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Home My WebLink About5167-zFO~ NO. ~[ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Occupnncy No. ~1~321 ...... Date ............ A~,u~t.. 9 .... , 1g.7.1. THIS CERTIFIES that the building located at .FSd~iler. I~ ............... Street Map No. x~ ......... Block No.. XX ...... Lot No. ~ .... 61'eenpor.t.. N,X, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... l~,~x~ · · .1.~;.., 19.7-~ pursuant to which Building Permit No... ~.1.~ dated ........... 1~]~...1.~..., 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 .... Fri.~ate. ~ne..f. am~l.y .dwetl..~ng .................................... The certificate is issued to . G.e. rarcl .&. l~tha...Le2xien ....... 0wn~s ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Hm~se ~ ~1~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT 2 frillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 5i67 Z Permission is hereby granted to: ............... ~.~..4..~r..~ ......................................... ................. ~en~rl~ ....... a.~.~ ....................... i to ..... ~..~.~t~.~..ez~n~..~---,,~ ~:tJ~ ......................................................... ~t premises located at ......... [...~ .~...~.~.~.~..~.~..~..~.~.~...~..~..~.~.~..~..~..~.~..~...~....~.. ............................ ..................................................... ~.~~ ........... ~.:[, .............................................................. pursuor~ to opplication d~ed ............................. ~.~.. ....... ~i.~. ....... , 19...~....., and opproved by the Building Inspector. '~:ee *...~.'.~ ........... TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE Examined .......................... , 1 . '" 19.!~ ..... Permit No. ~' / ~ 7 ~ Approved ........................................ , ............................ Application N o..~.../'...~...X~... .............. Disapproved a/c ........................................................... APPLICATION FOR BUILDING PERMIT I'/'-' INSTRUCTIONS o. 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 of property must be drawn an 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 application, 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 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 MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance 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 demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, I~ilding code, housJng~code, and regulations. J (Signature cf appl~o6t,,o~me,7 V if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builds- ................................................ .......................................................................................................................... Nome of owner of premises ~-...(~....~...'~...~.. ~..../~..../~.../~,.~-.../('..~. A~- ,~.,,~.~-/~/ 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. Map No.: ........................................Lot No.: .~ ...... Street ond Number ............. ....................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy use and occu anc,' ~/I~>~/~'~-'~'L~..~..~...~...~...~...~.. b. Intended p . ' ..................... .~...:!.~ .............................. ~ ............................................................... 3. Nature of work (check which applicable): New Building ................. Addition .................. Alteration .K ............... Repair .................. Removal .................. Demolition .................. Other Work (Describe} ........................................ 4. Estimated Cost ..~'...'./'...~'.~-~-"-~' (to be paid on fi!lng 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 occupancyi spec;ify~ nature and extent of each type of use ............ ; ............... 7. Dimensions of existinn structures if o,,,,' Front .~...~. o,-. ~ Height ............. Z~. Number'of ~;~;,es ...:'"/: .'".i.i...iii~iii'i..'~'~:...::":i:~.~::['::i:"['"ii:[[:" ..~.~::: ........... ; ........ Dimensions of same structure with olterations or additions: Front ........... .~L..~.. ................. Rear ...~..~... .................. Depth ~.~ ..... He ht ../...'~.... u ' .................... g .............. N mber of Stories ........ , ...................... ' .~..' 8. Dimensions of entire new construction: Front ....~.. ............................. Rear ........................ Depth .....~c~....i ............ Height Number of Stories 9. Size of lot: Front ...... .~..~...:, .....Rear .~...~....i ............. Depth .../.~O ' ... 10. Date of Purchase ..........I!'/..~.~..~..~..~ ................................ Name of Former Owner ....................... ..~4~..~...~.......~..~..~'~'~ ........................ 11. Zone or use district nwhchoremsesarestuated /~....~...$/~/7'/~9~( 12. Does proposed construction violate any zon ng ow, ord nanoe or reou at on? ............. 13. Name of Owner of premise~...~.~.~.~...~'.-./~...~,: :Address .~...~ ............................................... ....~...~... ~.~..~hone I~ ~.~..~. ' ~/~'~ Name of Architect ...................................................... Address ......... ;~. ................................ Phone No.' .................... Controctor~', ~'~//'6~x' 7'~ A,e4 ~' 'Adw~-~ /~.. No.~.~.,....~..~..~..~ Nome of ..................................................... ress~.....~...~. ..................... ~ .....Phone PLOT DIAGRAM ; F~ae~te clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back d mens ons fram 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 NEWL~_OI~,~7~, tee o[i ---] (Name of Individual slgnfn'g appllcaiCon) above named. He is the ....................................... ~ ................................. .~ .................................................... (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 a~d 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, State o~ New York .o. 52-8125850, Suffolk Term Expires March 30,