ignature of applicant) Term Expires March 30,