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Home My WebLink About5540-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. gS063. .. Date [cml' THIS CERTIFIES that the building located at ~/i.q'lage' bane Map No. lc.~ . Block No. ~ .... Lot No. Ir. Xa:. 01'.ient ].9 73 Street conforms substantially to the Application for Building Permit heretofore filed in this off,ce dated . ~ept; 30 , 19 ?] pursuant to which Building Permit No. 55t+0Z dated .~ep% 30, 19.?]., 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 Aeeeasox~r bud.:l.clLu~ -, IqAs%$oltele .soalet4r ........ The certificate is issued to 07ste~ .Pon4~ ~.i~%e~eal Soe:~e%~,. Ow~e:~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDkRWRITERS CERTIFICATE No . l~. IlOUSI. NUMBLR '1~' Street Village Lane Building h~spcctm FOII,M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRI~MISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5540 Z PermiSSion is hereby granted to: ............ ot premises ~ocot~ ot ........... j,/j.....V~.~eee..,i,j ............................................................................ ......................................................... ~:j.ntJ ......... Il;Z; ..................................................................... pursuarv~ to application dated ................................. JJ4tJl~ ........ .~j~.., 19...V.~, and approved by the Building Inspector. Building InSpector ilk Approved FO]?.~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. D~sapproved a/c ............................................................. ..~..~.. ...... Apphcation No.....~....~.~.Lf...~..! ........... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This apphcation must be completely titled ~n by typewnter or ~n mk and submitted in duphcate to the Build~n Inspector. b. Plot plan showing location of lot and of buddings on premises, relationship to adiommg premises or public streets ~ areas, and g~wng a detaded description of layout ofproperty must be drawn on the d~agram wh,ch ~s part of th~s opphcatior c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Budding Permit. d. Upon approval of thru apphcat~on, the Budding Inspector will ~ssue a Budding Permit to the apphcant 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 ~n whole or m part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding 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 buddings, additions or alterations, or for removal or demolition, as herein describe~ The apphcant agrees to comply with all apphcable laws, oral, nonces, building code, housing code, and regulations. John Tuthill A/C ..... Oy.s.~mp.ands .. Miat~.ic~.l...S~Ci~ty. .................. (5,gnoture of applicant, or name, if a corporation) (Address of apphcont) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu~lde Agent of 0~e~. .... Name of owner of premises ....0.Y..%~.C~..p.O.~l, fk.~i.a~,D~ica],...sc~&~¢y. ..................................................................... If apphcant ~s a corporate, signature of duly authorized officer. ,/ ................ i~'"~";~:t'f~"~f"~'~l~'~¢["~¥f[~¥f ......... 'Z-~ ~ ~ 7, 1. Location of land on which proposed work wdl be done Map No ..... ~ ........................... Lot No ...... ~ ............ Street and Number ........... .~./.~...~J~J,~,§.~...~.~, ............ Or. ie~ .....~..% ......................................................... Mumcspahty 2 State ex~stmg use and occupancy of premises and ~n*.ended use and occupancy of proposed construction: a Exis,t,ng use and occupancy .~.J:.s...~..°...~..~..q~...3r.......b..~.i..l~.~.~§...~...~.~.il~,C.~LO~ .............................................. b Intended use and occupancy ........ ..s..~...m..e....~;~.J:..t..h....~....8,..e..e...e..%~..0.~.~-..~J~,~.'c,.o~'J.~.33_..b~i;1Cr~zz§ ................. 3. Nature of work (check which apphcable) New Building .................. Addition .................. Alterahon ................ existing buildin? Repair .................. Removal .................. Demohtlor .................. Other Work (Describe)"~'~'~'C'['"~' 4. Estimated Cost ........................................................... Fee ...~f~ ............................................................................ (to be paid on f,l,ng this apphcation) 5 If dwelling, number of dwelhng un,ts ............................ Number of dwelhng un,ts on each floor .......................... If garage, number of cars .......................................................................................................................................... 6 If business, commeroal or m,xed occupancy, specify nature and extent of each type of use ........................ 7 Dimensions of exist,ng structures, if any: Front ........1.6 ................ Rear ...1.~. ......................... Depth .1..~. ............... Height ..1.~....+~,,. ......... Number of Stones ....... o=e ................................................................................................. D~mens~ons 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 Stones .............................................................................. 9 Size of lot: Front ~.C)Q..~+ ............... Rear ......... .1..1.0. ................ Depth ...... ..~.0...+.. ............. 10 Date of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zone or use district in whmh premises are situated .......... '.'..~..~.~...~.~.~..~. ...................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulahon) ......... Z~). ........................................... 13 Name of Owner of premises ..0~r.~..t.e.:~. ~..,...~,...[~.~..Address ....Q~J.e~'g .......................... Phone No ................... Name of Architect ..................................................... Address ............................................ Phone No ................... Name of Contractor ...... ..~..:....~.~.~.e...s~.:$. ..................... Address ......[~.~.~i.t~C!¢ ................ Phone No .................... PLOT DIAGRAM Locate clearly and d~shnctly all buddings, whether ex~sting or proposed, and indicate all set-back dimensions fron property lines. G~ve street and block number or description according to d~ and show street names and indicate whether interior or corner lot STATE OF NEVi' YORK. ~ ¢ ¢ COUNTY OF .~.~.¢~'* .............. ~'~'~ .............................. ~o.h~..T~t~b_f_~.~ ..................................... being duly sworn, deposes and says that he is the apphcant (Name of individual s,gnmg opphcat~on) above named. He is the ............ ..~.g.e..~.~....q.~....g.~.~.~ ......................................................................................................... (Contractor, agent, corporate offmer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and ill( this application; that all statements contained Jn th~s application are true to the best of his knowledge and behef; an, that the work will be performed m the manner set forth in the application filed therewith. Sworn to before~..O.., me thiSof --~ 19.~..~~~/,.~^" ~~.~ ................. _day .......... ................ , Notory Public ' : ...... County '~¥~ ............................. ELIZABETtt ANN NE~LLE NOTARY PUBLIC. St~te of New York Nr~ 52-8125850, Suffolk term Expires March 30, lg~