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Home My WebLink About5661-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z .~.6.1 ....... Date ....... .8~. p.~.gr~.b.e.r .~-9., ...... , 19.73. THIS CERTIFIES that the building located at .. l.~ao~, ilr. tve ............. Street Map No .... XX ...... Block No.. AX ...... Lot No.. 2~. z~d. 2~ ...... ~l~al~o~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Dec.~lbe~ .13~ 19.7.1. pursuant to which Building Permit No.. ~(~.Z. dated ........ Da~e~lber..~., 19.~.1., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . .. Pr.~,v.~;.e..ac .e.e.s. aory.(a~or.~ge.)..l~t,],d,i~g ........................... The certificate is issued to ...l~ay/~.r~d.. 1t....t.gtlakl~ ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~:~.* ............................. UNDERWRITERS CERTIFICATE No...I~i~. ........................................... HOUSE NUMBER ..... ~7.(~ .... Street .....~'~l, aOl~. DI"~'V~ ............................... .................................................. gU~I~ ..................... POI~I NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 5OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: at premises located at ...... ~l~....~J~lJ.~ ..................................................................................... .................................................. II~l~elmllm ......... 11.~. ................ : .................................................... pursuant to application dated ......................... ....~J~.....~JJ .............. , 19......elr, J and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved '~ ~ " '~ ~' / ~'~ ........................................ , 19 ........ Pemit No ..................................... 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 streets or areas, and giving a detailed description of layout ofproperty must be drown 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 permit shall be kept on the premises available for inspection throughout the progress of the work. - e. No building shall be occupied or used Jn whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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, ordinan~ces,'L~xding code, housing code, o~ regulations. ' .../..... ~. ~?...,.~...~?...0..,....~ .,..~ .o.~.o.e.~.,..,....~.: ..z. :. .................... (Address of applicant) State whether applicant is owner, lessee, age'n, architect, ~ngineer, gene~ral contractor, electrician, plumber or builder. ....................................................... .o.~.e~. ................................................................................................................................ Name of owner of premises ........... If applicant is a corporate, signature of duly authorized officer. -"~/~ (Name and t~tle of corporate officer) 1 Location of land on which proposed work will be done. ~op No,: L t Street and Number ........... ~,~,~...~,~.~,.,..~ .................. ~,~.~,~g~ ~ .................... ~ ~ ~ ~nicipolity State existing use and ~cupancy of premises and intended use and ~cuponcy of pr~osed constructi~: : ......................... .................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe} ........................................ Steel shed for tools . ~' (cost $6D.00 shed) 4. Estimated Cost ............................................................ tee ......................................................................................... (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 ............................................................................................................................................. 6. If business, commercial or mixecl occupancy, specify nature and extent of each type of use ....~ .... 7. Din~nsions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ..................................................... :: .......................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ....... D.'. ..................... Height ..~....-..Q ................. Number of Stories ................................ 8. Dimensions of entire new construction: Front 6'X .~'X ?' .................................... 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 are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ..~.;.~...'.....~.~..~.~ ............ Address .....~..~...~..o...~...D...~.~?..?..~. ............ Phone N~a.e..~....~.~.?...~. ..... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil 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 comer lot. STATE OF NEW4~O~ ~.~.. !cc · COUNTY ~ ..~ ...... .f'"'"', ............... .~'~'.~.....~......~ ............. being duly sworn, deposes and soys that he is the applicam 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 that the work will be performed in the manner set forth in the filed therewith. Swam to before me this Of ........ :..~ Notary Public, of applicant) ELIZABDrH ANN I~0?ARy PUBLIC, State of No. 52-8J25850 Suffolk Term [xp'ir~s ~4'arch 30,