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Home My WebLink About5565-zFOI~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No.. Z.~.~83 .... Date ...... 0C.t.o.b.~r. 1.8., ...... , 19.73. THIS CERTIFIES that the building located at . $.tia,$~at.e.r...Ave.: ...... Street Map No... Z2J, O .. Block No. XX ....... Lot No.. ~2..&. 79.. ..Cut. ehpgu.e .... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .;4arch. 2.9 ~ .. , 19 .71. pursuant to which Building Permit No. ~.6.~Z... da~'e)~ .... ,~iaz'~h .30~ ..., 19. 71, 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 .. l~.riv~te .o~le famiJ~y, ch.~elZi&g .......................... The certificate is issued to ~h~ma:;. 3lx,.aria ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~. zt ~ .... UNDERWRITERS CERTIFICATE No...PrJNoi. NG ............................... HOUSE NUMBER · ~670' - Street ..... St;it.lwater ..~v~, ............... ............................................... G~hogu~ ................... .......... .. Building Inspector 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) 5565 Z Permission is hereby granted to: to ..... ,~:.~..~~..~..e~~..~~ ........................... : ............................ at premises l~ated at ........ ~..~..~..~.....~..~ ............................................................. ................................................... ~.~]:~Y~_T...~. ......... ~~ ............................................ .................................................................. ;.~. .......... .~ ............................................................................. pursuan,t to appJic~ion d~ed~ ~ 19....~ and approv~ by the Building Inspector. ~ ~~ ~ ~ ~ ~~ Building Inspector _ ...... ./ .-_.. INSTRUCTIONS ~ '~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building: Inspector. b. Plot plan showing location of lot and of bu.ildings on premises, relationship to adjoining pmmleal or I~bll¢ streets or areas, and giving a detailed description of layout of property must be drawn an the diagram which Il part M ~hle application. c. The work covered by this application may not be commenced before iguonce of Building Permit. d. Upon approval of this application, the Building Inspector will Islue a Building Permit to the applicant. Such permit~-~ shall be kept on the premises available for inspection throughout the pragre~ of the work. e. No building shall be occupied or used in whole or in port for any purpa~e whatever until a Certificate of Ooc~panc~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuont to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y. ork, and other applicable I.awl, Ondlnance~ or Regulations, for the construction of buildings, additions or alterations, or for remov01 or demolition, al herein ~m~rlbed. The applicant agrees to comply with all applicable laws, ordinances, building cede, housing code, and regulatlonl. c ,.,- (Signature cf applicant, or name, If a ca~paratlon) (Address of applicant) ~' -- - State whether aaplicant is owner, le~see, agent, architect, engineer, generc~ contr~tor, electrician, plumber or bullder~ (Name and title 'of corporate officer) I. Location of land on which propased work will be done. Map No.: ../.~..~. .......................... Lot No.: '~.~..~..~. ....... Munlc~allty 2. State existing use and occupancy of premises and Intended use and occupancy of prapaeed comtru~tlon: b. Intended use and occupan? . ......................................... ..~. ................ ~.....~. ....................................................... 3. Nature of walk (check whi, )licable): New Building .................. ion ...... .~... ....... Alteration ............. Repair .................. Removal .................. Demolition .......... ,.~... Other Work (Describe) .................................... 4. Estimated Cost ........t ....................................... ............ Fee .......................................................................................... (to be paid on fi~ing this application) 5~ If dwelling, number of dwelling units .......... J ................ 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 ...=,I,.~.~ ................. Rear ~T[.ZJ..., ...................... Depth ....~ .......... Height ........................ Number of Stories .......... /. ................................................................................................ Dimensions of same structure with alterations or additions: Front ...4~.'~. ..........................Rear .e~.'~. ..................... Depth ..~/.~..'. ..................... Height ............................ Number of Stories ..... ~/ .......................... 8. Dimensions of entire new construction: Front ..4~.~.~ ......................... ' Rear ..c~ .................... Depth ..~,~. ............... Height .................... Number of Stories ...... :./. ....................................... .~. .......... .......... , ....................................... · 9. S,ze of lot: Front ..vZ~.~c~.......~ Rear :.,.~'~.,.~. ................... Depth .~.~,~t~......~,...6~o~> 10. Date of Purchase/~-.~...~.~...~1~'...~,~/. .............. No,~e ~f ~F~orm~r Owner ~/,~..~l~v~ .......................... 11. Zone or use district in which premises are situated .......... ~')......~ ....................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation;~. .../~...~.~,~ ................................................. 13. Name of Owner of premises .7~x~,~,~...,,~'J/3~_.e~.~..Address~,~/~.To...~'E~/~,~c...y/.r~,,. Phons No.~...',,~'~.~.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor .................................................... 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 interior or corner lot. STATE.OF NEW ~ORK, y / ! ee ............ ~:'~t..~'.~.t~.~.~-~........,6..~.~; .............. being duly sworn, deposes and says that he is the applicant (Nome of indK'idual 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 make and f e' 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 ~ner set forth in the application f ed therew th. Swam to before me this ......... o, ...... .... . Notar' Pub c . . ................ ~ ......................... y , ..._.-.--.....:~~.~... ~-ounh/ (Signoture of applicont)