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Home My WebLink About5051-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..~?.8.1. ..... Date .............. .Feb.... 5. ..... , 19..?.~ THIS CERTIFIES that the building located at ....N~.S...g.f..d.d. 1..e...R~...(..C.B.~..7.). Street Map No .... ~x ...... Block No... xx ..... Lot No...xxx... C~tehogue.. 1~ ,~[, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... llo~...i~ ...., 19. ?[1 pursuant to which Building Permit No.. ~.0.5.0..Z. & dated ....... N..o? .... !6. ......, 19..7.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~.lva.te. orca .fa~¥. d~elllng .w~h .addtt$oll ./~. ][~lCe~.QI~I..b.~d. g. vith addition The certificate is issued to . .T~.o..~..F.,C .Gp.n.n.$g~.~.... ~e.~. ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Dep~rtment of Health Approval ...~. :~: ............................. UNDEBW2ITE2S CE2TIFICATE No. p.e~2~ ................................... HOUSE NUMBER ... 1.~.~[R~. .... Street ....~[.dd~e. ~c~d...(.C.l~.) ................ Building Inspecto~ FOF~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI"HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5051 Z Permission is hereby granted to: ............ ............................. ....... ~ ........... t,C-1..~ ct.~ ~ · -ll~e~. ................................... to ......... i~l~id...a~ .. i~,:l~ti.:~l~ ..0~ .. ~l~t~,~.. &~l~llels~...~tJsJ~ ............................. at premises located at ........... ~/~..J~e..~l~J ............................................................................. ............................................................. ~u,t, el~o g.,,,,~e ............................................................................. pursuant to application dated .............................. .~, ......~. ............ , 19..~1~L, and approved by the Building Inspector. ~ Fee $...~'m~t~J. ........... Building Inspector / /o~af NO. I TOWN OF SouTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIC! SOUTHOU), N. Y. m,ned I Approved ................ ..~....'. ................. , 19...~..... Permit No. Disapproved a/c ................................................................ ~:~ /-I [1 ^P,LIC*T,ON ,OR ,UiLD,NG .. .................... · I~ o INSTRUCTIONS a. This application must be completely filled in by typewriter or in Ink -,nd submitted In duplicate to the Building~j Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining pr~'njees or public Itreets or areas, and giving a detailed description of layout of property must be drown on the diagram which IJ pert of thle oppllcatlon.~ c. The work covered by this application may not be commenced before issuance of Bulldlr~ Permit. d. Upon approval of this application, the Building Inspector will Issue a Building Permit to the applicant. Such permit~ shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used In whole or in part for any purpose whatever until a C~rtlflcate of O~¢upancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pureuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lawl, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demalltlon, ag herein dmmrlbed. The applicant agrees to comply with all applicable laws, ordinances, budding code, housing cade/,and regulations. ............................... (Signature cf applicant, or na~, If a cmperatlon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contrcmtor, electrician, plumber or builder. Nome of owner of premises ..... ,~.o...m.?....~....M..~,G.,~,n.~.$.~..]:.e. ...................................................................................................... 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 done. Map No.: ........ ~ ........................... Lot No.: ......:1~.........~... Street and Number ................. 3i/,~..~t. ct~l,~.e..]~ei~c~.....~g_C~t;~,~o~l~ ......... ~../'. .......................................... r... 2. State existing use a.nd occupancy of premises and Intended use and occupancy of proppesd conctructlon: ~ a. Existing use and occupancy ...... .[~'I~'/~,'J;P,,...~8.~&i~. ......................................... ' ............................ i ......... ,~..''~ b. Intended use and occupan? . ........... ~.l~ll.~...~.:J,~../~l~,...~gl,~.~.~;J,~/~ .................................................................. 3. Nature of wmk {check which applicable): New Building ................. Addition ....~. ........... Alteration ............. Repair .............. ....~Removal .................. Demolition .................. Other Work (Describe) .................................. (to be paid on fi~ing this application) 5. If dwelling, number of dwelling umts ........................... Number of dwelling units on each flor ...................... If garage, number of ~ ............................................................................................................................................ 6. If busine~, commercial or mixe~ ~cu~ancy, speci~ nature and extent of each ~pe of use ............................ 7. Dimensions of existing swuctures, Jf any: Front ...... ~Z ................ Rear ..~/ ....................... ~pth .~/ ...... Height ...~.~ .............Number of Stori~ .... ~ ..................................................................................... D]mensions of same structure wi~ alterations or additions: Front ....... ~ ....................... Rear ...~. ................ Depth ~ ~ ~. ................................ Height .... Z ................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~.~ ........................ Reor...~ .................. D~th ..~.~ ............... Height ...Z.~ ......... Number of Stories ..... ~ .............................................................................................................. 9. Size of lot: Front ..~.~...(. ............ ~ / Rear ..... ~ ............................ Depth ........ ~..~.~ .............. · of P~ chose ~ ame f F 10 ................ ~ ..................................... N o o~er ~ner .~ ......... .~ ...... 11. Zone or use district in which premis~ are situated ................................................................................. ~ ................. 12. ~es pr~os~ construction violote any zoning law, ordinance or regulation? ............................................................ 13. Name of ~ner of __ ~. Address ..~..~..~ premiss .......... '*'"'r~¥'" ......... .................... ........................ Phone No. ...... Name of Archit~t ....~.~.~-- -- n~ ..... ~ ......... A~ress ............................................ Phone No .................... ~ame of c~tractor ...~-..~.:~~/~J~ ................ A~ress ....................... : .................... Phone No .................... --~ ~ ~'- PLOT DIAG~M ~ ~ate clearly and distinctly all buildi~s, whether existing or pr~osed, a~ indicate all ~t~ck dimensions fram p~pe~ lines. Give strut and bilk number or description according to d~, and sh~ street nam~ and nd cate w~th~r interior or corner lot. / ,¢1 .4_ STATE OF NEW' YORK, Icc COUNTY Of ................................ ~'~' ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 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_l~efore me this ........ ...... doyo .. ................... hlotaet_ Public. .......................................................... County ~/~i~lnal~ t) DOMINIC ~ISClTELLI ' ~Signafure of appl/~/~t) NOTARY PUBLIC, State of New York Ne. elHi~d in Suffolk ~e~.