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Home My WebLink About5665-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No ....Z~.~'~. ·. Date ...........3ep~e~ber. J-gt-., 19.75. THIS CERTIFIES that the building located at . 6.~.0..l:~.o.r~. ~}F~v.e ......... Street Map No ..... ~ ..... Block No. ~ ....... Lot No... ~}~.. Cll~CI~o~II~I ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... DEC,. ~.~t..., 19.~.~.. pursuant to which Building Permit No .... ~.~.6. ~Z dated ......... MC.. ~.~t .... , 19.7~., 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 .. Pr~,v~e..one..~t~..~¥]s..~],lr~G ...................................... The certificate is issued to . .1~'.t;~,2. ~??.~.:~. ...................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...l~p.~.,. ............................ UNDERWRITERS CERTIFICATE No ....... N. :.B? ....................................... HOUSE NUMBER....~80 ...... Street...l~l~l~.o.~..D~,.l.v.e. ................................. ............................................... Cutchogue ...... -t ............... Building Inspector FORNI NO. ~ TO~/~N OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5665 Z Permission is hereby granted to: to D(~te ............................. ; .......................... , ................... ............ i ................ ...................... ~.~....~ ..................... ~ ............... Make a~ter~ie~ at p~emises located at . . '~0 . ........................................... ~.U~.~....e. ........... K,~.,,..~. .................................................................. JJe~ 'J~ : 19. z'~' and approved by the pursua:rd' to opplicetJon doted ............................................................ , ...... Building Inspector. FO~ N~, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .... ........ Approved ........................................ , 19 ........ Pemit No ..................................... Disapproved a/c ............................................................................................ APPLICATION FOR BUll-DING PERMIT Dote .................. /...~...ZL.~.... ............. , 19.7./., .... 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 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 permit 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 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 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, ordi nonces, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant)~ ....... State whether applicant is o_wner,, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 ..... ~.~.~...~..,/tt~.~....,~.~'~, ................................ :..C~.~J.~,/~...~m. ......... ].. ............ Munic~'pality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~.......~T....~.kt'l.:.... ~..~../.Z~.¢. ~ ....... b. Intended use and occupancy .~..¢ J,~ ~. . . . = 3. Nature of work (check which applicable): New Bu~iding .................. Addition................../ Alteration .................. Repair ............. ~ .... Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ........ ~..0.0..~ ................ : .................... Fee ....~......~ .................................... .~.~¢q...~.....~..~..~...C...H.. .... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ..e..~....~. ............ 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. D mens ons of ex st ng structures, f any Front :D.~. ..... Rear 2 eP. n.~k '~' Heght ..~....O. Number of Stores .'~...~..P. . .~.~.~.....~...~../~.~,,o..~...(3/4t~ff..~,~;,~, .~...¢~.~.~. ....... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ............................................... . 9. Size of lot: Front ............ .~.5~.. ........ Rear ............ .~...~'... ............... Depth ......... .?...?..0. .............. 10. Date of Purchase ............/../..7..~. ................................ Nome of Former Owner ..~....~C...~..~..~..~.S...~..~. ........................... 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 ..~..:.~...~..L~ .~....~..~.. ........ Address ...6.~..6.....~.~..~.0...~....~....~=... ........ Phone No.7..~...~.C.?..??..~ Name of Architect ...................................................... Address ............................................ Phone No. Name of Contractor .................................................... Address ............................................. Phone No ....... PLOT DIAGRAM '" - Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setdaock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE Of N~Y~JL~I j~/ . ! ¢ c COUNTY oF~r~..._...~.~.~ ~ , _ ............................. · .~/. ....... ..~....~....i.;~.:.."~~..being duly sworn, 'd~oses and soys t~t he is the applicant (Name of individual signing application) above named. He is the .................... ~;. .................................................................................................. (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e peffo~ed the said work and to ~ke and file this application; that all statements contained in this applic~ion am tree to the best of his ~owledge and belief; and that the work will be performed in the manner ~t fo~h Jn the applicati~ filed ther~ith. Sworn to befo~ me this ............... ...... ......... - · .............. Nota~ Publi~~.~z~4~.~..~Coun~~ ~lgna~re of applican~ ............................. HOTARY PUBLIC. Stye 0f New Yerk N0. 52-812S85~ ~uff01k ~,rm [xpires March 30. 1~