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Home My WebLink About5177-zTOWN OF $OUTHOLD BI~m.nING DEPARTMENT Town Clerk'~ Office $outhold, lq. Y. Certificele Of Occupancy No. ~67.~.~ ...... Date ........... ~/ep~ ...... 2.~. :., 192~. THIS CERTIFIES that ~e b~g locat~ at . .~..~es~ .Hill .~ ....... S~t Map No. ~ ......... Blo~ No. = ........ ~t No, .= ....F~t~u~..~ ,X, ........ co,om su~t~fi~y to ~e AppHeaSon for B~g Pe~t h~eWfo~ ffl~ ~ thl, o~ce dat~ ............ ~r.. ~., 1~. ~.l pm~t ~ w~ch B~dJng P~t No. ~ dat~ ............ ~.. ~.., 19~.1.., w~ ~u~, ~d co~o~ ~ ~ of ~e ~ men~ of ~e applicable pro,iota of ~e law. ~e occup~ for w~ ~ c~ca~ h ~su~ ~ . Business. bull~n~. (. ~eata~t). ~it~ addi.tion. & .al~ration. ~e ce~icate ~ ~u~ W . A1Sr~..q~ ...... ~F. ............................. (o~, less~ or ~t) of ~e ~or~d b~din~. S~o~ Cowry Dep~ent of He~ Approval ~,~e ............................... ~~IT~S C~T~CA~ No. P~4~ .................................... HOUSE ~ .. ~C.5 .......S~t .. Jie~..~:$~ .~C~l ...................... . C~y. of..G/0; .pic~d. up. A. p~d. by..~. B~be. ~29~ ..................... ......,. ........ B~dlng ~r TO~(N OF SOUTHOLD BUILDING DEPART~£1qT TOWN CLI:RK~$ OFFI~£ SOUTHOLD~ N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5~77 Z Permission is hereby granted to: ................ ~.!.~.~ ........ ~...~..~.~..C..~. pursuant to application dated ................................ ~.~.........~....~...~.., Building Inspe;:tor. .~ ~.....~ .............. 19.7..l.., and approved by the Building Inspector lt~J~r No, 1 TOWN OF SO~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥. Examined .......................... ~ .......... , 19..~.... '% ~i~pro~d a/c .......... ~_ .~ .................................. ........................ .............. (Building Inspector) Application No......~...../....'~...~... ....... APPLICATION FOR BUILDING PERMIT Date ............... ..~.....~....../.:. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und 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 de'roiled description of layout of property must be drawn on the diagram which is pert 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspec'tor. APPLICATION IS HEREBY MADE to the Building Depertment for the issuance of a Building Permit per~uant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ord nantes or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr bed The applicant agrees to comply with all applicable laws, ordinanc~,,~building code, housing code, and regulations. ......... .,...-,- ~..~.<,. ~..../..~~.£,,,:?-' .................. /'(Signature of applicon_t, or norr~, if a corporation) ........... PP ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ .~/~..~.~.~ .......... : ................................................................................................................ Name of owner of premises .......~.~ ........... .~ ................ ~...~: ................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Lacation of land on which proposed work will be done. Map No.: ................ /~.../~ .............. Lot No.: ........................ Street and Number ..,...~....L:..~......../..~/../.~./~......~.0.~. ................................ ,~.~./'~.../..~-,.u~ ....................... Munlcipelity 2.State existing use and occupency of Premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ...~..~.~.~..~.~.~x:2~.../~.......~.....~./..a...7~../~.~. .. ~ ......................... b. ' ntended use and occupancy ~ ......%.~.......7'.~'..-~. ~.£../.~( .~. ~/.~'$' ..=...../~?.r;..~../..~.....?~47,~4(. ~....'...~...~'.../..~.......~/?.~.¢~ 3. Nature of work (check which applicable): New Building ~ ................. Addition............,.....~ Alteration .................. Repair .................. ~Removal ..................Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ~...'~...~....~.....~.. ................. ~ ...... , ....... 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 ...................... ~-~4/ 6. If business, commercial or mixed occupancy/ specify nature and extent of each b/pa of use 7. Dimensions of existing structures, if any: Front ....... ..~....~.. ............. Rear ~'~ ~' Depth Height .......c~......O. .......... Number of Stories ........ ~ .......................................... ~, ........................................... / ........... Dimensions of same structure with alterations or additions: Front ........... .?.~... .............. ~ .... Rear ....... ..7..?... .............. Depth . .~...~.. . Hei ht ...... .~...~. ,,~ .... Numb~ of Stori t 8. Dimensions of er)tire new construction: Front .../'/~..?...~};.../..~..~..?...~:ear ...................... Depth ............ Height ....... ./..~.. ...... Number of Stories ........ ./. ....... ' ........... ~- ............ Size of lot: Front ......./Z/X'../~/..../..~..C...~...~-~ear .................................... Depth .......... iiiiiiii'~'~ .............................................. Date of Purchase ......~:...?~,..~...~...~...~... .............................. Name of Former Owner Zone or use district in which premises are situated ...................... .: .................... ./.. Does proposed construction violate any zoning law, ordinance or regulation? ././. Name of Owner of premises ...'~..~.?....~..~......~.~.~..../~...Address Name of Architect ................................................... Address ~ Name of Contractor .....~..~...~.,,~.,~,........~...~.../...~....~.~..~......Address~/~'~'7- PLOT DIAGRAM ~ ~ete clearly and distinctly oil buildings, whether existing or pr~pe~<lines. Gi~e street and block number or description whether interior or comer lot. ~ Phone No ..................... I No ........ all est-back dimensions from street names and Indicate STATE OF ' ' COUNTY OF ~S..q. ------ ................... , ............................... .-~ ...................... duly sworn, deposes and say~ thor he Is the applicant (Name of Individual signing application) above named. He is the (Contractor, agInt, co~oratl officer, It~.) of said owner or owners, and Is duly authorized to perform or have performed the said work and to make a~d flli this application; that all statements contained In this application are tmi to thl best of his knowledge and belief; and thru the work will be performed In the mannl~ ~et forth In the application filial thlrewlth. __ Swam to before me fi'III ................. w york / '