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Home My WebLink About5581-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.~.662. ..... Date ..... .,]'.~xte .13 ., 1972 THIS CERTIFIES that the building located at . $f3 blain l~oad Street Map No. X~ . Block No. ~ ..... Lot No. ~ . . ~atli%llek It,Y. conforms substantially to the Application for Building Permit heretofore filed in this offme dated OUt; 21 , 19 71 pursuant to which Building Permit No. dated .. OCt; ...21 . , 19 ~1., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is 14.~xecl. oect~pa~ey dwell~g .& stere' (garcle~ 'ten%er) .... The certificate is issued to ~rl~..;[a~llxlllam. d .& W. ife ... O~:ner8 .... (owner, lessee or tenant) of the aforesaid building. I{~,TF,~ shxb~ec~ %0 ¢ompie%io~: of ln~erlor Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No C.e.~... rena.$ ng ttOUSE NUMBt~R ~1~00 ' Street 14aLtt RO8.¢1 Building ln,,pcctor TOWN .OF, SOUTHOLD BUILDING DEPARTMENT TOWN CLEF. K'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT t CYHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ ,~ ...... N? 5581 Z Permission is hereby granted to: to at premises located at ...... JJdl~J..JJil~.JJ~ ..................................................................................... .............................................................. ~.t..~kt .....~,.~.,. ........................................................... pursucm~' to application dated ................................. Jli~....JJj .......... , 19...~., and approved by the Building Inspector. 9544 u~ FOU'M' NO, I * BUILDING DE~RTMENT ~ TOWN CLERK S OFF:~~/. .... ~ ..................... , ,~.~Z ~ ,,o ~o ................................. ........................................ , Disapproved a/c -~ 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 public stree.ts, or areas, and giving a detailed description of layout ofprpperty must be drawn on the diagram which is part of this applic~'lon. 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 wi!l issue a Buil.cli.ng Pe ,r?it to the applicant. Such permit shal! be kept on the premises available for inspection throughout the progress at 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. APPLICATION IS HEREBY MADE to the Building Deportment 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, t~, ~%] /~ss of applicant) State whether applicant is~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... /~/~(.~/'~.~/......M.~..:....(~-..../~/'-~./,~**~**..** .~........~.~*.(~//....C'.....~I**..../~..~ ..... if applicant is a corporate, signature of duly authorized officer. .................. ......... ~. Loca,on of ~aod on which prppo~ wark w'~ b,~don~. ~ap.~o.: .., ....... ~ .......... ~Es......~'C~'~ No..., ........ 2 ....... Str. t and N,,~ber .......... .~..~..~. ....... ~.~..~..~......~...!E!.~.../....~...~.,~...~.~.~L?...~..~ ............. ~ -- / ~'~J 0 0 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of l~OPased ¢o~structio~: o. ,s,t,ng use and cupo y ......... .......... .......................................................... b. ~ntended use and occ~n~y ...... ~.~...~.~. ............. .~.......~.~ .......... ~ ................. ~. ............... 3. Nature of work (check whi~ New 'Building .................. Addition ....~.. ........... Alteration .................. 'i Repair ......... ~, ...... Rem:,~ ~'~'C~ Demolition .................. Other Work (~scribe) ....... , ................................ 4. ~timated C~t ~.Oj.~--..~. ~ ............. "..,...Fee .......................................................................................... (to be paid on filing this application) 5.If dwelling, number of dwelling units ..J....~.~~er of dwelling units on each flor ...... ~. ................... If garage, number of ~rs ............ ] ............................................................................................................................... 6. If busine~, comme~Jal or mix~ ~cupancy, specJ~ nature and e~ent of, each ~ of u, "'~~'7 7. Di~sio~ of existing structure, if any: Front ....~O.~. .............. R~r ...~ ...................... Depth Height ..~O.~. ............Nu~r of Stori~ ....~...~...~.~L~.....~..~.~ ......................................... Dimensions of ~ structure with alterations or additions: Front ..~ .......................... Rear ....~. .............. ~pth ....~.'~ ................... Height ....~.~ ........ Number of Stories ....~ ........... 8. Dimensio~ of entire n~ construction: Front ........ ~O..~ ................. R~r ~.,..~.1...... D~th .~.~ ............. Height .................... Nu~er of S~ries .......... ~ ................................................ y ............................. : .......................... 9. Size of lot: Fret '-'-]~"c'"', ..... Rear .......... [.~ ...............~pth ..~.~..~ ...... L.~O ~ · _. ~ 10. Date of Pu~hase ...... 1.~..[~.~1. ............................ Nome~f Fo~er ~ner ...~.~....~/.~,[.~O.~ i 1. Zone or use district in which premiss are situated ............ ;~ ...................................................................... ~ ......... 12. ~s pr~o~d construction vioJote any zoning law, ordinance or regulation.;) ...... ~.~.....~ .................................... Name of ~ner of remises~ ~, ~UI~~,~ .~ .[~ ,. ~ ~ 13. P · ~' .............. ~'x~'"'~ m~'~""~- ~,~ne mo. ~..s...~; ..... Name of Archit~O~.~..~...~tV~.A~ress~L~,..~...~a~..~ P~ne meme O~ ~rector .................................... ;..' ............. Address .................................. ~.. ....... P~ne No ..................... PLOT DIAG~ ~ete cl~rly end distinctly ell buildings, whether existing or pr~osed, e~ indicate ell ~t~k dimensions ~rom prope~ lines. Give street and bl~E number or de~ription ecco~ing to de~, ~nd sh~ strut nem~ end indicate wh~er interior or com~ I~. STATE OF NE'Vt~(~I~,J ! ¢ c COUNTY OF ~. ........... ~ ~"~, t ........ 7~/~.~..~,~'.....?.~.J........~..L~J,J.[~.~.~. ....................... being duly sworn, deposes and says that he is the applicant '(N~Jme at 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 make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thav the workwill be performed in the manner set forth in the application filed therewith. Swam to before me this ~-~ . ELIZABETH ANN NEVILLE ~/ NOTARY PUBLIC, State of New York N0. 52-8125850, Suffolk CouZ[l~ Te~n Expires March 30,19~.~/ ~ ARCHITECT PLAN SCALE: Vt;' "I"0 DATE ARCHITECT 0 o T¸ PLAN NO: iA- 45'Y~ = - DRiWWIM 9CALE: I/4"' L I"' ~) DATE ,;I ARCHITECT "~48 F.'V~ ~T. R O 0 F o ~ L /v ARCHITECT c T 0 ~ - ( c,,.,., r-) % I.. C iT '1 '0 :k.~ ,-- PLAN SCaLe: ' ,¸% c ARCHITECT 4t7 WE~I MAIN ~TREET ._4 t s T-' } PLAN NO, ~- 4C~'~c~ _ '7 OF ~ SCALE: J"0" DATE ~- -.L. LLCT~ICAL 7 0