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Home My WebLink About5493-zFORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No...~.1.8 .... Date .... J~ .27 ................ , 19..~.~ THIS CERTIFIES that the building located at .... 70~ .G&p.~; ./$d~l .Or~,~e. Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ... ~.~9~l~b. er. ~. ..... , 19 .?l. pursuant to which Building Permit No... ~92~ dated .... 81~p.~mbs~..8 ...... , 19..~.l, 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 ...... PI',~I;~ .0m~..P.~$iIt. The certificate is issued to ... I~,. II~Ol*~e .(t~m ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......... .~.,..R., ...................... UNDERWRITERS CERTIFICATE No. HOUSE NUiVIBER ... ?0.~. ....... Street . .C.a.t~.t..' .~...4.d..O.~..1.?~.~..~..t.t. 1..t.~.c.k.l..N.:Y. :.. Building Inspector TOWN O~ $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~SOUTH~D, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE: PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5493 2: Permission is hereby granted to: at premises located at ...... ~l~;..t~. ..................... I~J~..~t~J~J..jJ41l~..', ................................................. ......................................................... ~e,t~.t~1~ ................................................................................. pursuan¢ to application dated .......................... JJtlJ).~ ....... a .............. , 19...~.~J., and approved by the Building Inspector. Fee $...~jt,~J ........... u~ lng nspector I Approved FOR~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Pem,t No ...... D~sapproved a/c .......................................... APPLICATION FOR BUILDING PERMIT ate .................... INSTRUCTIONS a This apphcot~on must be completely filled in by typewriter or in ink and submitted in duphcate to the BuddJn Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets r areas, and gwlng o detailed description of layout ofproperty must be drawn on the d~agram which is part of this applicotio, c. The work covered by th~s application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will ~ssue a Budding Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the progress of the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable 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, ordinan~ ~g code, housing code, and regulations. ..................... (Sighature of applicant, or nome, if a corporation) ,~-~ /w.~:., k~;' ~.-- · , (Address of applicant) State whether applicant is owner, lessee, g , hitect, engineer, general contractor, electncion, plumber or build.- If applicant is a corporate, s~gnoture of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed w. qrk wdl be don.& Map No.._. ............. ~ ............... . .... I.~t No ..................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........... ~...~ .................................................................................. b. Intended use and occupancy ........... ~ .... ~ ...... ~ ........................................ ' ::' ' 5': ':':' 3. Nature of work (check which applicable): New BuffdJng .................. Addition ...~ ...... Alteration ............. Repair .................. Removal .................. Demoht~on .................. Other Work (Describe) ....................................... 4. t mated Cost ........................................................ .......... 5.If dwelling, number of dwelhng units ............... / .......... Number of dwelhng un,ts on each floor ....... / ................ If garage, number of ~rs ............. ~..~~ ..................................................................................................... 6. If business, commercial or mixed occupancy, spec~ nature and extent of each ~e of use ........................... 7. D~mensions of ex~sting structures, if any: Front ....~ .............. Rear ...... ~ .................. Depth ~... Height ........................ Nu~er of Stones ...... Z~ .................................................................................................. Dimensions of same st~cture with alterations or additions: Front .................................... Rear ....................... Depth ................................ Height ............................ Numb~ of Stories ............................... 8. Dimensions of ent,re n, construction: Front ............ Z.~ ................ Rear ....... ~: .................. Depth ~y..L ...... Height .................... Number of Stories ................... [ ........................................... .......~ ....................................... 9. Size of lot: Front ..... ~.~ .............Rear .... ~..~ ................... Depth .~..~.... ............... 10. Date of Purchase ....................................................... Name of Former Owner ...................................................... 11. Zone or use district in which premises are s~tuated .................................................................................................. Does proposed construction violate any ~ning law, ordinance oE regulatto9p ...... .~ ............ 13 Name of ~ner of pr~.~..~~ Address~.~..~... Name of Architect ..................................................... Address ............................................ Phone No .................. Name of Contracto~~..~_~ ............... Addres~~.~l~. Phone No ................... PLOT DIAG~M Locate clearly and distinctly all bufld,ngs, whether ex~stmg or proposed, and ~nd~cate all set-~ck d,mens~ons fror prope~ lines. Give street and block number or description according to deed, and show street nam~ and indicat wh~her i~terior or comer lot. STATE OF NEW ;~'~RI(~. ..~' 1~ ................ ~ ............................ being duly sworn, deposes and says that he ~s the opplica ' (~"~;~JiV'?~t~'~l signing application) above named. He ~s the ............................. ~ ................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or hove performed the sa~d work and to make and f this application; that all statements contained that the work will be performed m the manner set fo~h m the appli~ion filed therewith. Swam to before me this ~ ...... ~ ...... ~¢yof~.~ ............. , 19.~/.. j~ · ............ ................... ELIZABETt~ A~ N~VILLE NOTARy PUBLIC, ~tate 0l Netv York No 52 8Z25850, Seffol~ Ter~ ~p~re~ ~arch 30,