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Home My WebLink About5067-zFOBM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy N /.~b.2~ Oct 12 ., lg 71 o ............. Date ............................... THIS CERTIFIES that the building located at ...H.e.d.~e...S.t. ................ Street Map No.. xx ........ Block No... xX ..... Lot No..xx .... Fishers..Island .. ~{...~,.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... No.v.... 20., 19. ?.Q pursuant to which Building Permit N°. . 50.~.. dated ............ .N.o.v....2.~..., 19.7.Q., 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 .... ~ri.v.~te..Qne. f.~i~y..dwel-~Ing .................................... The certificate is issued to James Peishoff Owner (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N...~ .. .............................. / Building Inspector ! FOIC~I NO. 2 TOWN OF $OUTHOLD · i BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE/~ISE$ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5067 Z ~e .......... i- .............. ~,,, .......... , ,~....~ Permission is hereby granted to: ........... .~..~.a....Cc, n.~r.~t~.....~/¢ ...... ju. l,e~lmff ................ · ~!.~hot,~..;~at~ ........... ~ ................. at premises located at ...~)/.~.....~[~.~..~,~ ...................... ~ ................................................................. y ...................... , ...... :.: ...................... ~i~h,,~.r ~...~i~a~ ............ ~,'"~'~- ........................ :'~ ............... ~ ........ pu[suenl' to opplication dated .............................. ~ ......... ~[~d~...., 19.. , end approved by tho Building Inspector. FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT! TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Examined ...................................... Approved ........................................ , 19 ........ Permit No ...................... Disapproved a/c ....................................................... ....................................... (Buildin~ Inspec/r) APPLICATION FOR BUILDIIqG P~RMI'I INSTRUCTIONS a. This opplication must be completely filled in by typewriter or in i~k ond submitted in duplicate to th~ Building Inspector. b. Plot plan showing location of lot ond of buildings on premises, relati~)nship to adjoining premises or public streets or areas, ond giving a detailed description of layout of property must be drawn ~n the diogram wh ch s p<~rt of th sot P cat on c. The work covered by this application may not be commenced befor~ issuonce of Building Permit. d. Upon opproval of this opplication, the Building Inspector will issue'~;3 Building Permit to the applicant. SL,ch permit shall be,kept on the premises available for inspection throughout the prc~gr~ss of the work. e. No building shall be occupied or used in whole or in part for any pulrpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the i~suance of a Building Permit pursuant to the Building Zone Ordinance of the Zowfi of Southold, Suffolk County, New Y. brk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, Or (or removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, build)ng code, housing code, and regulations. / (Sign.~,F..e o ,~,6pplicent, or name, if a corporation) / .. ................... (Address of applicant) ~' ' ' State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder Nome of owner of premises ....... .~;~..,.- ...................................... .~.,~._ ...................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which propos,ecJ, wo? will be dorje. Map No.: ....~ ................... ................ Lot No.: ........................ ~il t ,~ ' C. ,~, "'r° Street and Number ..... ~./. .... :.t.:.: .......... '... ..................... Municipality 2. State existing use and occupancy of premises and intended use an~ occupancy of propos~ construction' a Ex st ng uso and occupancy .~.~¢ ........ ~ "~/' ' b. Intended use and occupancy ........................................................................................ 3. Nature of work (check which appllcab[e): New Building .................. Addition .....(~...... ..... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ tf 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 same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ....... ~ .................... Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction vi/p~late any zo~g law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ddress .~......:...~//. .. .: .........Phone No. '.~.~F~.~ .,~'...~...?..~ Name of Architect ...................................................... Address ............................................ Phone No ............. ,: ...... Name of Contractor ............ Address . ..,~,....../}..: .............. Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. .STATE OF NEW YORK, COUNTY OF ......................... .............. ~//..~:-.~..~ ............................ being duly sworn, deposes and says that he is the applicant (Narr¢ of indivi~.a~nin~ ?pp~O.on)~_._ above named. He is the ...... ~~~ ............................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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. ........................ day of ............................................ , 19 ........ Notary Public,. ........................................................... County ............ 7'-' .............................