The URL can be used to link to this page

Home My WebLink About5149-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy The certificate is issued to of the aforesaid building. THIS CERTIFIES that the building located at / ......... 0 W 0 /fA Y IVA -r~ ?~_q '/FOAstreet ~> Map No. 7& ~ . Block No....~ ... Lot No...I.O ..... conforms substantially to the Application for Building Permit heretofore filed in this o~iee dated ..... ~ ~q~.~ 19.~//pursuant to which Building Permit dated ...... ~ ~A ~, 19.7/, 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 ..... ~f .... (~ .~./.4.5~ . . . ~l.f.~. ~.L. ~ ~/.~ ......... (owner, lessee or tenant) Suffolk County Department of Health Approval ............... UNDERWRITERS CERTIFICATE No .... I 0 o 0 ~ ~ Y ~/A'7'E',r'e__q '-R'v/a ~ [lOUSE NUMBER ...... Street Btuldmg Inspecto~ 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) No. 5149 Z Permission is hereby granted to: .............. 4~e~..~..~teet~ .......................... .......... :..-~mm .......... ~ ~1~-~- ........................ to .4~..--m..~t~..e~.-ez~t4~. ~m~ ............................................................ pursuar~ to application doted .~ ........... : .......... ~1~ ......... ~ ............ , 19..~., and approved by, the Building Inspector. < TOWN CLEIK'S OFFICE . / Examined ~...~...¥....~....'7....., ................. , !9-- .... ' ~ ~pplicration No ............. ~,~ ............. ,..vd ........... :.:. ...................... , ,,...':... , ......................................................... ~.. ........................ ,..,...~ ,~,..,~ ....... ;~.,., ...... ~ ........... .... " INSTRUCTIONS 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 premiMs or p~blic streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of ~i~ application. c. The work covered bY this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building In. spe~:tor will issue o Building Permit to the applicant. Such permit shall be kept on the p~emises available for irapection throughOUt the pragrr~s of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY NLADE to the Building Department for the issuance of a Bui ding Perm t pursuant to the Building Zone Ordinance of the Town .o.f Southold, Suffolk COUnty, New York, and other applicable Laws, Ord nantes or Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as here n descr bed The applicant agrees to comply with all applicable laws, ordinances~ ~nd regulations. (Signature of applicant, or name, if a corporation) . . .4. . . Z . ...... / (Address of applicant)t State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~...-..~....~e.~.../~....~.C~ .................................................................................................... ~'~ 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~ done. Map No.: ...~...~...~...~..~.,~-~.~....... Lot No.~ ........... Street and Number ..~/-~//-/,~A~..~ ........ · ........ ~L~.~J~...~..~..e~.G~.~Z~ ......... ~I t---fao o .~ " ....... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of praposed comtruction: a. Existing use and occupancy ~ e~ b. Intended use and occupanc?'....,~......~...c~.. ................................................................................................... 3. Nature of work (check which applicable): New Building ~ ................. Addition ../~.~ ....... Alteration .................. Repair .................. Removal .......... ~ ....... Demo t on.. . Other Work (Describe) ........................... 4. Est mated Cost .............. ~.~ .................. Fee .. ..................................................... (to be paid on fJ~ing 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. Dimensions of existing structures, if any: Front ..... .~...~. .............. Rear ..... .~..~ .................... Depth ...~.....~ .......... Height ......~....~... .......... Number of Stories ..... ~ ..................................................................................................... Dimensions of same structure with alterations or additions: Front ...... (.~..'-~ ..................... Rear ....~.~ ................. Depth ...l~.~ ..................... Height .....~.....~.. ............... Number of Stories ..... .J. ......................... 8. Dimensions of entire new cc~nstruction: Front ........... ~..~' ................ Rear ....(~...~.. .............. Depth Height .....~'.....~... .... Number of Stories ..J. ................................. 9. Size of lot: Front ......... ;...~.~ ......... Rear ......... .~.~ ..................... Depth .r,~.~ ..................... 10. Date of Purchase .......... ~..~..~/. .... Nome of Former Owner .~.~.../..~...~...~. .................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construcNon ~'iolate any zonJna aw, ord nonce or regu at on; '3. Name of Owner of pr?_emises~'~ -- '~---.~.~[,.~..~"~.~.~......Address .~.~.~V'Z.~...~..~j.~'~hone'N°'~.-~...~.~.~-- '"~'""'"""~ Name of Architect ...~.~..~e~l~.?~ ....................... Address .~..~..5~,.~.~[X~.~'....~..~.'.. Phone NoJl..~...~g,~ Name of Contractor .../../~,.~...,~'....~.~ .~.~_ ............... Address(~,,t~//~..~.r~ .~..~l~.~t/phone No.~ ./'..~./~..t~.~-"~ PLOT DIAGRAM Locate dearly and distinctly oil buildings, whether existing or pried, and indicate ~ll set-I:~:k dimensions from property lines. Give street and block number or to deed, nd shOW street names and indicate whether interior or comer lot. - '" ' - ~,1~ I'~ t STATE OF NEW Y~ORK, Je e COUNTY OF ...... ~ ~,'~',~.. ....... .............................................................. ~emg duly sworn, deposes and says that he is the applicant (Name of individu, al signing aPplicat on) above named. He is the (Contr_~,~tor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo'rmed 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 that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ~ / Notary Public, .:. ............. :; ........ :,rtlC.~x/?E~'~E~,.~.. County .... (~'n~'~i;~';~i ....................... +~Z,~ ~ 4z,? GEORGE G. FOSTER ARCHITECT II ,,L.. F_ 5"' .9 F U