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Home My WebLink About5053-zFORM NO, &' TOWN OF SOUTHOLD BUH.IIING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.. Z~0~8 ..... Date .............. A.tl~.....~.1..., 19.~.. THIS CERTIFIES that the building located at . .~.~17. A.~.s.. &..~..~...l~_~v~....~. Street Map No...~ ........ Blo& No ..... ~ ...Lot No... ~... ~0~0~...~,~.. ....... co~o~ subst~fi~y to ~ App~afion for B~ding P~it here~fore ffl~ ~ thi~ office dat~ .......... N~ ..... l~., 19..~ P~u~t ~ whi~ B~g Pe~t No .... ~ dat~ ........ ~ .... ~6. ..... , 19..~ was ~su~, ~d co~o~s to ~ of ~e ~ ments of the appUcable pro~io~ of ~e law. ~e occup~cy for w~ch thl, c~ca~ ~ ~su~ ~ .~ly~e. ~,. r~ly. ~we~l .~ .~.$~1~ ...................... ~e c~fficate is ~u~ to ...~osoph. PA~oI~ ....... ~e~ ' (o~er, lessee or ~t ) of ~e ~ores&d b~ding. S~o~ Co~ty Dep~ent of He~ Approv& ~.~ ............................... U~ERWRI~RS CERT~ICA~ No...~ .................................. HOUSE ~ER.. 1.0~ ....... Street... C~ar. AVe. 1~) ...................... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5053 z Permission is hereby granted to: pursuan$ to application dated ............................ ~. ......... ~,~.....~.,,., 19.....~J~J and approved by the {~ ' Buiding nspecto/ / PO~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ....... ,Permit No. Disapproved a/c ~ ~ · (Building In~ector) / Application No...~...0...~.~. ........... APPLICATION FOR BUILDING PERMIT ~ ~L~ Date ................... I .l/J~. ............................. 19.7 ..~.. ..... INSTRUCTIONS ,a. This application must be completely filled in by typewriter or in ink and s~omitted in duplicate to the Buildi Inspector. ' b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of prcperty must be drawn on the diagram which is part of this Iocatic~ ~ c. The work covered by this application may not be commenced before issuance of Building Permit. d. UPon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Su 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 pu. rpose 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, SuffolE Ceunty, New ~York, and other applicable La~s, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ord !nances and regulations. .......... ' (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, g~neral contractor, electrician, plumber or builder. Name of owner of premises .~./.~SL.~.~..'..~....~ If applicant is a corporate, signature of duly author~ed officer. ..... ...... ~/ (Name and title of corporate officer) . 1~ Location of land on which~, ,~ -_ /~.' ~ ,, ~,_ .~,fpr°p°sed work will be done. Map No: ....................... : ....... ~'7 ....... Lot No: .................... Street and Number ..~--~.~........~4~.......(-~13g~......~.*~..6~....~.(~:~1~'6/~a~."~'.~-... ~.(~&~...~.X"~..'~ ..... /O~ ' 2. State existing use and occupancy of premises and intended Use and occupancy of'proposed construction: a. Existing use and occupancy......~,.*~Z~:~:'~1~-~-~--...i .......................................................................................... b. Intended use and occupancy.....~'~~ ........... : ............................................................................... ~. ~) Nature of work (check which applicable): New Building .................... Addition ................. ~.Alteration ................ Lt.. Repair .................... Removal .................... Demolition .................... Other Work (Describe)., ................. 4. Estimated Cost ............... ~f~.~F,,~. .................................... ee ..... :.~..' ................. ;....: ...................................................... (to be Paid on filing this application) §. 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 .... ,./.Z ................... Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front .....~... .................. Rear ....~.. ......... : .......... Depth ....... ,~..../~.x ........ Height ..../..,~... .................... Number of Stories ................................ 8. Dimensions of entire new construction: Front.....L ......................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ........ /.~..~....*. ....... Rear ........ ~/~.0...~'..~ ....... Depth ...... /.~J~..~ ............ 10. Date of Purchase ../,~'.~,~E'/~X~.... .......................... Name of Former Owner .~l[4/~rs~.fJZz,/~.. ............................. 11. Zone or use district in ~vhich premises are situated ................................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? .~..0......-~.. ................................... 13. Name of Owner of premises~...../~a~.~Ji[i~J(/..~ddress ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor~/~::~tliL.~...~.: ........... Address ~ .................... Phone NO. '~i~'...'..~...~..~.'-~. PLOT DIAGRAM Locate clearly and distinctly all .buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ) S S. COUNTY OF ............................ ) ...... ,~,~.a~-*(ei~. ....... ~m~.~~ ................ .,. ....... b,,eina duly swor,0, deposes and says that he is the applicant · - (Nc~i'ne'Of individual'~ig"nir~g ahpllcation) above named. He is the..~.~l~..,.....~.~./...~....~'''~ ............................................................................................................. (Contractor, agent, co~orate office.r, etc.) of said owner or owners, and is duly authorized to perform or ,have perfo .rmed the said work and to make and file th s application; that all statements contained in this ap. plicat, ion are true t6 the best of hi.s knowledge and belief; and that the work will be performed in the manner set torth ~n..the_~application~ filej;I th,~'ewitJ~. Sworn to before me this //~.~9~. ......... /.~...-=.. ..... day of ......):..~... 19...-Z~..... M^m0~ A.,~GE~' (Signature of apphcant) "-' ' 0'". PUUUC, of ,,w Yo t .... '~.~r~.:..~,.Coull~52-3233120 Suffolk County Notary i-uouc~-'~..:..:...~...-~.uu i~rm Expires March 30~