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Home My WebLink About5458-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTIt~.NT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No...z.5.3! Z... Date . .Jl,l~. 22 ................. , 19.. 73 THIS CERTIFIES that the building located at .. ~ 5.5.51;~ .$J;ie.e.~ ......... Street Map No...8.6~ ....... Block No ........... Lot No .... ~ .&..~ ..................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...AII~Uil;. ~..0. ........ , 19..7.% pursuant to which Building Permit No.. dated ...~41&U~l;. 13, ......... , 19..Ti, 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. rl¥&l~e. 0~e. F~,y. l~.~ll~.l~ ................................ The certificate is issued to .......... ¥ia0.~l;. ~£i~ele ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... N .* R.' ...................... UNDEi~WRITERS CERTIFICATE No. N,R, HOUSE NUMBER ....1.~.~. ....... Street ....~.i.x..S..t.r.e.e.t.,...L~..ul'..e.l.,. ~.,.Y... .......... FORM 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) N? 5~58 Z Permission is hereby granted to: V~l~t~ ~j~[~ premises locoted ot .....~.....~..~.3~....~....~...~......~..~.~.~.~~ ............................................................ ............................................. ~...s..~ .......... ~ ....... ~...~... .................. i .................................... pursuant to application dated ............................ .~....~.....~..~. ............... , 19..~...., and approved by the Building Inspector. Examined AU[~. 1 1 1911 Approved .......... ......... ~O~ ~TO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. ,9 ........ PemitNo ....... Disapproved o/c '. ........................ ~ ............... ; .............................. (Building Inspector)/ APPLICATION FOR BUILDING PER~IT Application No ................................ ~r~ INSTRUCTIONS o. This application must be completely filled in by t,/pewriter 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 adjoining premises or pubJic streets or areas, and giving o detailed description of layout ofproperty must be drowr~.on the diagram which is part of this application. c. The work covered by this application may not be commer~ed before, issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a'~uilding Permit to the applicant. Such perm t~,~ 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. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ~ ( 'g o e of applicant, or name, if o corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber, or builder. ....................... ..o...~.~..~...v'. ........... ~"":'"; ...... ~ ......... .,..., .............. ; ....................................................................................... Name of owner of prem ses ...~./..,Y/,..,~_,E,..,Y/...,T.. /VI ~ n I .~. ~ ~ / ~ .................................................... ............................................................ =. .......................... If applicant is o corporate, signature of duly authorized officer, rT,~,~ ~/-~ ~ ................. .........,-- Location of land on which proposed work w~ill be do, ne. ~op No.: :>s......~...~.../. .................Lot No....~..~.......~..'~ O ...... Street and Number .......................... ...... ~L~i;i~'i~'~ ...................................... State existing use and ~cupancy of premises and intended use and ~cu~ncy of proposed construction: a. Exisiting use a~ ~cupancy ................. ; .......... ~ ........................................................................................ b. Intended use and ~cupancy ~....~.~.~....~;~. ~.~...~ ...... ~ ~. ~.~./..~.~ .. ~.~ ~ ~ .. ~..~ ~ ~ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration Repair ....~ ........ .~emovol ..................Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .....:......~.....~.....-~..:....~....C).. ........................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. ..-~... .......... Number of dwelling units oq~each floor ....... ...~.. ............... If garage, number of cars ~ . .... " ... 6. If business, commercial or mixed occupancy, specify nature and extent of each ITpe of use ....... ..-7; ................ 7. Dimensions of existing structures, if any: Front ............~.~9 .......... Rear ...... .~.....'~.. ...... '~ ........ Depth ....~...~ ......... Height ....... ../.. ............. Number of Stories .............. ~./;?..~,.....~......7-~....r..~.. ~ , .................... D~mens~ons of same structure with alterations or additions: Front .......................... ...'~.... .... Rear .....~..~.. ................... Depth .............. ./~...J. ......... Height ......... ..%~....~....~.. ...... Number of Stories .............. ~".~.....~.....'L. 8. Dimensions of entire new construction: Front ............ .'I~...~i.../~..-./..... Rear ..... /...~....~. .............. Depth / HeJght~..l~....~. .......... Number pf Stories ................... ..~.....>Z....~.. ........................................................................ 9. Size of lot' Front .......... /..~ ......... Rear ......... ,d.....~.. ................... Depth ......... ./..~.. ............... 10. Date of Purchase ........ ./...~..~....~. .................................. Name of Former Owner ~..~...~~ 11. Zone or use district in which premises are situated .....................................................................................................// 12. Does proposed construction violate any zon ng aw, ord hence or regu at on? ................ ~ ... 13. Name of Owner of premses~--,.~..~]/Y~IR/~E[''~' Address /.,Al'cAe /.~..~ ~9",E~':~'''''''2'~''''~'~'~7 ..................................... %: ................................ e no. Name of Architect ............... ,~S.~.t~w...'~...........~....?; ...... Address ........~I~..~-.....~......'. ............... Phone No ............... Name of Contractor ............ ~.~..~....~P,,,.../. ............ Address ........................... ~ ............. Phone No... ~f../~.....'~.....~.~. PLOT DIAGRAM Locate clearly and distinctly all building~,'whether existing or proposed, and indicate all set-beck dimensions from 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~I~,/~J t¢ COUNTY OF ..~)~'f~. ........... ............... 7;;.~.~.;~ ...~ .... ; ........... ; ................. b,.-, duly sworn, d~o,s and says t~t he is the applicant tmame aT inaivJaua~ ssgnJng appdcation~ above named. He is the 0 ~N~- ~O~.~. (~ntractor, ag~t, co.orate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e ~ffo~ed the said work and to ~ke and file this application; that all statements contoined in this applic~i~ a~true to the best of h s knowledge and belief; and that ire WOrk will be performed in the manner ~t fo~h in the ~plic~im. fil~ th~with. Sworn to before me this ~ . / / I ...... .. ......................... . e of New NO, 5 York ~ 2 8Z.258~, Suffo k Cou erin Expires March ~,