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Home My WebLink About5544-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. 5.C190 ..... Date ............ Al~ril.... ]9..., 1973. THIS CERTIFIES that the building located at .~a~;. ~I'SD, .La..(.PW2. ~ ). Street Map No.. XX ........ Block No..3:X ....... Lot No...X~...l~eOla:l.¢....N,Y ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 0¢.t.. · 1+..., 19. ?.]. pursuant to which Building Permit No..~b~. dated ........... 0~J; .... .bt..., 197].., 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 P.r.~v. a~;.~..o..~.o..f.a .m;i.~.y..~..w.~.],]...~.llg ........................................ The certificate is issued to . Ns].son. Ax:~r~ ....... 0~-ner ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... Iq.,8,... ......................... UNDERWRITERS CERTIFICATE No....penal.ag ...................................... ttOUSE NUMBER .... 9'~0 ...... Street... S,~'l't. blO,~.~h. ~"& .............................. Building Inspector [ FORM NO. 2 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? Z Permission is hereby granted to: ............ ltWZW~tg/"~.3:~it ....................................... ................ ga.~..~ta~sb../,a ................................ ............ l~a,ee, aJ.e .............. I~.Z.. ........................... to 11~tle.o.a.t,a.. earta~d~t~..~t~tel~*.~_-~ e,..oa., sma~..let~.&..~..~..~~ .............. at premises located at ........... JJ~..~ti~,..~j~,-~,j~../iatjZ[tll .................................................................... ........................................................... l'acanta.... ~.~. ...................................................................... pursuan~ to opplicotion doted ......................... ~lO.~***..ba .................... , 19....~ ond opproved by the Building Inspector, Fee $.-.~00 ............ FOB][ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. ¥. ,, ,, Approved ........................................ , 19 ........ Pemit No ................................... Disapproved a/c ................ ~t~u,o~ng Inspector) / APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ..................................., 19 ...... 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 Js 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 tolthe 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 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 all applicable laws, ordinances, building code, housing code, and regulations. (Signature~r,~ ~ /L,'~°f 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 ...~.../..~.~.~...~.?.../..W. ....... .Z/.~.~../...~.~../~.. ................................................................................................. If applicant is a corporate, signature of duly authorized officer. L~ ............ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~(Name and title of corporate officer) 1. Location of land on which proposp~cl work will be done. Mop No Lot Nb Number/~/ ,~ S~ ~ c,,-,,-'~ ~-~ ..~.. ......... ~; ........... Street and .......... ~.~. ....................................................................................................................... Municipality 2. State existing use and occupancy of premises end intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~.~;~' .~r~......~/.... ........................................................................................ b. Intended use ond occupanc~ ........................... 7'-'-- ......................................................................... 3. Nature of work (check which applicable): New Building .................. Addition~/ Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe)~s,~..~.~.~6 4. Estimated Cost ~ ~ 4 ~ ............ Fee (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 7. Dimensions of existing structures, if any: Front ...... ?.. .................... Rear ...~..~. ....................... use Dep~/.~...o~1~.. Height ./..~.. ................. Number of Star es ~ ........................... D menson[s_of same structure with alterations or additions' Front ~..~..~..~'~.. Rear ~, Depth /~.:~...~,~(-.~.~,~J-teight ../...~. ..................... Number of Stories .~ ...................... 8. D~mens~o s of ent re new construct,on: Front~.. ............................ Rear .~ ................ Dep~th~-~ ......... - ...-. Height ............. Number of Stories ..~ ......................................................... '~.~..~.~.~~' 9. Size o Io: F at ............................ Rear .................................... Depth ............. ~../_..~.~,.~-) ~ .n_ , , 10. Date of Purchase .....'~./~..~.l.~.~. ................................ Name of Former Owner .'.~:.~ ..... 11. Zone or use district in which premises are situated ..... ...~....~..~ ........................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? '"~"~t ......... : .................... , ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....... ..~...~w .......................... Address ............................................ Phone No ..................... 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 I~terior or corner lot. ! [ ~ . ~ ,,~, ~ ~ ~o .~ / . / / _ ,.. ...... . (Nome~ indivf~ua] sig~ing a~lication) above named. He is t~e ...................................... ~ ......................................................................................... (Contractor, agar, co,orate officer, ~tc.) of sai~ owner or owners, and is duly authorized to perform at hove performed t~e said work and to ~ke ~d fil~ t~is application; that all statements contained in this application a~ true to the best of his knowledg~ and b~li~f; and that ~h~ work will b~ p~rfotmed in th~ monner set foRh in th~ applicati~ filed therewith. Swam to b~fo~ m~ t~is ................... .......... ................... ~/,. ~ ,/' ..j..~. . . ............ ~ ...... x.x.:.=....~ ......... x ....... ~..m.....~ ....... ~ ........... No~. Publ~,~-?:yZ,~,,~.~ ....... Coun~/~ (Signature of applicant) ~,~1~8~. Suffolk ~x~lres March 30 19~