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Home My WebLink About5533-zFOR,M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk'~ Office Southold, N. Y. Certificnte Of Occupancy No. Z5668 Date Novembex, 27~ 19. ?3 THIS CERTIFIES that the building located at ...J.~¢kS.o. ll. ~.v.~, ........... Street Map No...XX ....... Block No ..... iEE...Lot No.. XI(.. N.e.k~. $~.f. oI~ ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Se.pt,. 29 ~ ..., 19.7.1. pursuant to which Building Permit No...5~33~ da~ed ........ Ye.pt.. 29t .... , 19.?1., 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 Private one faratly dwelling with addition The certificate is issued to ...... .J.o.s. ,..F.e..n.t.o. ll .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No ..... ~. .1. 2. .8 .6.8.2. .............................. HOUSE NUMBER ...~(~? ........ Street ....J.a.c.l.:~.o.n.. ~.t.~.e..e.t ...................... New Suffolk ........... ......... POEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5533 Z Dote .......................... lept ...... Permission is hereby granted to: ...... to .jtl~bl..~..m~bl~,4jij~...mm..mm~:mt~:g..~l~j~t~l...¢&,t, mmm..~tj~,jj~m .................. at premises located at ..... ~/~'"'tJ'~JF~JRI~"~ ........................................................... i/' .................... / pursuar~t to application doted ............................... ~j)~- ......~ ......, 19.~1~J..., and approYed~ by the \ Building Insp~tor. Fee $.--.~00 .......... \ TOWN OF SOUTNOLD TOWN CLERK'S OFFICE ~UTH~D, ,. Y. Examined .6~e~....29., ...... , ~9..~. ~pr~ed " " 19 " P~it No ..... 5~3~..~ ............. Disapproved a/c .... ............. ..-..-. .......... .'T.. '.~ .'T......-...~ .-...-. ....... m .-..m..= m .-..'=..~...-...-: .-..= .-...~ .-.. (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 -errnit V~ 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 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 oil applicable laws, ordinances, building code, housing code, and regulations. ~ v, / (Signature of applicant, or name, if a corporation) .............................. ....... ............... State whether applicant is~owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...............~.~...;...~..~~ If applicant is a co~orate, signature~' ''of duly authorized officer (Name and title of co~orate officer) 1. L~atJon of la~ on which pr~o~ work~ill be done. Mop No.: ........................... ~ ....... ~.~ot~ ................. ~...~ Street and Numbe ........... ~.~.,.r.~...~ ............... .,.~r.=........... -..............~.....~ a. ~isiting use a~ ~cup~y ....~...~.~..~.;..~....~ ............. ~.~ ...... .~.~.....~...~ ................................................... b. ntended use end ~cu~y ......... ~ ........ ;. ~~~.,~.~~ .... 3. Nature of work (check which applicable): New Building ...... ..~........ Addition .................. Alteration ....4. .. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............ x ............................................. ~Fee --~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If ga~6ge, 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 ..~ ......................................... ~. ...................................... ~ ........... Dimensions of same structure with alterations ~)r additions: front -.;....;..~;......; Rear .~H...[.~., Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~....~;.',...; ..... Rear ...... ~.~.....~... ........... Depth ........................ Height ~ ....... Number of Stories ........... ~ .............................................................................................. Size of lot: Front ...... ~D" ................. Rear .................................... Depth ................................ Date of Purchase ..... '~..~. ................. ; ............................ Name of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No .............. .~_ Name of Contractor ........................................ ; ......... ;;Address ........ ~ .......................... ~:...,.. Phone No....'~ PLOT DIAGRAM Locate clearly and distinctly all buildings, 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 con~, r lot. o 10. I1. 12. 13. STATE OF NEW YORK, ~ S S COUNTY OF ...... $~Efo].]~ ........J' ' .................... ~.~;Q~...Q~I,~I~ ........................................ ,...being duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the ............... .¢:O~'.~,~.~ ................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that' the work will be performed in the manner set forth in the application filed therewith. Swam to before me this Notary Public, . ~LIZABETH ANN NEVIL~ NOTARY PUBLIC, St~te;~/ New York /90. 52-8125850 ,~li!fftgk: County 19 2'1 )~ '--'- ' County O~ SU~o'lk (Signature of applicant) THE NEW YORK BOARD OF FIRE UNDERWRITERS CS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK. NEW YORK 10038 ,,.,e20, N 128682 THIS CE~IFIE~ THAT o~y t~ el~t~ ~ui~me~ ~ ~sc~ ~ ~ int~uc~v t~ ~ol~ant ~ on t~ ~ ap~icat~ numar in t~ p~m~es of ~osepn ~,encen, s/s Jackson ~t. ~0' e/o Kimlginor Point Rd., New Suffolk, L.I. ~. ,h. yo~o~.~ ~o~.,~o.; ~ ~,~e.~ ~ ~,~ F~. ~ 2.a r~. garage, outsid~t~o. ~ ~ November 15, lq73 ~ exami~d on ' ' and found to be in complia~e ~ith the requirements of thh B~rd. FIXTURE LECEPTACLESI SWITCHE I FIXTURES I OUT,,TS r" I s I,.cA.o-c,.,i-uo-,¢~., i~=~1 DRYERS FURNACE MOTORS FUTURE AF~UANCE FEEDERS RANGES iPECIAL REC'PT ICOOK~NG DECKS l OVENS I DISH WASHERS AMT, K.W. I AMT. K.W, ~4T, K.W. TIMECLOCK$ BELL IUNITHEATERSUNITHEATER$ MULTI-OUTLET SERVICE DISCONNECT I NO. OF METER EXHAUST FANS AMT. H.P. DIMMERS A,~AT. WATTS S R V I C E NO. OF CC. COND. A.W.G. ;~,O. OF HI-LEG A,W.G. qO. OFNEUTRALS A,W,G. P~R ,~ OF CC, COND. OF HI*LEG OF NEUTRAL ¥t.B. Hul and Matt it uck, L.I. Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.