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Home My WebLink About5471-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~.~..0. ..... Date ............ &I~,~tI~tL. 30 .... , 19.~. THIS CERTIFIES that the building located at . 1~/~..ltOr. t;l~. tt~ .......... Street Map No...XX ........ Block No. ~ ....... Lot NoXX ..... ~o~xtAmo],d.~ .lidt,, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 9 .... , 19.~1. pursuant to which Building Permit No.. ~71Z. dated ........... Aug...20..., 19.71., 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 . .Pri~rate..one. f. amil ..dw.X ng ...................................... The certificate is issued to . .l~ts...-I-l~®n® .L. i~;*oh ....0~rnel' ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · ]~eli, .............................. UNDERWRITERS CERTIFICATE No .... ]~.e.l~, ......................................... ItOUSE NUMBER.. ~ ..... Street .... Nor.th .Roall. (Clt~) ......................... Building Inspector ~ (THIS PERMIT MUST BE KEPTON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZEI~) N? 5471 Z Building Impector. Building Inspector ft i I /9' n-~ E,E m BUILDING DEPARTMENT /.~/~,~.,, L~.~- 0,'/~ : TOWN CLERK'SOFFICE ~ ~ ~- SOUTHOLD, N.Y. ~/, ~ ,~ ~ Examined ..................... ~...~.~, 19~ ~pJication No....~.~ ............. ~ ~proved ...................................... 197~.. PemitNo. ~/ ~ . ................................... Disapproved a/c ........ ~ ................................................. ................................................ ............... (Building Inspector) ~ APPLICATION FOR BUILDING PE~IT ~ Date ...~.~.~ ....... ~.~ ............... , 19.~ ....... ~ 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 adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part 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 a 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 part for any purpose whatever until a Certificate of Occupancy shall have been gra?~fl~-t~ilding 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, 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 all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) CAddress of applicant) /V. V. IIq'll State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ ..............' . . owner of premises ....~..~.~......j[l~.~'..~...E.......~..,..~..~.'~..~g..~.. ......................................................................................... ~; Name of If applicant is a corporate, signature of duly authorized officer. ~1~ ~ _ ~ (Name and title of corporate officer) Location of land On which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number ..~.O1~3-t4 ~OGI~ -%O~..T./yI.~?~ ~ ~ Store existing use and occu~ncy of premises and intended use and ~cu~ncy of p~os~d constmction: ~ a. ~isitin~ use a~ ~cupancy ..................................................................... ~ ....................................................... b. Intended use and ~cupancy ~.~l~ ~[ . ,~.~ ~;ZM . 3. Nature of work (check which applicable): New BuiJ~ing .................. Addition ......~... ........ Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .....?...~.~..~).,...e.~...~.. ......... i ................. Fee .......... ...~.~.,.~J~ ............................................................... (to be paid on filing this application) 5. 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 ....... /~. ............ Number of Stories ~../-~E ................. Dimensions of same structure with alterations or additions: Front ...... .~.5. ....................... Rear .....%-~... ................... Depth ~..~...'.~.~..:T..~....~...~..E~... Height ...... ./...~.. ................ Number of Stories ...... .~...~...~-.. ................. 8. Dimensions of entire new'constructiom Front ~...~.~..~.~.~.T.'~....D...~..~/,~ ...... Rear ~.~'.m.,~'~ ..~...~.~. [:~t~ ~o'C~,'~ 4~ Height ..../~.: ........... Number of Stories ....~)...~...~ ............................................... 9. Size of lot: Front ..... ~...;~ ............... Rear ..... ..-~'.~. ......................... Depth ..../.?.~...~. .................... 10. Date of Purchase ..... ~F.~..~.....~......~?..6..~' ...................... Name of Former Owner ~r~..~,g.Z~...~.~:E~Y....~..~..~....c.~... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regu at on? ./~..~. ............................................... 13. Name of Owner of premises/~ ,./~',~/J~..~.~,.~'.'.~.Aclclress ~T.~...~0.X.~.~'..~..~..~. ..... Phone No..7..~..- .~,~....7.~'. Name of Architect ...................................................... Address ................ : ........................... Phone No ..................... Name of Contractor .~..~.~)i~..~...~.~/~,~...~...~_... ...... Address .7~/...~.s./~..~l..~...~.~.....~....l~..~e' No. E~.'.~...~/....~.~..~ 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 according to deed, and show street names and indicate whether interior or comer lot. .~'~/OE ! STATE OF NEW YORK, ' J c ¢ COUNTY .OF ................................ ~r.~ ...~., ~ ~ - ........................ ~]r4.~ .......... .~./..'~.. .................................. being duly swam, deposes and says thotshe is the applicant (Nome of individual signing application) above namedSHe is the ...... ~/.~.J~.~.~, .................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contoined 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 applicatiot~ filed therewith. Sworn to r~lefore me this /~ ~--~, ~ -- /') .... _. :.__ of ......... ............ , ' .... ' .............. ........ : ................... .................... (./ELIZABETH ANN NEVILLE- / Count~Jl< (S gnature of applicant) NOTARY PUBLIC, State ~f New No. 52-81~58,~0. Sutfol~Cou Term Expires March 30. ]g