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Home My WebLink About5619-zFORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~1~?[/~1 ..... Date .............. &ll~... 2~ .... , lg. ~1~. THIS CERTIFIES that the building located at . W.//~ .3~1.1 .H~,.1.1 .&~ ...... Street Map No.. 'XX ....... Block No...XX ...... Lot No. ~..F/,~hers. ;~Slalad... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... I~v' · 6 ..... , 19.0. pursuant to which Building Permit No.. dated ............ 1/~..%0 .... , 19.71., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Privat~ 'one' '/~a,~i2.7 ' dw~tling ...................................... Tile certificate is issued to . 'John 'P~' (~&iXll.~l'd ........ ~wn~r ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · .pen&t,n$ .......................... UNDERWRITERS CERTIFICATE No.. ]~l~dt~lg ........................................ HOUSE NUMBER... ~ ..... Street ................................................. Building Inspector TOW.':N OF $OUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SQUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5619 Z Permission is hereby granted to: at premises located at .......... .I~./.i~...~.~...~[.~.~.~..,I~N~ ........................................................................ ................................................. ~.i...s.~.e..r.L.!..~..l~...~..,....!~.L,. ............................................................ -. pursuant to application dated .................. :. ...... ,~V~ ..... J~ .................. 19r~.1...., and approved by the Building Inspector. Fee ~....I..9.~.q9.. ......... Building lnspecto~ FORM lqO, 2. TOWN OF SOUTHOLD BUILDING DEPARTMENT ~TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved h, 19/,! .... Permit No. ~ .............. ;,'.,. ........................................ , Application No......~...(../../? ....... D~sopproved a/c ............................................................................ APPLICATION FOR BUILDING PERMI'T INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the BuHdin inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets, areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio, c, The work covered by this application may not be commenced b,fore issuance of Building Permit. d Upon approval of thru application, the Building Inspector will issue a Building Permit to the applicant. Such perm 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 port for any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit purauant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with oil applicable laws, ardinoncesf~tuilding cod~hou~c~ode~ and regulations. John P. gaillard (Address of State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde~ Owner Nome of owner of premises ....... J. oh~..~.....~ai~l~.~ .................................................................................................... If applicant is a corporate, s!gnature 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 .... !~.e..s...~....°...~.....~..~..~.~.D....~.:~L..~.~,f~=l~.~.,~.,~L~t~.R..Z~L~~ ............ '. ................................. Munici~llW 2 State existing use and occupancy of premises and intended use and occupancy of propos~ construction: a. Existing use and ~cupancy ........ ~.~~ ............................................................................................... b Intended use and occupam, ..... ~es~e~&[ ............................................................................................... 3. Nature of woik (check which applicable): New Budding ...,~.. ............ Addmon .................. Alterahon ........ Repair .................. Removal .................. Demolitlan.,...~.. ........... Other Work (Describe) ............................... 4. Estimated Cost .........~.~,,5.~g.0..0 ................................... Fee ..~lg.,.~).0 ................................................................ (to be pa~d on filing this apphcation) 5. If dwelling, number of dwelling units ..0...~..~.. ................... Number of dwelhng units on each floor .................... If garage, number of cars ........................................................................................................................................... 6. If business, commercial or m~×ed occupancy, specify nature and extent of euch type of use ....................... 7 Dimensions of existing structures, if any: Front ....~..;~.~.~ ..........Rear ...~...~15 ................. Depth ,~2 L/.2,~-! .... Height ..~.~.~ ............... Number of Stories .~..~.l.V,~...p~E.~,~c3~k..~.~,~...a~d...c.e]~.a~..m~0..~E..~ ..... Dimensions of same structure with alterations or additions: Front ................................... Rear ........................ Depth ................................ Height ........................... Number of Stories .............................. 6 ~ 8. Dimensions of enhre new construchon. Front ........ .~. ......................... Rear .... .~.~.~. ................ Depth .2.8.~..~.m~x.. ] Height .... ~.~.! ......... Number of Stories ..Q~f~...~.~.&l~L..~.eZ~ar.) .................................................. Size of lot: Front ........................... l~ear .................................. Depth ...~.e..e...?...]:.o...~ .d..i.a..~r~ a~,a¢~ed Date of Purchase ]~e.v±~.~e...~/.vz/..o...~.. ~....Ge~]~.a~e of Former Owner ..~.~.,.~..,.~;[],~r.d, ...................... eceased l~ A s~ 19~ - · Zone or use district in ~hic~ prem,ses are sltu~a~t .............. ~sz.dem~z.al ..................................................... Does proposed construct,on ~olate any zoning law, ordinance or regulahon~ ...~q ................ ~.j .................... Name of Owner of premises .J..:.~.,..Q~.$%],f~r.~ ........... Address ]5.Q..~a,.~J~..5.~...~b ,..~,Yl~hone No9~.5.-..01-~5. Name of Architect [}~.G~C...~p.us.e,,L"tc ................... Address A~%on~a~s..O...1..~..2..O.. ..... ph6olneT~4c2%9.-..9/~50 Name of Contractor .~&$11...u~ug. wrz .................... Address ............................................ Phone No ................. 10. 12 13 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set4~ck d~mensions fro property lines. Give street and block number or descriphon according to deed, and show street names and indica whether interior or corner lot. See a~ached Plo~ Diagram ! STATE OF NEW YORK, t c ¢ COUNTY Of ................................ ~' '""' ................. ~.~.~...?..,....~.~,~.~..~1, ....................................... being duly sworn, deposes and says t~t he ~s the appJio (Name of indwidual signing application) above named. He ~s the .................................................................................................................................................... ~owner ~ and is duly authorized to perform dr have performed the said work and to ~ke and this applicahon; that all statements contmned Jn th~s apphcation are true to the best of his knowledge and belief; that the work wdl be performed in the manner set fodh in the application ~led therewith. ~ _ Swam to before me this , ..................... .... ............... . ..................... .......... No,o CS,,. ure .... Quahtl~ m Ktngs Coun~ ~mmlsslo~ Expires March 30,