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Home My WebLink About5491-zFORM NO. 4 TOWN OF SOUTHOI.D BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No...Z53.~ .... Date ..... Augu~.t .6~ ........... , 19.23. THIS CERTIFIES that the building located at Old O~¢hard./~ne ...... Street Map No.. X ........ Block No ..... X .... Lot No. . .EaS.t .l~arioll~. N,Y., .......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ....... Sep.t, ?~.., 19 ?~L pursuant to which Building Permit No. dated ........ Sept, .8~..., 19 73~, 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 · l~.lva.~ .A~e~$S~ B~ld~ng .................................. The certificate is issued to Dougla~ Rogers ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................... UNDERWRITERS CERTIFICATE No ............................................ HOUSE NUMBER · - 29~ .... Street .. 4)t~10~,¢]~-z~l · Ro~I .................... ............................................ East. N~rion~..N,~, .............. ..... ¥.~..~. .... . .~-¢...-/ ...... Building Inspector / FOR~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5491 Z Permission is hereby granted to: ...... ~4m&:~U..iia~ea ....................................... ................ tja~;~.aa~.~j ..................................... to .,9a~..a~.a~4l,.~e~..~_~..~j~g-.a~eee~aox~,..~.la4~ll .................................... at premises lactated alt ..... :J~/~-,~O~elJ:--~:j~J~r~-, ~ ........... ; .............................................................. ................................................... ~at-.~q~ .............. t~T~ .......................................................... pursucm.t to application dated .............................. JJ~ .........~ ........ , 19..~.., and approved by the Building Inspector. _Fee $...~,0~ ............ · J Building Inspector / Examined Approved FO]~M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. 19 ........ 19 ........ Pem,t No..~C~ ............ Application No...~....~....~..~'.. ............. D~sapproved a/c ............................................................... ' ~ (Building I n/~ctor) APPLICATION FOR BUILDING PERMIT Date ............ ~....?.. ................. 19..~../. .... INSTRUCTIONS a. Th~s application must be completely filled ~n by typewnter or in ink and submitted in duplicate to the Buildm Inspector. b. Plot plan showing iocation of lot and of buildings on premises, relat~onshlp to adlommg premises or public streets c areas, and gwmg a detmled description of layout of property must be drawn on the diagram which is part of this apphcat~or c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector w~ll ~ssue a Building Permit to the apphcant. Such perm 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 Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Budding Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances ~- Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ............ ............................ (~gnat~fe of applica~nt,~,~? name, if a corporation) ......... ........... .................. ~%~.,~.~-~.~,~ ~(~ (Address of applicant) - State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu~lde If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which~// ,,~ // //,//--pr°p°~ed work wiJl be ok)ne LV~ap No-~ f'7', ~,,~ ~: .... Lot No ...................... Municipality State existing use and occupancy of ~ntended use and occupancy of proposed construction: o. Exisiting use and occupancy ............................................................................................................................. ~ b. Intended use and occupancy ......... ~.~1~..4~.~...~ .......................................................................................... 3. Nature of work (check wh,ch applicable): New Budding .................. Addition .................. Alteratton ................ Repair .................. Removal .................. Demolihon ................. Other Work (Describe) ...................................... 4. Eslimoted Cost ...... ~ ........................................... Fee ....................................................................................... xe~..~ .(~....~.. (to be paid on fihng this application) 5. if dwelhng, number of dwelhng units ...... :Number of dwelhng umts on each floor ......................... If garage, number of cars ............... ~........~..~.-..~. .................................................................................................. 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7. Dimensions of exist,rig structures, if any: Front...~.~.~./. ............... Rear ...~....O...r.. .................. Depth .......'~....O...../.... Height /co/ Number of Stories Dimensions of same structure with alterattons or additions: Front ....... ~......~:.. ................... Rear ....... / Depth ........ ~...4~.. ................ He,ght ....... ./..(~../.. ........... Number of Stones ........ ~ ............. 8. Dimensions of entire new construction. Front .................................... Rear ............ 7.T:7.z..::..~C~pth ..................... Height .................... Number/of Stories ........... ~;,7.;:.7 ................................................. ~. .................................. .................................... Depth ............. ~.. ............. 10. Dale of Purchase ....................................................... Nome of .ForumrOw~ner ............................................. 1 1. Zone or use d,str,ct ,n wh,ch pram,sas are s,tuated ......... ~-'~r-~...~..,.~.... .............................................. 12. Does proposed construction violate_ any zoning la~, ordinance or rec~u ahon> . · ,.~..~'~.....r. ................... 13 Name of Owner of premises .7,~2~t~.~.~.....~.~,ddress,o -/.~ .'~Z'~-z~-~.~-~W..:~'° ,,---~.~ -~-- ...... Phone No. '...'"'""'"'""'"""'"'"' Name of Architect ........................................... : ......... Address ............................................ Phone No .................. Name of Contractor .................................................... Address ........................................... Phone No ................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and md,cate all set-back dimensions fron property hnes. G~ve street and block number or description according to deed, and show street names and ind~cat: whether inlerior or comer lot. STATE OF NEW' Y(~K,/',~/)j/ t ¢ ¢ couN r oF ....... .................. :: ..... .~.~f./'7~.~ .~........o~r~...~.z~..~..: ............ being duly sworn, deposes and says that he is the apphcanl (Naffqe of,u~diwdual signing 9~phcat~on) ~. ,/5~/// ' above named. He ,s the ...... ~.,.~/(,..~~/~,, ...................................................................................... (Contractor, agent, corporate offtcer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and fil~ this application; that all statements contained m th~s apphcation are true to the best of h~s knowledge and behef; ant that the work wdl be performed in the manner set forth m the application filed therewith Sworn to before me this ........ ;....z.. ....... ..... ......... / -,,:--', .................. .............. ..... o, ........ T BOK~. N Notary Public, Slate of New York No 52-0344963 Suffolk County Comm~;,,on Explrc~s March ,30,