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Home My WebLink About5572-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.~.~82 ...... Date ....... 0c.tnber. 18 ~ ........ , 19.73. THIS CERTIFIES that the building located at .Founders..Ps.th. ........... Street Map No. Found~B.. Block No... XX ..... Lot No..br2e.~.3.. S.o.u~;ho. ld. .............. conforms substantially to the Application for Building Permit heretofore filed in this office 2......... 0e~, .1~, .... , 19..7.1 pursuant to which Building Permit No. ~.~2~.. .0c.~, .18.~ ..... , 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 . .P. rlvate, one. family..dvel.llng ...................................... The certificate is issued to .. Alec..Elak .......................................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) ..... I,I.,.R o .......................... UNDERWRITERS CERTIFICATE No, . .Pl~l)ll~G .................................. HOUSE NUMBER .. ~,170 ....... Street ... Fmmde~.s. P~;h ....................... ......................................................... 3o.uthol,~[ ............. Building Inspect(Ir FO~m 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? 5572 Z Permission is hereby granted to: ...~w,....t~,ll~,~ ..... ~ .~..........~..e...e....~,~...~. ...... Building Inspector ~'o at premises located at ..... ~.,~1;~1...~2..~z~ ..... ~.e~'~_.'~c[~.~...~tl~.ttL~t~. ................................................ · W .~.. Founders Path 8outho~l pursuant to application dated ....................... .0.¢..~ ..... .~ .................... , 19,.~..1.., and approved by the Building Inspector. TOWN CLERKSOFFIC! / -- :_ ' ,; / ~ · S~TH~D, H.Y. ~/~'~ ~ Approved ........................................ , ]$ ........ Permit No ............................. Di~pprovecl a/c ...................................... .~.....~,,,.,,--';'~ '- Application No ............................. APPLICATION FOR BUILDING PERMIT ~ ~ ~t, ...... ..C)...~...?. ............ !..~. ................... , ,9~f ....... 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 buildings on premises, relationship to adjoining premlees or public streets 6r areas, and giving a detailed description of layout of property must be drawn on the diagram wMch Is part of thle application. ~ c. The work covered by this application may not be commenced before issu,~nce of Building Permit. ,~/v d. Upon approval of this application, the Building Inspector will Issue a Building Permit to the applicant. Such permit'a- 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICAT ON S HEREBY MADE to the Building Department for the issuance of .a Building P. er,mlt pumu?.nt to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~,nd other oppllcoom ~.OWl, Ordinances or Regu at OhS for the construct on of buildings additions or alterations or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, build ng code, hous ng code, and regular ~ ~' % ~ ........ ('"iS ~r~;h~'~'~"¥'~l~'l~'l'i~'~;~:~i'~:'~'~'r~'~','i'~'~"~'~'~'~[~'~ ........ . ~ 'f/a~.....£ 9. .................................. (Address of oppllcont) State whether applicant is owner, lessee, agent, chitect, inglneer, general contractor, electrician, plumber or builder. ~ ~ ~ ~.~ ........................................................ ,. Name or owner aT premises ....$..:.1 ........ 1....i.:.,~.,.~ .......... ,~.t.,;..~. .............................................................................. .~ If applicant is a corporate, signature of duly authorized officer (Name and title 'of corporate officer) I. Location of land on which proposed work will be done. ~ap No.: : .......... Lot No.; ........................ Street and Number ....... .,.~.,.0..?.~.~..~, ........... .?.,/,.~..,'~.,~ ................................................................................. Municipality , 2. State existing use and occupancy of premises a?d intended u, se and occupancy of proposed construction: r o. E~i,t,nguseon~oc~upancy ........ /...~.;../~ ......... d~..~.LL:.~.~. ......................... ~,,, ............................ . . ,, ~//~/,~/~_~.._ ~ b. Intenaea use eno occu~ on;- ....................................................... / ......................... ,~,.....; ............ ..~ ......... ~ Nature of walk (check which applicable): New Building ................. Addition ................. Alteration .~...:~ ..... Repair .................. R.~mova, .................. Demolition ............ Other Work (Describe) .................................. 4. Est mated Cost .... ~'J.~ ...~.....~..~.:.~ .(~... .................... Fee .......... '~"..~........C~...r, .............................................................. (to be paid on fi'.ing this application) 5. If dwelling, number of dwelling units ........ L ................. 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 ....~.~L ..................... Depth ...~-. ~ ! ...... Height ...... J.~....I. ........ Number of Stories ...... ~.. ............................................................................... Dimensions of same structure with alterations or additions: Front ..... ..'~....~...~.....[ ............... Rear ~...~.../. Depth ....... ~,..~. ................. Hmght ...... Z.~... .............. Number of Stories ......... ~ ................... 8. Dimensions of entire new construction: Front ........ ..~:...?.~ ................... Rear ........"~...~. .............. Depth ...../.~..~. ............ Height ...,~.!,.~..!.~. .....Number of Stories ...... /.. ............................................................................................................ 9. Size of lot: Front ............................ Rear ................................... Depth ................................ 10. Date of Purchase ........................... Name of Former Owner ...................................................... 11. Zone or use district in which premises ore situated ........... ~ ...... ..~...o...~...~.~......~..~,......~ ............ 12. Does proposed construction ~iola~'e~ any zoning law, ordinance or regulation.:) ...... I ............ ./~.....0. 13. Name of Owner of premises ...~/..~..C.(.......~...~..~J.~: ....... Address ~,~.c~....~.4[...~ ............ Phone No..~..~...~'...~..~...0.~y Name of Architect ...................................................... Address ............................................ Phone No Nome of Contractor~..c~/'/4~'..~.....~./]///./.~.~/-- .......... Address .......................... ...~:L~...'~.e~ c~/ 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 iot. STATE OF NE'~/j~K/L/~J JS.S COUNTY OF ,..,h~j~jr, d~-,/..[......~' ', ............... ~.~./~..~/~....~-.:.~.!://~//~..~... ......................... being duly sworn, deposes and says t~t he is the applicant (Name of individual signing application) __ above named He s the .... Cb~.~.~.~¢ .......................... .............................................. (Contractor, agent, co~orate officer, ~tc.) 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 true to the best of his knowledge and belief: and thor the work will be performed in the manner set fo~h in the application filed therewith. Swom tobefore methis~ ~ ....... ......... ................ : ...... . ....................... Noto~/ Public, ~. Count,' ~.0~~.::,, ~~ (Signo~re of applicant) T~m ~pires March 30, A ~< S ~lccT ]] O~' 3 O¥3 IRt ~ ~-C EDWARD E.