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Home My WebLink About5575-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy N'o.~¢.~,0 ... Date . D~ 2% .. , 19 72 THIS CERTIFIES that the building located at N&vy. S~; ........ Street Map No..~ ..... Block No.:~ . .. Lot No. ~ 01'ierli;.. N,¥, conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... 0el; 19., 19 .Ti. pursuant to which Building Permit No. ~?~Z dated ...... Oct; ]9 '', 19 ~ , 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~2t~/ate olle family' dwell~ .......................... The certificate is issued to C_h_ristian .Probsi;. · O~ner ............... of the aforesaid building. Suffolk County Department of Health Approval ~use ~ t060 (owner, lessee or tenant) ..... Building Inspecto( TOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y, BUILDING PERJV~IT ('i'1-11S PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5575 Z Date ~11~ t9 19 ~ Permission is hereby granted to: .... ............. ............. '........or...L..~.~ ............................................... to at premises located at 9~ J~ ~ · pursuant to application dated .............................. ..~...~.....??. ............. , 19;.?.!., and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLO, N. Y. 19..T!.L. Approved ........................... ~..~. .......... , 19 ........ Pemit No .~'~ ~PPLICATION FOR BUILDING PERMIT Date ............ ~..~.. .......... ./...~. ........ , 1 ~)Z.f. .... INSTRUCTIONS a This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin Inspector. b. Plot plan showing Iocahon of lot and of buddings on premises, relationship to adjo~mng premises or public streets, areas, and giving a detailed description of layout of property must be drawn on the diagram which ~s part of th~s applicat~or c. The work covered by this application may not be commenced before issuance of Building Pertain d. Upon approval of this apphcat~on, the Budding Inspector wdl ~ssue a Budding Permit to the applicant Such perm shall be kept on the premises avadable for inspection throughout the progress of the work. e No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupam 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 tk Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of braidings, additions or alterations, or for removal or demohtion, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (S'g~/ture aT applicant, or name, ff a corporation) .................. .................................. (Address of djSplicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budde If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ..................... ~ ....... Lot No ......... Street and Number :~....~.....~.....-~...~.....~..,. ~2~ ..~...~..,~-~ .... / ~ ~ ~) ..... ~r~ ................................................................................ Municipality ~' ....................... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Ex~s~ting use and occupancy b Intended use and occupancy 3. Nature of work (check which applicable). New Bu,ldmg .................. Add,t~on ................. Alterat,on ............... Repair .............. .../, Removal .................. Demolition ................. Other Work (Describe) .................................... 4. Estimated Cost .~.~...~..~../..~.../.:....O..~ ........................ Fee ........................................................................................ (to be pa~d on fihng this apphcat,on) .5. If dwelling, number of dwelhng un,ts ........................ Number of dweihng un,ts on each floor ....................... If garage, number of cars ........................................................................................................................................... 6. If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use .......................... / f 7. D,mensions of ex,sting structures, if any: Front ....... .~...~..~ ............ Rear ....~... ......................... Depth ....~f...?...( ....... / Height ......~....~.../. ......... Number of Stones ....... /...~ ............................................................................................. Dimens,ons of same structure with olterat,ons or add,t,ons: Front ........ ?../...( .................... Rear ..?../...~ ............. Depth ....... .~.../../. ................ Height ............................ r, lumDer of Stories ......... ~ ............... 8. Dimensions of entire new construction. Front .... ./...?.../. ...................... Rear / ~/ Depth / z-/ ' Height / ~ ' Number of Stories J 9. Size of lot: Front ...... ./.../..~...[ ........... Rear ..... ./.../.~.~ ................... Depth ..... ./....~..~....[..~...../..~....0.' 10. Date of Purchase ....................................................... Name of Former Owner .../..F..~..../....~ ......... 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 ...~-~.~.:....~..~ ........... Address ...... ~.~ .................. Phone No .................. Name of Architect ........... ............... .--.....~...~-- ......... Address ........................................... Phone No ................... Name of Contractor ...... ~....~..~"~ ~/'~'~'-- .......... Address ~"~~ Phone No.~..~.~.~.?...~/~../. PLOT DIAGRAM Locate clearJy and d,stinctly all buddings, whether ex~stJng or proposed, and indicate ail set-b~ck d~mens~ons fro~ property hnes. Give street and block number or description according to deed, and show street names and Jnd~cat whether interior or comer lot. /7' I, //4' /r^ vI STATE OF NEW' '~ORK. ~ ,=. ~. COUNTY OF ...,-.~.~,~....~..¢..~....'.'.'.'.'.'.'.'./~......f ..................... Z..~..~..~.......~...~ .z~../J~.....zz....~.....~... ..................... being duly sworn, deposes and says that he ,s the opphcar (Name of ind~wdual s~gning appkcot~on) above named. He ~s the ..~.~..Z~.~..~.~.~. ........................................................................................................ (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 fll this application; that all statements contained m th~s apphcat~on are true to the best of his knowledge and behef, an tk, ot the work wdl be performed ~n the manner set fo~h m the application filed therewith Sworn to before me this ...... .......... ................. . .............. ................... o, ..... :: .... T .......................... Nota~ Public, __/~vl ~RY fi. KLOS ~0~Ry p I~L~. oTt r.- 0F ~'U.'~ YORK ~5L- ~t6~)2~ ?JrfCik O"