The URL can be used to link to this page

Home My WebLink About5550-zFOR~ NO. ~ TOWN OF SOUTHOLD BUILDIN(~ DEPARTMENT Town Clerk's Office $outbold, N. Y. Certificnte Of Occupnncy No. Z.~. ~. ~. ...... Date ........ O~.~p.b. er. ~2.~ ....... , 19 2.3. THIS CERTIFIES that the building located at . .~.~'..V.~.q .w...RQ..~.~ ............ Street Map No... ~ ...... Block No.....X~.. .... Lot No...X~......Sq..u.~..o.~.~ ................. ~-'~onfonns substantially to the Application for Building Permit heretofore filed in this office ,~--~--"-~ted ....... 0.c.t.:. ~.! ....... , 19. ?.1. pursuant to which Building Permit No... ~;~.0. g. dated ....... .0.?t.:. ~.~ ........ , 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 ...i~..~.v. ~.t.q..o.n.e..f...anAi..1.y .d.w.e.],..1.i.n~ ..................................... The certificate is issued to . ...W.:t..1.1..l..a~..V..a~....M.~..t.e.~. ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval NR UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER 107~ Street 14a:~n Bayv:Lew Road Southold r ........ ........ /" 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) 5550 Z Permission is hereby granted to: ....... · G,..¢oe~..~,/1~....*~*..gem~%®l' ......... ................. ~..~,..~1 ...................................... ...................... ~.tM,~m~. ................................... ~ d ~ ~cl~ ~ ~ ~I~,I~,.U~g ...... to ........... ..'~..~. ....... ~ ........ - .~..~ ~.~. · ~...~. l~ · ..~.~ ~....~ ~~1~ .......................................... at premises located at .......... ~G.~..~.....[ ................ .~ ~..~...&..~.t~e..~ll~tlll~..~R~'..~,... pursuant to application dated ................................ 0.g.~. ......... .~. ......... , 19.~..]..., and approved by the Building Inspector. Fee $.~.~...~. ............. Building Inspector / l~O~,~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined .... ~....~... ............... Approved ~ 19...~...(. Pemit No...~..~...~..~-~ Application No ...... ~.~..,~....C~.. .......... APPLICATION FOR BUILDING FERMIT INSTRUCTIONS State whether applicant is owner, lessee, agent, archit Nome of owner of premises ....... (Signature of apl~i~ant, or name, if a corporation) (Address of applicant) engineer, generol contractor, electricion, plumber or builder. If applicant is a corporate, signature of duly authorized officer. ~ .................. ......... ' - 1. Location of land on which proposers,work will be~dg~e. M. ap N.o~: .;~.~ot No ..................... '"'~1 Street and Number .~,~¢...~.~..~-~¢~.......~.~....~.~-/~.': ................................... : .................................... ~' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy.....~?~ ........ ~....-~cr2~ ..................................................... i ................ b. I nte nded use and o cc upancy . .. ~.....~-~-~"~--~. ~x?.~....~...-~.... ~,~.....~,~...~'1,~ ............. 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 drown 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 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. 3. Nature of work (check which applicable): New Building .................. Addition .~-~........... Alterotion .................. Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost~..,~.~....~-,..'~. ................................... Fee .......................................................................................... (to be paid on filing this application) 5. if dwelling, number of dwel|ing 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 use ............................ 7. Dimensions of existing structures, if any: Front ..... ~..~. ................. Rear ,~..~ ........................ Depth ...~...~.. ......... Height Number of Stories ...~ ............................................................................................. Dimensions of same structure with alterations or additions: Front ...~...J~.. ....................... Rear ...-~..~-. ................. Depth ..~.~.. ....................... Height .....~.. .................... Number o/f Stories ...,~:~-. ............... 8. Dimensions of entire new construction: Front ....~i~.. ........ ~.. ........... Rear ~ ...... ~ ........ Depth ..~../...~.....~ 9. Size of lot: Front ...-/.~..~... .......... Rear ..../.~..?.~.. ................... Depth ..../....u.....~..... .............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning.~ ...:~J __ ,~ r~";-;'"'~"~'^'law' ordinance or regulation.;> ........................................................... 13. Name of Owner of premises .~.,~......~J~.~Address~.~/~..~..~..~hone No. Name of Architect ...................................................... Address-.-.--.-..~. ~-_.-._.... P_~J~Lm ~P o ..................... Name of Contractor .~.~.~..-~.......~...<~.. .......... Address ~M-~...~...-~L~...~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-Jecljcate whether interior or comer lot. STATE OF NEV~OJ~,/~ COUNTY OF ..~~.....~'~ above named. He is the .......................... ~/'/~---~-"~--~- ............................................................................................... (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 contoined 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 opplJcation, filed therewith. Swom to bef~. e this ~ ,, ,~..... ~ .................... ~ day of ........ .~.....~...~ ....................... , 19..-'~..~./....,~.~ . .............. ............... Notary Public, . ........................................................... County (Signature of applicant)/