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Home My WebLink About5564-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. g.~.932 ...... Date ............. Dee ..... ~. ....., 19.7.2. THIS CERTIFIES that the building located at . $/6 .l':ew..Su££~k. Age .... Street Map No..~ ......... Block No.. ~ ...... Lot No.~...~a~.2tuek..~,Y.~ ......... conforms substantially to the Application Eot Building Permit heretoEore filed in this office dated .......... 0~.. ~.~ ..., 19 7.$. pursuit to which B~lding Pe~it No. ~g · · dated ........... ~et...~.~. ·., 19.7~., was ~sued, ~d conEorms to all oE the r~uire- ments oE the applicable provisions oE the law. The occupancy ~or which this certificate is issued is Prigate. s~ir:=~tng, ponl. &. ace.as sor.~, b~ ] di~ .&. da~. cae ........ The certificate is ~sued to H. ns ,. J~me s. [~, · ~l~is ..... Y~e~ ..................... (owner, lessee or tenant) of the afores~d building. Suffolk County Dep~tment of He~th Approv~ ...I;, R, ............................. UNDERWRITERS CERTIFICATE No .... ~,~, ......................................... HOUSE NUMBER..~790 ...... Street .....Eew..Suffo~. A~e .......................... / .... B~i~ding Inspector ~ TCYW'N OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 556~1 Z Permission is hereby granted to: ........................ t~a~t~l~ ................................. at premises located at .........~'s~...-~..~,J~O~-.&tft~i. .................................................................. ......................................................... · ,~,.$t~k ....... ~,~.,, ................................................................ pursuant to application dated .................................... ~i['"'"~ ....... , 19...~.~., and approved by the Building Inspector. BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ..... Permit No ......................... Disapproved a/c ........................................................ ~ (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 publ c streets or areas, and giving a detailed description of layout of property 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 permit shall be kept on the premises available for inspection throughout the progreSs of the work. e. No building sh~ll 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 of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. .................. ................... , · 1. Location of land on which proposed work will be done. Map No.: ....................... . ,/... ........... Lot No.: ........................ Street and Number ......... .~..~.I,TI~.....~...~..~.J~.Im.~...Z..~..~...., ............... .~....[JJ~..L!..~.~..~ ................ Municipality -- '"' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ ...~l J~j I~ ... ~'-'~l~J.t .~..~... [.~'~.l .J~l~ ...................................... " " b. Intended use ond occuponcy ............................................ :.] ................................. 3. Nature of work (check which applicable): New Building ..~1~ ......... Addition .................. Alteration .................. Repair .................. Removal ................... Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............. ..~..l.l~.-...:..~.~,.i.,.:.: ........... Fee .......................................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ........... [........L..:....Number of dwelling units on each floor ............................ If garage, number of cars ....................................................... ~ ................................................ fIf business, commercial or mixed occupancy, specify nature and extent of each type of use ............... i ............ Dimensions of existing structures, if any: Front .....~i~.. ....... ....... Rear ...... ~ ............... Depth ~ ......... Height ..... ~.... Number of Stories ............ ~ ................. i ......................................... ; ........................ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ N~ umber of Stories ................ 't' .............. t 8. Dimensions of entire new construction: Front ....,~o ........................ Rear ....~.,~ ................ Depth ...~....~,. .............. Height .....I.~i.] ....... Number of Stories ............... ~. ........................................................................................... Size of lot: Front ....~,~l~.~.!...?. ....... Rear ....... ..~.~......4.: .......... Depth .).!g,..ll~Ll~ ........... Date of Purchase ................ LQL~..! ............................. Name of Former Owner .........................~llllllll~..: ............ Zone or use d~stnct m which premises are s~tuated .......................................................................................... ~...,....~ Does proposed construction violate any zoning law, ordinance or regulation.> ....... N..~ .................................... ~...~ Name of Owner of premisesL~l~l~,.~.,.l~/~l~,l~f.{...Address .ltl/~.'~..I.'t%l.¢il~ ................ Phone No...~ .......~!!~.....~ Name of Architect ~..¢~l~,~..~.(?,~.%b.!.~ .......... Address .....~..~.~ ........................... Phone No.~4~.~.'..~."i..~.. Name of Contractor ~.~^.~.,..~'~..~...~..~.(~.~-~/.{,.Address~.C~...~.~l.l~,~.l.~..~..&~.. Phone No.~.~.¢~..'..~.~.l.~l PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from or description according to deed, and show street names and indicate 10. 11. 12. 13. property lines: Give street and block number ~ether interior or corner lot. STATE OF NE~_ YOBK, COUN** ........ . - - ........... ~.~....~.,..:~.~...~.~., ..................... being duiy sworn, d~oses and says that he is the applicant (Name of individual signing application) 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 ~ke and file this application; that all statements contained in this application are t~e to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me thi~ ~ ELIZ~B~H A~ NEVILLE ~ ~ ' NOTARY PUBLIO. Stite of New York No. 52-8125~. Suffolk Co~ 140/ O~E~5'T' op' ~L~P~ , r