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Home My WebLink About5589-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No.. Z~.Z~ .... Date . .~.v~-X..2~. ............... ,19. ?.~. THIS CERTIFIES that the building located at . .62.0.0.0. ! .~%.n...~.o.~.4. ........ Street Map No ........... Block No .......... Lot No ............................... conforms substantially to the Application for Building Permit heretofore fried in this office dated . 0etober. 28 ...... , 19~.1 ~ pursuant to which Building Permit dated . .Oc/~o. ber. 28 . .., 19.7.1., 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 ...B..ll~i.n..e.s.s..B..u~..1.d%..~g. ........................................... The certificate is issued to . P. ort of the aforesaid building. Suffolk County Department of Health Approval c~. Egyp.t..E~t.e.rp.r.i~e.. %n.c., .......... (owner, lessee or tenant) Pending UNDERWRITERS CERTIFICATE No ........................................... HOUSE NUMBER . 62000. .... Street .... Mair~ ~oa~ .~Og.~.h.0%.d,..~, .I.,..N. ,.~.,.. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COM~I_ETION OF THE WORK AUTHORIZED) N? 5589 Z Permission is hereby granted t~ ~ pursuan~ to opplication doted .................. ~..~. ................ , 19.~.1..., and approved by the Building Inspector. ~ee *..ff.... .................. Examined oproved ,/ ,/ ,, ? ........................................ , 19 ........ Pemit No ..................................... TOWN OF SOUTHOLD ~..~,~ BUILDING DEPARTMENI~... TOWN CLERK'S SOUTHOLD, N.Y. ~'~/~' pp No ................................. Disapproved a/c ................................................................................... ~. ........ AP'LICATION FOR BUILDING PERMIT ~ ~'- ! 9...'~..1 ..... ~ Date ................................................ , INSTRUCTIONS a. This application must be completely filled Jn by typewriter or in ink and submitted Jn 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, ordinances, building code, housing code, and regulations, ~, (Signature of applicant, or name, if a corporation) .................. ............................... · State whether applicant~ ~ ~-,~-~ - 1,'~-~k.,,.-~/'~is ~e, a!i~en.~:~.rchit~c~ engineer, general contractor, electrician, plumber or builder Name of owner of premise;'i"~.~.~:~~.....~......~ ................ ::::::::::::::::::::::::::::::: If applicant is a corporate, signature of duly auFhorized officer. {Name and title of corporate officer) 1. location of land on which proposed work will be done. /~ap No · · ...............kat /Viunicipality 2. State existing use and occupancy of J,~.l~emises and intended .~use and occupancy of proposed construction.' a EXstn useandoccu ancv/~.~).~~~ ~I'Z~' ~'~-~,~, · g P - -- ................ ,,~ ~7 .......................................................................................... , 3. Nature of work (check which applicable): New Building .................. Addition ..... ~ ........ Alteration .................. Repair .................. Removal .......~ ...... Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...,.*f..~.].O'T~t~ .................................... Fee r.~...: ................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~.0.~...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: Front ............................ 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 .................................... Depth ................................ 10. Date of Purchase ........................................................ Na~e of~Fo~.~er ........................................................ 1 1. Zone or use district in which premises are situated ........... ~.. .................................................................................... 12. any zoning Name of Owner of premisesP~.~....~..~......~.Address ...~ ................... Phone No ..................... Does proposed construction vb31ate law, ordinance or re_.gulation~ ..~f..~.. 13. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................. ~::b...................~..7~.'.;.~'. ................ Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dime property lines. Give street and block number or description according to deed, and show street names ~ whether interior or comer lot. ~ Fsions from ~d indicate STATE OF N~O~_~ t~ ! ~ c ' COUNTY~ ~ _...OF .~.LI~ ...... ............ .7~..7~'/'J~. ........... /.~,~./.~-'.~.~. ..................... being duly sworn, d~oses and says that he is the applicant (Name of individual signing application) above named. He is the ......................... ~.~.~ ....................................................................................................... '... (Contractor, agent, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to perform or have perfo~ed the said work and to ~ke ~d file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~rk will be performed in the manner ~t fo~h in the applicati~ filed therewith. Swam ~jore me this ELIZABETH ANN NEVILLE NOTARy PUBLIC. State of New York No. 52-8~25850. Suffolk C0untv-- T~ Expires March ~,