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Home My WebLink About4692-zFO~M NO. 4 TOWN OF SOUTHOLD BUILI~IN(~ DEPARTME. NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.z.~?~+~ ....... Date ............. ,Inn ...... ~.~..., 19..7.~' THIS CERTIFIES that the building located at ...P. ac~ic. ~.~;ree.~ ........ Street Map No..xx ......... Block No...~ ...... Lot No.. ~ .... ~at.t, ituak., l~...I, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Ap~';~l.. 20 19.70. pursuant to which Building Permit No..bt692Z. dated ......... Apl-iX... 2D., 19.70., 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 ... Pxiva.te. acaesso~.y. {~torage.)..bttL151ng ......................... The certificate is issued to . .]~dwarcl. l¢tleansk~ ....... 0~ol" ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... }t,l~, ............................ UNDERWRITERS CERTIFICATE No. pen,ck,.rig .................................... HOUSE NUMBER ...~-?.5 ....... Street ...P. aeit~.c. 15.t ........................... ....... ........... 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) N? 4692 .... Z Permission is hereby orantec~:h/~q pursu~ to application dat~ ............................................................ , ~y ........ ,ana approv~ by the Building Inspector. Fee $....~.~...~.....~.... ...... /_.~r~ '.~ ' ~'~ Building Inspector' (,..)1.~// BUILDING DEPARTMEHT ~ ~ ~/,1,~ , . ~. '~ ~ · TOWN CLERK'S OFFICE /~///,.~ /'/'~.--. ,~',~,.~ - ~ ,. ~ ......................... ........ A ,, t,on No. ................ Approved ............. ~.....-~.., I~Z.~.. Permit No. Z.~.....~...~ //~/- '~/~'~ ~' ..... (Building msp~tor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. 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 adjoin ng prem sos or pub c streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of ~hie application: 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. Such Permit shall be kept on the premises available fqr inspect on throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy sholl have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuont to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ord nonces or ~.egulati.o. ns, for the construction of buildings, additions or alterations, o~for removal or demo it on, as herein described. lne applicant agrees to comply with all applicable laws, ordinances, I~lld~ng code, ,l~using code, ond regulations. (Signature o? applicant, or name, if a corporation) (Address of applicant) -- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~/~'~1 ~.J~ ' ~ J L C. ~/~' / If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) I. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ~../....'.....~...~.~ .......... ...~..~..~./..,~.././e, ,': - ...................... ........................... 2. State existing use and occupancy ~f pl~tses end intended use and occupancy of proposed construction: a. Existing use and ~/~- ~'~q/4/Z y' .4)...~'....~...~-:.../A/~..~ ~ occupancy ......................................................... b. Intended use and occupancy ............................................................................................ ~ 3. Nature of work (check which applicable): New Building .................. Addition I'/ Alteration Repair .................. Removal .................. Demolition .................. Other ~Vork (Describe) ........................................ ti t DCP "f: ~ . 4~ Es ma ed Cost .......................... ..~..~ ........................... 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 af 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 ................ /'...~... ............ Rea~' .i.iii.?ii~ii.iiiiiiiii Depth ...... ...~......~. ................. Height ............... '../.....'~....Number of Stories ......~....A(....~.~. ............... . . . ....... ........ 8. D mensmns of enhre new constructmn: Front ....................................Rear ............. · ............... Depth Height ......... ./....~. ..... Number of Stories (~ ~v' ~ Size of lot: Front .......... ./....~.....o.. ...... Rear ... ......... ./....~....~......-~.. ....... Depth ...... .~.....~......'~...../..?....~..i ~ Date of Purchase /'~--~' .~-... Name of Former Owner ~Z~) ~Z~I~'~..~' Zone or use district in which premises are situated ~>~'~ / Z~ Does proposed construction violate any zoning law, ordinance or regulation? ~-Z &> Name of Owner of premises .~....~.......,~l/~..~...~....A~.../...Address ..~....'~..../..~...~...~...../~...~...~..... Phone I~.~...~...~...~../..?.~. / Name of Architect ..................... .., ,J....... .................... Address ............................................ Phone No ..................... .................... ~ ...... .../~.... ....... Address Phone No ..................... Name of Contractor ,-~ 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 to deed, and show street names and indicate whether interior or corner lot. dotary go't. ~Ac F:rc- STATE OF NEW YORK, ~ S S COUNTY OF ................................ $ '' ............ ~..~..../~....~...~....~.. ......... ..~.../....~....~..~...~..~ ....................... being duly sworn, d~oses and. says t~t he is the ~pplicant (Name of individual signing application) abo~e named. He is the: ............................. ~.~.~.~.~ .................................................................................................... (~tmctor, agent, co~orate officer, ~c.) of'said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke ~d file this application; that all statements contained Jn this application are tree to the be~ of his knowledge and belief; and that the work will be performed in the manner set fodh in the applica~ fil~ t~e~ith. Swam to before me this //~ [I ) i -e , - .............. ............................. Public,~_~.:....~.~..~ ....... ~~.~ Coun~ (Signa~re of applicant) ~- '~ ~-- ~- [ ' ~ ~OTAEY PUBLIC, State of New York Ho. 52-8]25850, Suffolk County ~rm ~pJres March 30, Zg~