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Home My WebLink About5592-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .~...~..n.e.w.o.o.d...I~..ad ...... Street Map No....Y~ ....... Block No..X~. ........ Lot No. ~ ..... C..u~;.c.h.o. g~l..e. .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... .0.e.~;,. ~(~ ...... , 19.7.J.. pursuant to which Building Pemit No...~9.2.Z.. dated ....... 0.Cl~;,. ~8.~ ...... , 197~., 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 .. l~¥a~e, go~ago..(aC¢.e.~$0ry) ....................................... The certificate is issued to .... .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N.~.R... ............................. UNDERWRITERS CERTIFICATE No. Perldin~ HOUSE NUMBER ~ Street P:h~ewood l~oad Cutchogue Building Inspector FOIL~ NO. :~ TOWN oF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, BUILDING PERMIT CI-HIS PERMIT MUST BE KEI~ ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5592 Z Permission is hereby granted to: .................. ~o~....~.~...a~ .............................. -~ ....................... ~e~e~.e~.'. ..... ~.~ ..... ~.~. to ...~3A..~.~,d~t~..e~.~~..~,e.~i..~e .......................................................... at premises located at ............. ~.~ ...... .~..][;'~J~l~..Jd/;~-..~ .............................. i ........................... ........................................... .~J,.~.t~...~k, ......... .C.~,t~a ......... ~/,Z · ..................................... ~ursuc~ to application dated ........................... /[~t~....~.~ ......... '. ...... , 19.~.~.,, ,and approved by the Building Inspector. THE NEW YORK BOARD OF FIRE UNDERWRITERS tEIb BUREAU OF ELECTRICITY ~-- 85 JOHN STREET. HEW YORK. NEW YORK 10058 De0e,*Er N 134234 THIS CE~IRIES THAT only t~ el~t~ ~uipment ~ ~sc~ be~ a~ ~nt~uc~ ~y t~ appli~nt ~on t~ a~ ~pl~cat~on numar ~n t~ p~m~e~ o~ Ha~y 5hawj ~lnewood Rd,~ Cutcnogue~ ~,~. ' ' ' ' ~,,~i,,do, December ~7~ ~9~ and found to be in complla~e wlth the requirements of thls Bourd. F XTURE I I I F XTURES RANGES C~KING DECKS OVENS ~SH WASHERS EXHAUST FANS I I SERVICE BI~ONNECT ~ ~0 CS x ~ 2/0 ~ ~/0 ~J Robert A. Goodale 525 Orchard St. New Suffolk, N.Y. 11956 · ~N~I~L MANAGER Per 11 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN OF SOUTHOLD ~'~ /~'~'~<'~~ BU !LDJNG DE PA RTM ENT ~-,,~ -~/* ,/'~'~ ~~ TOWN CLERK'S OF~CE S~THOLD, N. Y.~ Application No....~.....~....~..~ ......... ~ , - APPLICATION FOR BUILDING PERMIT .' INSTRLTC~IONS a. This application must be completely filled in by typewriter or in ink. and submitted in duplicate to the Building Inspector.. b. - PicOt 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 applicatiotc 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 shah I~e occ~,pied 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 /V~DE to the Building Department for the issuance,'of a Building Permit pu~nt to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, add other applicable Laws, Ordinances or Regulations, for the construction of buiJdings, additions or alterations, or for removal or demolition, as ~, .e. in descrlbed. The applicant agrees to comply with all applicable laws, ordinances, build, lng code, housing code, and ~a~clons. ~ (~;~tu~ ~f alNSlicant, or name, if a corporation) ....... State whether applican¥ is owner, lessee, agent, archit~ct,"~ l!~ , g~ , , . p o bui der. ........... "' :' ................. : .............................. Name of owner of premises ...~......'~..'.~ .'...~ ..................... : .................................................................. If applicant is a corporate, signature of duly authori~r~d of icer. r 1. l_ocotion of land on which proposed..~work will be daftlY% Mop No.: ............... , ........................ lot No ......................... Street and Number .....................~.'.~,'~/~.: .................... ~ .......................................................................................... ~' ~ Municipality 2.State existing use and occupancy of premises and intended use and occu~n~/~f proposed construction: o. Exisiting use and occupancy ,~..~....~'..~.~./~/~" ........ b. Intended use and ~¢Lq~ncy .................................: ............................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ............. Alteration ................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Est mated ........................ 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. D mens ons of ex st ng structures, f any: Front ...~.....~. ................. Rear ....~......~...~. .................. Depth .~ ............ Height ......~....~......~ ......... Number of Stories ......... ~ ............................ s...., ................................................................. Dimensions of same structure with alterations or additions: Front .J~..~.. ........................... Rear ..~...~.. ................... Depth .....,~...~.. .................... Height ......~......~'.. ............... Number of Stories ...... .~... .................... 8. Dimensions of entire new construction: Front /~.' · ~ ~,~ I · ~. '· ............................ ................................ Rear .~..~ ....................... De~th Height ....~ ......... Number of Stories ...... ..~-.. .................... ~'. ~....~...~...~.. .~...~....~......~...~.~;;/~' 9. Size of lot: Front .../..~..~.:.1.~. ......... Rear /.~..~.: ~. ........... Depth .../.?...~..,.Z~.. .............. ' ............................. 10. Dote of Purchase .....,~.~..~..~......./...~... ....... ~..~..~.../. ...... Name of Former Owner ~..~:..~..:..~..~....~....~.../.~.......~.,~.../~......~..~... 1 1. Zone or use district in which premises are situated ................................................................................ 12. Does proposed construction v o ate any zonin~ law, ordinance or reaulation> ~ .................... 13. Name of Owner of premises ..~..'..~,......~....~....~..~'1~ Address .~....'~.~.~. ~-'~;)"~ ......... ;~'~"~.'.~'.' Name of Arch tect ~.~ .... A ~:~[~'~' ...... ~' ........................... · · .......................................... ddress .......................... f/. ~."..~. ~.~.. ..... Phone No ....... Name of Contractor ........... ,,,~',~.~---~ ...................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate cleorly and distinctly oil buildings, whether existing or proposed, ond indicate all set-bock dimensions from property lines. Give street ~nd blc~:j~Olul~ber or descr )tion according to deed, ond show street names and indicate whether interior or comer Io STATE OF NEW YORK, COUNTY OF~..~ ............ .. .................. r...~¢~,.~.....~..,...~ ............ /. ..................... Demg duly sworn, d~oses and says that he is the applicant (~e of i¢ividual 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 ~ke and file this application; that all statements contained in this application a~ true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith· Sworn to bef~e me this ....... /~..~.~ day~f~~~'~~~~ ~.. ~~ ........... , 19~.. co.. ...................... ............................. LEFT S/DE ELEVATION REAR ELEVATION FRONT ELEVATION UTILITIE6 KITCHEN STUDY F-LOOP.. PLAh,,!