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Home My WebLink About5175-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~+1.82.. Date April THIS CERTIFIES that the building located at l~t R~a~l Map No. C~ll~. Belt PE31ock No. Lot No. Pi; -!+~t1+9~51 Street $outhelel N conforms substantially to the Application for Building Permit heretofore filed in this office dated .. March 19 19 71 pursuant to which Building Permit No. ~]~Z dated March 19 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 .. Private .erie .family. ~welling The certificate is issued to Jeh~ Wi~se~nm. · of the aforesaid building. Suffolk County Department of Health Approval Heuse # 390 f~rner ....... (owner, lessee or tenant) · N.R, ............... PVT ........ ' Building Inspector TOV/N OF $OUTHOLD 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. 5175 Z Permission is hereby granted to: pursuant to application dated ............................... XGt~Ii' .......... ~ll~ ....... , 19~..t...., and approved by the Building Inspector. £ee $'~v,,'O(~' ............. TOWN Of SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OI~FICE SOUTHOLD, N. Y. ~ 19 ........ Permit No ............................. Approved ........................................ Disapproved a/c ........................... ~ t..~~ ~ - ~'~:'~'''''~''''~''''~''~ ............... t ............... .................................................... APPLIP..,ATION FOR BUILDING PERMI1 // ApPlication No ............................. 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 premises or public streets or areas, and giving a detailed description of layout at pruperty must be drawn on the diagram which Js part of this application. c. The work covered by this application may not be commenced before Jssuoflce 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 ir,,spection 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 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 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, bu,ildJng code, housing, code, end regulations. (Signature of applicant, or name, if a ~orporation) (Address of applicant) Name of owner of premises "4:""~'"/'""~"'~"~'/~'"'~'"~"~' ........................................................................................................ If a~licant is a co~orate, signa~re of du~ ~orJz~ officer. ~ (Name and title of co~orate officer) ~ ......... ........ '. ............. 1. Location of land on which prap~ed work will be done.~ap Street and Number .................. .~. ........................................ .Q.~. ................................... ,/,,:~m..,.--~l~ ~ ,.j:,~'O Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~_ /~- / ~' b. Intended use and occupancy ............... .~.~.~ ............................. ;: ................................................................. Nature of work (check which applicable): New Building .................. Addition ................../ Alterotion .................. Repair .................. Rq.moval .................. Demolitio~ .............. ;;,, Other Work (Describe) ........................................ 4. Estimated Cost ........ i~.......'~...~...~...'....'~.. .......................... Fee ....i. .............................................................. (to be paid on filing this opplicotion) 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 end extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front .....~.. .................. Rear ...... ...'~....~. ................ Depth ...~.~... ........ Height ...../.2~..(. ......... Number of Stories ........ Z ...................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height .......................... vN~mber of Stories ................. ~. ............. 8. Dimensions of entire new construct on: Front ........ ./...~... ................... Rear ........ /.....~.. ............ Depth .,./...~. ................. Height .....A.~...f. ......... Number of Stories ..... ~.. ................................................... , .......................................................... 9. Size of lot: Front ............................ Rear ................................... Depth ....; ......... ~ ................. 10. Date of Purchase ...... J..~....~....~.. ................................... Narn~ of Former Owner .~.~.~...~../..C. ............ : .................... 11. ZO~e-~'r--~'~-district in which premises are situated ......... .j~'.~.~-~.~.. ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Ow.er of premises .~..~..~.~e~l~. ....... Address ....;~.L?.~.(.d. ................. ~ No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Co,tr~tar ..~.:...~..~ .................. Add,,, ...~.~I.~...~ ................ P~ona No.~..4~.:~. 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 shaw street names and indicate whether interior or corner lot. ~'~"~:.x'~~.~.:l ~ ' STATE OF NEW yOR COUNTY Ot: ............ ~ ................ ;~ S.S. / ...................... ~. ~..~.~. ...... ~'~..~.JJ[~(~..~......, ................. being duly ,orn, d~es and says t~ he is t~ applicant (Name of indiVidual ~gni~ati~ ,s ............ : ....... ..................................................................... / ~ . ~tmc~r, ~t, co~e officer, ~c.) of said ~ner or ownem, and is duly authorized to perform or h~e perfo~ed ~e ~id work and ~ ~e ~ file this a~l[cation; that all Statemente c~ined in this appIJc~Jon am frae ~ ~e best of his knowl~ge a~ belief; and that the ~rk will ~ ~rformed in,he manner ~t fo~h in the ~lic~i~ fil~ t~i~. Swam to ~fore me th,s ~ ~ // ~ 4 / ........... ....... o,