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Home My WebLink About5582-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate Of Occupancy THIS CERTIFIES that the building located at ]~a~r~.~..I~1. & .511~.t~h .1)1,. ~,Street Map No. ~eSe- N~k Block No ........... Lot No. 7~ .&- 78 .... ~o~t~hold.. ll.,l[,.. · conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Oal~. · .21- ·., 19.. ~1 pursuant to which Building Permit No...~8~. dated ......... O~t .... 21 .... , 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~l. vage .~.e .:E&m.:t. ty. ~.W®tl~l~g ...................................... The certificate is issued to . .Mtso .R.. ll~al'n, ei® ....... ~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...Ii,It, ............................ UNDERWRITERS CERTIFICATE No .... ]tI,~e ......................................... HOUSE NUMBER.. ~ ...... Street .....~.&~r~'i~.~..R~N~, ............................. . ~. ~-,~.c,.~ ................. ~.]. · Building Inspector [ I~OIL~ NO. 2 TOWN OF $OUTHOLD BUILDIHG DEPARTMENT TOWN GLERK'$ OFFIGE Sou'r~D, No ¥. BUR. DING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5582 Z Permission is hereby granted to: ....g/m....~5 ........ ~.....~d.5~&~.!.~ ....... Building Inspector. Fees ...... .~ ...~.~.,. Building Inspector '~ '( 19...:[.. Pemit No .................. z Approved ........................................ , ..~.....~....?..~. ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ................................. Disapproved a/c (Buildir~lnspector) APPLICATION FOR BUILDING PERMIT Date ..................... ,J./. ..... INSTRUCTIONS 't ,, a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building,, Inspector. c~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty 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 permiJ~.~ shall be kept on the premises available for inspection throughout the progress of the work. Q e. No building shall 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. 7' 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 ap,plicable laws, ordinances, building code, housing code, and, regulations. ......... ii' '6A';~~[ ~"~";~6~';;;;i;;~)~~ ..... ........................... '(',~,~Jress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... ............................................................................................................................................... If applicant is a corporate, siggoture o~:July authorized officer. ~ame and title of corp6rate officer) ona N mb. ............ .6 o m O .. so o; '66 66i6 .................................... 2. 5tote existing use ond ~cupancy oG Premises end in~endod use end ~cuponcy of pr~osed c~struction: a. Exisiting use and ~cupancy DO E P~ b. Intended use and occu~ncy ~ ~ ~ property lines. Give street and whether interior or comer lot. 3. Nature of work (check which applicable): New Building .................. Addition ...... ~.... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .................. /.. ~.......~....0. ......................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .~'..../~..~.-~.. ........ Number of dwelling units on each floor ............................ If garage, number of cars ....................... ..~....A~...-~,. .......................................................................................................... 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 ..... ................. Depth ......~...~./.. ....... Height ......... /.~. ........ Number of Stories ................ . .~..,/~,.~ .................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Numbe. r 8. Dimensions of entire new construction: Front .................... ..~..~ .......... Rear ............ /....?. ........ Depth ..../......~. .............. Height .................... Number of Stories ~A/L--- 9. Size of lot: Front .......... ./...~..,.~....~..... Rear .................................... Depth ........... ./..~...~..~. ...... 10. Date of Purchase ........................... ./...~...~....~......--_ ....... Nome of Former Owner ....... ..c~...,~...~.......~...~ ............. 11. Zone or use district in which premises are situated ...........................,?',,~...~.../. ...... ..~.....~l...,~,...~. ..................................... 12. Does proposed construction violate any zoning law, ordinance or reaulotJon? ................. ..'~....~. .................................... 13. Name of Owner of premises fZ;.'~......C'.....~..'.;:.L'..'J..-T.:.....Address ............. ~,~?.-Z-..~.~.~...c.~C:~ ...... Phone No ..................... Nome of Architect ........................... ~ ..................... Address ............................................ Phone No ..................... Name of Contractor .....~l......~-.~./..L...L..~......~........~.~.-/~..~Ad'~dreC*ss ......... ..~..~./.Z.~...4:../~ ........ Phone 1~o.~...~.........~......~. PLOT 'DIAGRAM Locate clearly end distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from block nUmber or description accordin! to deed, and show street names and indicate STATE OF NEMI YORK, COUNTY OF ............................. ................................................................................................. being duly sworn, deposes ond soys that he is the opplicant (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 make arnd 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 forth in the application filed therewith. Sworn to before me this ..................... ' ';),, -: : " :. : ' ". ................. . . . P. . . , ................................. No. 52-8125850. Suffolk C0u Term Expires March 30, 19~/~