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Home My WebLink About5173-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~[ . . Date . . .&pr;~l,. · 2~ , 19 THIS CERTIFIES that the building located at (}grtli~m"A' I~t &'~o~ A~freer Map No. Fa~e~ ~lock No ...... Lot No.. ~ · · ~ola ~,I, . conforms substantially to the Application for Building Permit heretofore filed in this office dated ~a~ $~ 19.~ pursuant to which Building Permit No. dated .~ 4~ , 19 ~., was issued, ~d conforms to ~1 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is '~Va~e '~e' fa~l~ ~wa'~l~ ............................. The certificate is issued to Vig~ 'O$~*~i .... ~e~ .......... (owner, lessee or tenant) of the aforesaid building. Suffolk Co~iy Department of Health Approval A[~il~ '2~- ]9~ ' ~'~* ~itla UNDERWRITERS CERTIFICATE No . p.a~ ........ ~ ....... ttOUSE NUMBE~ Street ~e~ ~' ~ Braiding Inspector \ \ FORM~ I~1'0. Z TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SO~H~D, H. Y. N°. BU~iLDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: . .-~,~-.~ap~i~..-.-~i.-~i~.-.-e,~ ...... to ....-.-t~mt~--ae~ .-~ms-.-t~amits'-. a~et;l, ing ............................................................................. at premises located at ........ ~b~ll~,...~....ji~iE~.~j:gM,..l~llt~I; .............................. [ .................................... .......................................................... ilmu~l,ll ......... ~.~ ............................................................... pu~$ucmt to opplicotion doted .................. ._ ......... ~ ..........~ .......... , 19..~[.., ond opproved by the Building Inspector. Fee $.-.1~{i~ ......... Ir S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: z The sDwage disposal facilities for a structure located at ~ ~ (Give deed location/ ~ ~ have e~en inspected by this department and found to be satisfactory. TOWN OF SOUTHOLD':~ BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICE ~THO~, N. Y. /~/* ~ ,., ~17~ ~amin~ ~pp~i~t~o~ ~o..=.......~.~. .......... ~i~pp~ed ~/~ ............... ~~ ........ ....................... ........................ (Building In~p~tor) ........................................................... ....... o. Thi~ ~pplicotion mu*t b* completely {i11~ in ~ ~p~writ~r or in ink In~oc~r. b. ~lot plan ~howlng I~ation o{ lot ~ o{ building~ on premlm~, ral~tion*hip to odioini~ pmmi~ or ar~, ~nd ~ivi~ ~ d~iled d~ription o{ I~out o{ pro~ must b~ drawn en c. ~ ~ork covered by thi~ opplic~fion m~ not b~ ~ommenced b~{ore d. ~pon ~prov~l o{ thi, ~p~licotion, th~ Building In~p,ctor ~ill ~ue ~ Building ~h~ll ~ k~pt on th~ pr~mise~ ~oil~bl* {or in~poetion throughout th~ pr~re~ o{ th~ wark. e. ~o building ~11 b* ~cupied or used in whol~ or in part {or ony pu~os~ whot~v~r *boll h~ be~n Omnt~ by th~ Building In~pactor. APPLICATION IS HEREBY/V~,DE 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 6pplicnble laws, ordinances, building code, housing code, and regulations. (Signature cf applicant, or name, if a corporation) (Address of applicant) State whether, applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde(. Name of owner of premises ...... .~.(..6 ....... ~..~.~'c.h.l.~l.,. ................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) I. Location of land on which proposed work will be done. Map No .~../'./(#/.L~......~.d...~.~. ........... Lot No.: ....~.. . Street and Number ~/l~'z~.l~l,~ .I~..,~..~J~.J~YJL..~'/~.~. ...... ..~...~...~.. ................. ~..~..~..~.../~. .............................. ' 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 occupan:.-, . ...... ~.~.~'z~..~,~... ......... .~ ............................................................................................ 3. Nature of work (check which applicable): New Building ,....../.... ..... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..........~...?~..~..o...o. .................................. Fee .......................................................................................... (to be paid on fi!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 sarne structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ ! 8. Dimensions of entire new construction: Front ............. Z.~.../. ............. Rear .......... ~...~..~ ......... Depth ..... ,~l~. ........... Height Number of Stories _Z' D .... ./..~...~.. ...................... Depth ..... /./~. .................. 9. Size of lot: Front .~.:~,,~'~.~ ............. Rear 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ P 11. Zone or use district in which premises are situated ....,,~, ....... ~.~/.~./.~... ............................................... 12. Does proposed construction viola.te any zoning, la,w, ordinance or r,egulatlon? ...... ~/.~'. .................................... ~ ......... 13. Name of Owner of premises .~.(...~..?..~.~'.~).L.q.I .......Address ~.~.l.f~...~ .~..~J~.....~...~..~r.... Phone No,,~X'.,~...~'.~'Z.~../~'/ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....... ,~(~...C ................................ Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and Indicate oil mt-bock dimensions from propm ry. lines. Give street and block number or description according to deed, and show street names and Indicate wheth, ~r mterlorlor comer lot. / STATE OF NEW ~RI~J_ ~7/. ! e. ......... · .~.~_.~L...~:..,..~...~ ........................... being duly ~rn, d~mes and says t~ he Is the applicant (Na~e ~f Individual slg~lng oppllcatl~) above named. He is the ........................................ ~ ~..~ ...................................... (~ntmctor,~t, co~omte officer, ~.) of said owner or owners, and Is duly authorized to pedorm or hove perfo~ed the said work and to ~ke ~d file this application; that all statements contaln~ in this appllcatl~ am tree to ~e ~lt of his ~ow ~ge a~ ~lief; and that the work will be performed In the manner set fo~h In the appllcatl~ filed t~r~ th. Swam to before ~ ~ls ~_ , ...... ........ ......................................... N~ARY p~, ~te ~ ~w Y~k ~- 5~12~50, r.m Expi~s M~h ~, ~