The URL can be used to link to this page

Home My WebLink About5635-zFORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .~.~f..~.~.1~..~..~.~.e. ?.~..~. ~...~. 3.fi Street Map No.l~..~..~.~-. ~. 9"'~lock No ........... Lot No.. ? .... .~.?..~..e....~.~. ~;.q, .t~ ........ conforms substantially to the Application for Building Permit heretofore filed in this offie~ dated ....... )~).0 .~.... ]..~..., 19..').! pursuant to which Building Permit No.~..~...~'.. ~ dated ~ ~1 19 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 ... ~ ! .~/.4 .T. ¢.-'...~. ff..g.-..~. ~...~.'.~.~.....~..~..k.../~..'..~..~. ................. The certificate is issued to. d./(..~..c,-~...../.~.~ ~...k..~. ....... O...O3...M.c.-f..~. .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..~...~..~. f... UNDERWRITERS CERTIFICATE No. /4/ - 7~ ,,~ HOUSE NUMBER... q .~..O. .... Street.. ?.~.~..~fi.~.~..~..~...~...~?..(..l~..... 0..V.-'(..~...~. ........ Building Inspector TOWN 6F $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD; N. Y. BUILDING PERMIT N? Permission- is hereby gr~hted 5635 (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) D~e ........................ ~.V~1~......t.~...., l~...~ pursuant to application dated ................................... ~J~jr .......... ~J~..., 19..~J.., and approved by the Building Inspector. Fee $..!.0..¢t0t ......... lrO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...l~lo.v..ell~b~v...,.1.°a,......, 19..?.1. Approved ...........:~ ............... .'~ .......... , 19...'.' .... Pemit No ......._~6~5..7. ............... Application No ..... ~ 6,~.5 .................. Disapproved a/c ........................................................................................ (Building nspecto~ APPLICATION FOR BUILDING FERMIT INSTRUCTIONS Date November 19 19....7.!. ..... 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 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 oppfication, 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 Jn 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 BuJ d ng Zone Ordinanc~ 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 demol tiaa, 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) (Address of applicant) State whether opplicont is owner, lessee, agent, omhitect, engineer, §enerol contractor, electrician, plumber or builder. Con~crae~co~· Name of owner of premises ... -T~ll~-q...l"J. Olll~.I1. ..................................................................................................................... If applicant is a corporate, signature of duly authorized officer.~ .................. ......... Location of land on which proposed work will be done. Map No.: .~.e, CO.l~::Lc....(.:~:L~.~m.~.~ I]~t~-). .................... Street and Number ...~.~i~z~.~...~D.0,~...O~.~..~$~yT~T~.ter...Pa~...~O,S.,~..P.~..~.U~.~g~ ............................ Store existing use and occupancy of premises and intended use a d occupan~v~6f pr6posed construction: a. Exisiting use and occupancy ..... .~,~.l'a..f~...'l~,l:g~ ............................................................. .~ .................................... b. intended use and occuponcy .......... ~I~fl...~s~l~.~'....~.lfl'~.].'l~.~ ........................................................................ 3. Nature of work (check which applicable): New Building ~.~ ........ Addition .................. Alterotion .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost 1 0 O0 ............... l~8.~.0CO.....e ........................ Fee ......... e...: ............................................................................ -- ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... D~ ................ Number Of dwelling units on each floor ............................ If garage, number of cars ' 6. If business, commercial or mixed occupancy, ~pecify 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 ........ .~/3 ............... Depth ..~..br ................. Height .................... Number of Stories ...4~e. ............................................. 9. Size of lot: Front ..... ~?.~ .................. Rear ............. -7.~ .................. Depth .............. ~,,R.0..~ ...... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ HA" d-' S"' J J. Zone or use district in which premises are situated ....... ........~...~. .................................. 12. Does proposed construction violate ony zoning ~ow, ordinance or regulation? ......... .r~ ............................................. 13. Name of Owner of premises ..~'~e.,~..J~oma~ ........... Address ....C~.ho~.e~ .................. Phone No ..................... Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~.,...~..~.1~.}r4~.~.~,I, ..................... Address ........ ~.~..~.~,.~.~g~ ............. Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~SS COUNTY OF .... ~tl~'~.k ........... )' ' ...................................... ,T~I~--~'~O~]&~ ..................... being duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the ............................ Q~Z~.t~..~e,~;o~: ..................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application, filed therewith. Swam to before me this .................. · ~. day of ........... ~,~...~]D~F,~ ............. , 19 ~.~ Notary Public ..... Coun ....... (S,gnature of applicant) NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk Term Expires March 30, 19,~;~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date 1973 Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed ~ocation) have been inspected by this department and found to be satisfactory. Chief of General Engineering Services