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Home My WebLink About5676-z~ FORM NO. 4 TOWN OF SOUTttOI, D :' BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z...~.0~(~. Date ............. ~;.?~.1...~... , 19 73 THIS CERTIFIES that the building located at . $./~S. l~io.r, th. Roac]. ....... Street Map No...x~. . Block'No..X.x ....... Lot No...x~.., ,..G.r.~enpq~J; ..... I~!?~ .... conforms substantially to the Application for Building Permit heretofore filed in this office Aug dated 19.;~. pursuant to which Building Permit No. Dec 16' ' ' '5696Z ' dated Aug )+,..1,96~ ~ .DeC .1~ 197].., Was issued, and conforms to all of the reqmre- merits of the applicable provimons of the law. The occupancy for which this certificate is issued is . PY. iV~$.~ .98~..~m$~.][. ~W~.~$~Pg ...................................... The certificate is issued to .TbP~. F.~ .H~$.!~$9~ ...... ~ ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~P.~ .8~...!?~. ,~. ~.'..Y~,~ .... UNDI~RWRITERS CI[RTIFI('ATE No .... ~-[~g , , .' ................................. HOUSE NUMBI:R ,29OD. .Sh'cc~,. ~ain. Rmad. IRT2~) ......................... Buiklmg Inspcc[or TOWN OF SOUTHOLD BUILDING DEPARTMEN'r TOWN CL~RK'$ OFFICE SOUTHOLD, N. Y. BUILDING FER/~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 5676 Z ~e ............. : ................ · ........................... , ........ Permission is hereby granted to: Building Inspector. ~Fee $.....~.J~ ......... pursuant to application dated ............................ ~,,...~ ......... i'...., 19..~., and approved by the Building Inspector TOW OF T N ~ NO~ BUILDING ~RTMEN¢~ ~/ TOWN CLERK S oFFICE 'UTHOLD, N. Y.~ ~ APPLICATION FOR BUILDING PERMIT ~ ~ Dote .~.....~........., 19...x?/.... ~ 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 pub ic streets or areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is part of this application. rr c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of th~s applicati.on, the Building Inspector will issue a Building Permit tO the applicant. Such permit shall be kept on th.e pr~mises o~?ilabl~ for inspection throughout the pr0gress of the work. _ e. No building she'll-be occu~e~r used in whole or in part ~or any purpose whatever until a Certificate ~f 'Occupancy shall have been granted by, the Building Inspector. ^PPLI~ATIoN IS IdEREBY 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, Orc[inam:es or Regulations, for the cl)nstruction of buildings, additions or alterations, or for removal or, demo t on, as herein'deSCribed The applicant agrees to comply with oil appliCable lows, ordinances, building'code, housing cede, and re,ions. · (Signature of opl~licant, or name, if a corl~'~'~i ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~ .Name of owner of prem ses 'If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. Map N0.:~.~ ...... Lot No. ~.. 2. State existing use~nd occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ~ ~..; ........ ~ .............................................................. b. Intended use and occupancy ..~ ~ ......................................................... ; ...... 3. Nature of work (check which applicable): New Building .................. A~cldition .................. Alteration .................. Rel:mir .................. Removal .................. Demolition .................. Other Work (D~cribe) . 4. ~timated Co~t ................................................ 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 ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Fran~' ....".;......~...~.. ....... Rear ........... .~...~.. ............. Depth ....~.~. ........... Height .....~...~ .......... Number of Stories .......... /. .................................................................................................... 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 ........... ./..~..~....~ ....... Rear ............... ../.~f. .......... Depth ....~'...~..~....~ ............... 10. Date of Purchase .~...~'.~..../.~..t.../~.~/. ...................... 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? .~ .................................................. Name of Architect ..... ~ ................................... Address ............................................ Phone No ..................... Name of Contractor ...~ ................................. Address .................................. ~ ........ Phone No ..................... I ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from properl~ lines. Give street and block ~umber or description according to deed, and show street names and indicate whether Interior~or comer lat. _~.O7' ~,~, FO~D/-/~/1~ STATE OF N~ YORK, tcc ~TE~LI~fi COUN~ OF ................................ ~'~ .................. ~~.~...~..~Z~ ....... being duly sworn, d~es and soys t~t he is t~ applicant (Name of individual signing application) a~ve named. He is the ......................................................................................................................................................... (Contractor, ag~t, co~orate officer, ~c.) ~ner~and is duly authorized to perform or have perform~ the said work and to ~ke 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 applicati~ filed therewith. Swam to before me this ' / / ' ......... ................. . ~/ ~ .~ .~7.'... ~.~Z...~ 7..2 X ................................... ~a~ ~ublic, .~.f~...' ............. J ............ Z.~.~... Coun~ _ ($i~ture o{ ppplioent) N~ARY PUBLIC, ~tate of New ~miD~O~ Expires ~arch 30, 19..-