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Home My WebLink About5629-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Zh'.89~' . Date ..... Noyemb. er '7 , 19 '72 THIS CERTIFIES that the building located at Wast. Creek. A~e . Street Map No. x~ . Block No. .~ Lot No. ~ ~tcho~e ~,I, conforms substantially to the Application for Building Permit heretofore filed in this office dated . . .Now ~..., 19 7J. pursuant to which Building Permit No. ~629Z. dated .EOV. 1.~ , 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.~$Yg~. $~.oragg .(. $~.~¢$. Dui.tQ$~g ....................... Noo~ .& fmo .D~/A/. Li.ttie. Peconi.¢ ~ay .C~ . (owner, l~ The certificate is issued to tiarm of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No I~ ,,~t, ItOUSL NUMBER 3QI40 Street . '~Oat, Building Inspector' ; /' ' ' FO~ NO. ~ TO~ OF $OUTHOLD BUILDING DEPARTMEHT TOWH CLERK'S OFFICE ~ SOUTNOLD, N. Y. BUILDING PERMIT (THIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL F.ULL COMPLETION OF THE WORK AUTHORIZED) N°. Permission is hereby granted to:il __ · · __~ _ is./. ~ .......... ~..~..~..o~.~.,~,:....~.44.~.:. ....... ~..~.: .r...e,~...~.~.~.:~&~..~..-... ................ ............. ~.~...~.~..~.~.~ ............................ ...~..~..~..~...~......~.~..~.....~.c~.c~..~' ~'- ......... ~.~.~.~..~.~.~.i ................................. to ...,. .................... .(.- ~ ~ ~.~ .~.,~ -~. ~ .~.....~....~.~..~ .~.~..~..~ ~..~.~.~. ......................... :~. ............................ at premises located at ...... ~..~. .......~......~....~...~. ...... .~..~.....~...-.'~-.....~.. ...... A..?...~. ..... ~ .......................... .................. ''~u ~'c ~0G~ ~ . . pursuan,t to application dated ......................... ~..~...~.....~..~... .......... , 19..3~., and approved by the Building Inspector. r,e ~.../..0...,.~ ..... Examined Approved FOENI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19].(. 19....?..( Pemlt No ...~:~.....~...?..~ .. APPLICATION FOR BUILDING PERMIT Date ...... ./.../..//.....~.. ..................... , 19..?.../.... INSTRUCTIONS a Th~s opphcat~on must be completely filled in by typewriter or ~n ink and submitted in duphcate to the Buddm Inspector b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets ~ areas, and gw~ng a detaded description of layout ofproperty must be drawn on the d~agram which ~s part of th~s apphcatior c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl ~ssue a Budding Permit to the apphcant. Such perm shall be kept on the premises available for inspection throughout the progress of the work. e No budding shall be occupied or used ~n whole or ~n part for any purpose whatever untd a Certificate of Occupant shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regubtions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe. The applicant agrees to comply w~th all apphcable laws, ordinances, budding code, housing code, and regulations. (S~gnature of apphcant, or name, if a corporation) .......................... ;T ........ ...... State whether apphcont ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu~Jde Nameofownerofpremises ~ ~ ~b'D ,~ ~. ~ / 7~ ~ ~' If applicant ~s 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.' .... ~k~ Lot No. ~" Street and Number ~,-'"J'7- g',~'g:g~,~ ~ ~ ~o Mumc~pohty State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction' a. Exlsiting use and occupancy b Intended use ~nd occupancy .Z~.~...~~...~...~~...~....~.~..~...~.C~.~.- 3. Nature of work (check which applicable). New Budding ..... ..~... ........ Addition .................. Alteration .............. Repair .................. Removal .................Demohtion .................. Other Work (Describe) ..................................... 4. Estimated Cost ...~../.'.'.~.,~.~.~.~'~ ..................................... Fee (to be paid on filing this application) 5 If dwelling, number of dwelhng un,ts ..... .../~.....~.....G.'~ ........ 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 ..../.~.~..r.!.v...Ir?~ 7 D~mensions of existing structures, ~f any' Front .......................... Rear ................................ Depth .................... Height ........................ Number of Stories ............................................................................................................. D~mens~ons 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 o,~, Stories .......~.'.4ff'..~..~ .................................................................................. 9. Size of lot' Front ...... ~......Z..../.......-~K~ear ................................ Depth ..~...~....~l.....~..~ ?.. .... 10. Date of Purchase ../..?.?..¥]:.....~ ~...../..~..~....~. ............. Name of Former Owner 11. Zone ar use district m which premises are situated ...... ~ ....................................... 12 Does proposed construction viotate any zomng law, ordinance or regulation;~ ...... ..'~'...~ ........................................... Name of Ow.er of premises ...... ................ Address ''t- Phone No. ~ ~ ~f RD. ~%,,~,:,JP',':', ' ................ Name of Architect ................................................... Address ' Phone No .................... Name of Contractor ....... ~'~ ......................... Address ............................................ Phone No ................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether exmting or proposed, and indicate all set-back dimensions frorr praperty lines Give street and block number ar description according to deed, and show street names and ind~cat~ whether interior or corner lot STATE OF NEW YORK, COUNTY O,F .,. ............................... .f "'"" .............. C~...~ ...... ~~ ....................... being duly sworn, deposes and says that he ,s the applicant ~Nome of individual s~gning opphcot~on) above named. He ,s the ...... ..~...~...~.~.~....'~..~.~..~....~,...*.'~...~....'~'....~.~..~.~.. ............................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa,d work and to make and file this apphcation; that all statements contained in this apphcation are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application' filed therewith. Swam to before me this ........................ day of ............................................ , 19 Noto P.blic,. ........................................................... County ..............................