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Home My WebLink About5466-zPOI~M NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certific le Of Occupnncy No. Z,~.~6 ...... Date .......... N~.mb.~. 7~ ..... , 19 .~.3. THIS CERTIFIES that the building located at 1~,1111~004. RO&~ ............ Street Map No... X~ ....... Block No .... XX .... Lot No. XX ..... Cu.t.chOgll~ .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... Au~,. ~.-7.~ ...... , 19. ?~l. pursuant to which Building Permit No... ~ dated ...... Aug .. ~LS~ ....... , 19..~_~.., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... Pr~..vat~ .zwl~n$~g..poQ1..(a~eez~oz~) ............................ The certificate is issued to ..... 8~u~f~. Ii.. Pl*~l,~zm ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approvai ...~. *.R.* ............................. UNDERWRITERS CERTIFICATE No. PE1K)IN(~ HOUSE NUMBER . .. ~t.~ ....... Street .... [~lJ~eW~.o.~.. R.o.~. ...................... ................... i ......................... ......................... Building Inspect6r TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5466 Z D~e ...................... ....... ....~...~ ...... Vermilion ts hereby granted to, Do Z' ~C~/~ B ~'Lc/7'~'/t//~/~ ........ ~ ..... ~d5.5..0.~. ....... E.....£..r.,.:Lq...~./A~ ~ ' _~ ~0premises located at ....................... Z.,~.~.. ...... .?../....~...~..~....~....~..~....~... .......... ...~...~...~.....~..' .......................... ~. ........................................................................... c".~....~..~..~..o...~...~..~-. .............. ,,,~..¥, ............... pursuant to application dated .............................. ~...~... ...... -t~...-,O~...--~...., 19.~..4(.., and approved by the Building Inspector. :Fee $ ..... ;,.-~.,. ............. Building Inspector EulLDING Df~ART~INT TOWN CLERK'S oFFICE SOUTHOLD, N. Y. ................. ~ ................................. {Buildin~ Inspector) APPLICATION ~.FOR BUILDING PERMIT INSTRUCTIONS o. 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 adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty must be drown on the diagram which is port of this 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 o 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 port for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Bud ng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, 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 oil applicable laws, ordinances, building code, housing code, and regulations. ...... ................ State whether ~. applicant is owner, lessee, agent, 'chitect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ............... :"-'" -- --- . w ................................. If applicant is a corporate, signature of'duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which prapoAed ~'ork will be done. NJap No.: .................................... Lot No ............. Street and Number ./~.~...~.~ .~--d~.~.. ~..~....'~-~'~'"'"~' 2. State existing use and occupancy of premises and Muni~p',~ ~='----~' intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......................... ~1 ' ~ ~- ~ ,~ /I- ' -- ~ ........... ~ .......................................... b. Intended use and occupancy ...../-~--,g4~l~....~"~f,,~.r~....~.....~ ............. ,-- 3. Nature of work (check which applicable): New Bui ding .................. Addition .................. Alteration ................. Repair .................. Removal ~.: ............ Demolitior; ................ Other Work (Descr be)./.~....~.,..~. 2,_~ 4. Est mated Cost ,.~ 7~g/) ~e~ Fee . ........ ~t~ (to be paid on filing this application) 5. If dwelling, number of dwelling unit~ ............................ 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 existin.~st~:tums; 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 .. ~.~1 ............... Rear ...... ~...(~1~ ................. Depth .e~.~...~. .................... 10. Date of Purchase ........................................................ Name of Former Owner ................................................... 11. .Zone or use district in wl~ich premises are situated ............................................... ,~.~ .............................................. 12. Does proposed construct on v o ate any zon ng aw, ord nonce or regu at on? ~..~. ~ 13. Name of Owner of premises ~..'..~.:..~~ress ..~.~.~.~..~~t~ne NameName o,°' ContractoArChitect~1~ ............................. .. ~~;' ...................... .AddressAddress .---,--.......-.....~..:.....~...~/Phone ........................................... ~ ;~~' U' ' Phone No.~.~No ......... ___ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines~ Giye street and block number or description according to deed, and show street names and indicate ~he~l~er inf~ri'or or Corner lot. STATE OF NEW YORK, ~ S S' cou L oF. ......................... I ,, "'C~~, ~u~ ""~'. ................. being ~uly sWorn, deposes and says that he is the applicant '" %~.~ (l~bme of'~di¥idual sigr~ing apglic~bn)~ above named. He is the ...... ~..,~.~ ...... ~ ........ ~., ................................................ ~ ~ ' (,Copfractor, agent, corporate officer, etc.) ........ of said owner or c~wners, and is duly authorized to perform,, or have, performed the said work and to make and file this applic.at~on; that all Statements contolned in this· application are true to the best of his knowledge and belief; and thor the work will be p~rformed in the manner set forth in the application, filed therewith. Swam to before me this .~ ~, ...... ......... o, ,,z/. z._/, £ · Notar~ Public,. .......... ~~.~.... C911)~.[5,~""w~'~'"'*~(~~/'''~ ............ ~ I~ Notary Public, State of New ¥o1~ ~Residiqg in S~ffork County ~ No. 52-3041000 ~,~ Commission Expires March 30, 197