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Home My WebLink About5144-zFORi~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at W/8 Ca se .L.a.n.~ ~o~ Nai~...Rdstreet MapNo. ~ ..... BlockNo. ~ ..... LotNo..X~... C..Ll.t?.h.o.g.u...e conforms substantially to the Application for Building Permit heretofore filed in this office dated . .l~..r...3. .... , 197.~.. pursuant to which Building Permit No. dated .... P..a.r .... 3 ....... , 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 .S. em.i.-~ub.l.i.q .~.u.i. ldl.n.g.~....H.i.s~.or.i?.a~. ?..xl}i..b.i?.t.?.n..o.~.? ........ Cutehoc-e Historical 2oelety Tennan/ The certificate is issued to Cutchague I~dep~nda~zt Congregation Cu~ch Society (owner, lessee or tenant) Owener of the aforesaid building. Suffolk County Department of Health Approval N.:R, .......... UNDERWRITERS CERTIFICATE No. p.en.d, ing ........................... HOUSE NUMBER .27320 ..... Street ....M?i.n...R.o.a.d. .......................... 25~ Case Lane .......... ]~il'~i~g' i~speclor .... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? Z Permission is hereby granted to: .... .~b,e~,~,~...~L(Lt~';Leo~..O. efo.,%#.'~r..A.]~epe~ea~ emi.at _4 & i~lmJ, eh JeelOt~r of ................................................................................ Cutehe~ at premises located at ...~....~,.t~J~...~...~....q§.ii~.. ]eJJJ~ ...................................................................... ......................................................... ~u~el~ ............ II.,~.~ ............................................................ -pursuant to application dated ................................... ; ............. ~. ................ , and approved by the Building Inspector. J:e, $....,.~',.0....~... ......... SCALE: 50'= I" BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined ....... . .~.../.~... · ./. · .'~../. · · ........... ,19 ........ Approved ........................................ , 19 ........ Permit No ............................. Disapproved a/c .............................................................................................. Apphcahon No .......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........................................................... , 19 ........ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Bulldin Inspector. b. Plot plan showing Iocahon 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 nat be commenced bafore issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the oppl,cant. 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 part 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 ~ssuance of a Building Permit pursuant to ti' Bu,lding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances , Regulations, for the construction of buildings, additions or alterahons, or for removal or demolition, os herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, hous.ng code, and regulations (Signature cf applicant, or name, ~f a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar builde Name of owner of premises ........... :.~...; ........~...~..~~.../.. ....... · .~-..~...; ..................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1 Location of land on which proposed work will be done Mop Na ...................................... Lot No ' . .................. Street and Number ........................................................................................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................ b. Intended use and occupant, . ............................................................................................................................. 3 Nature of wo~k (check whici~ applicable): New Building .................. Addition .................. Alteration ........... Repair ................. Removal .................. Demoht~on .................. Other Work (Describe) ............................. 4 Est,.mated Cost ............................................................ Fee .................................................................................... (to be pa~d on fihng this application) 5 If dwelling, number of dwelhng umts ............................ Number of dwelling umts on each floor .......................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 D~mensions of e×ist!ng 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 D~mensions of entire new construction. Front .................................... Rear ....................... Depth ............ Height ................... Nurnber of Stories ......................................................................................................... 9. S~ze of lot. Front ............................ Rear .................................. Depth .......................... 10 Date of Purchase ....................................................... Name of Former Owner ...................................................... 11 Zone or use district in ~h~ch premises are situated ............................................................................................... 12. Does proposed construct;on violate any zoning law, ordinance or regulat~on~ ....................................................... 13 Name of Owner of premises ........................................ Address ........................................... Phone No ................ Name of Architect ...................................................... Address ........................................ Phone No ............... Nome of Contractor ................................................... Address ......................................... Phone No ................. PLOT DIAGRAM Locate clearly end distinctly all buildings, whether existing or proposed, and indicate all set-back d~mens~ens fro~ property lines. Give ~treet and block number or description according to deed, and show street names and indica~ whether interior or corner Jot. / STATE ¢ N~ YORK, t COUN~ OF ................................ ¢~'~' ............................................................................................... being duly sworn, d~oses and says that he is the applica (Name of individual signing application) above named. He ~s the .................................................................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or o~ners, and is duly authorized to perform or have performed the said work and to ~ke and f. th~s application; that all statements contained in th~s applicabon are true to the best of his knowledge and behef; that the work wdl be performed in the manner set foRh in the application filed therewith. Swam to before me ........................ day of ............................................ , 19 ........ NoteW Public, . ........................................................... Cou~ (Signa~re of applicant)