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Home My WebLink About5255-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Occupancy THIS CERTIFIES that the building located at ~[,0,M.,Off. Map No. ~[~ ......... Block No. ~ ........ Lot No...~.. .~..~,~.~0l~... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... &p~:L~. gl., 19. ~).~. pursuant to which Building Permit No. ~.~J~... dated ........... &t~)~l...~12., 19 ~.., 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 . 1~*~,~. ~e. f~l}'. ~el]-~g ...................................... The certificate is issued to .. ~ohlq. I,,. P.~o~k. · ~)... O~el* ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval M~)..~O · .¶9~ .b~. II, -~. 1~ ...... UNDERWRITERS CERTIFICATE No .................................................. HOUSE NUMBER.~.~)O~ ...... Street.. l~el"~ll- ~rlY~.~ ......................... Building Inspector FORi~ NO. 2 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) N? 5255 Z Permission is hereby granted to: to ~g,i~i~ .. ~ ~¢ .,~,O...~?~ ~.]L.~,.. 4~ ~ ~ .~,~ ......................... ................................................. at premises located at -~ ' -~ ~' ~ ~,~/f~ ~'~. }te~z~, ,, -~/~ [(*~l~t'-'J~tT~et¢..~a~. ......................... ................................................ ~h~'~:~ .......... ~.**~ ................ : ......................................................... pursuon¢ to opplicotion doted ............................... ~r~. ....... ~t*'**' 19~,j***, ond opproved by the Building Inspector. Fee $..!i~ ~.~0 ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Permit No. 5~ '~ '~/ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and folund to be satisfactory. BUILDING DF. PAILTMNNT TOWN CLERK'S OFFICE '" 2/. ^pproved ........................................ , I~. . Permit No . . Diseppr'~ a/c ............................................................. ~ (Building Inspect~ APPLICATION FOR BUILDING PERMIT 19..~../..... Date INSTRUCTIONS a. This application must be completely filled In by typewriter or in ink und submitted In duplicate ,~ the Buildlng'~::; I~tor. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premieal or public streets areas, and giving a detailed description of layout of prapertq/must be drawn on the diagram wi~ch Is I~t of J~le apl)llcatton.'~'_' 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 al~llcont. Such shall be kept an the premise~ available for nspect on throughout the progress of the work. ' ~tt e. No building shall be occupied or used In whole or in part for any purpo~ whatever until a Certificate of Occupancy shall ha~ been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk Count, New York, and other aplallc~le Laws, Ordinances m~ R.,,egulat .k)ns, for the construction of buildings, additions or alterations, or f.or removal or demolition, al herein described. I ne applicant agrees to comply with all applicable laws, ordinances, building code, housing code, end reguletlorm. ........ ....... : ........................ ~.(S~.~atu~ o al~licant, ~ rfe~ne, If a coqio~Qtlon) ....... ........... , ......... ,. (Ad'dress HT applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ..e...~..~ .................................................................................................................................................................. N~me bf owner of premises ......... : ................... ~. .......................................................... ,. '~L~ applicant Is, a corporate, s~gnature of duly authorized officer. (Name and title 'of CarT)Prate officer) ~ 1. Location of land on which prOpo~ect"WO~r~,W[ll be done, J~Aap No.: ................................. Lot No.: ........................ · - . Municipality ' 2.State existing use and o¢¢uK~ancy of premises and intenttect.u, se and ocCul:~ncy of proposed comtruct'lon: a. Existing use and occupancy ..,......~..~....~,.~...~...?.. ......... ..~..~.~..~....x:.~....~/, .~. ................................................................... b. Intend,~ u, and ocC,~an:'.. ....... ~./..P~.~.~.....'..'. ................... i ................................................................ 3. Nature of walk (check which applicable): New Building ....~ .......... Addition .................. Alteration ............. Repair .................. Removal .................. Dem°lifion .................. Other Work (Describe) ...................................... 4. Estimated Cost .......... ./2(.Of ......... ~.~ ~.~ ........................ · t-ee' /, ...................................................................................... O (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 .....~....~......~.:~Z~ ...... .~...~..~..~...?..~....~..~... ......... ~..~j[ .~...#...~....~.. ....................................... 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 ......................... ~ ................................................................ _. ',..L... Dimensions of same structure with alterations or additions: Front ........................ ~'~.'. .......... Rear Depth ~ Height ............. .-: ............. Number of Stories ............L ................... 8. Dimensions of entire new construction: Front ......... .~...~......~ ............. .. Rear ........... .~..~. ........... Depth ..... .~...~... .......... Height ...~..~,....~...t. ...... Number of Stories ..................... ~Z. ............... ............................................................ ~ ................. 9. Size of. lot: Front .;:...~..~...~.../. ....... P, ear ....... ~.~....~..~ ................ Depth ....*~-~..~....~......~....~..~ ! 10. Date of Purchase ....... ~...~..~..,....~...~.~,.../..~..~..~. ....... Name of Former Owner ...~...~..,~....~...~:..~'..~...~..~...~.....A'..:...~..X:.~...~...~ 11. Zone or use district in which premises are situated ...~..~..,~./.~.....~..~./...~..~ ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~..~. ............................................. 13. Name of Owner of premises ..-J.~.~...~.......~...~...o.~'l..~/~ddress ~;~..~..~.~...~..~..~..~..,..~.,~. ...... Phone No. ~.~:.'....~.~?..~ Name of Architect ...................................................... Address ........... ~ .......................... Phone No....~ ................ Name of Contractor .~..~...~/.~.~.. ....... ~...~../...~.... ......... Address .~'.~.....~.....~'...~..~....~..?.....~..:.~.... phone No. ~.~.~...:..~..~ .~ PLOT DIAGRAM Locate clearly and diStinatly 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 show street names and indicate wyther interior or comer lot. STATE OF NEW YO~K S'c,4,~.~ !" .: /~e ~ COUNTY Of ..6Lu..~.~.~.~/..<. ........ ~*'0' ~ .......... J.~..~....~.........A.~:.~....X:....O...~...~'.~,.~.~l .............................. being duly sworn, deposes and says that he is the applicant (Name of individual S~nlng application) above named. He is the iJi~.....~..~-...~..~...~...~...~...~.. ......... e..../~....,A/..~...~. .............................. ':: ....................................................... (Contractor, agar, co~orate officer, ~c.} of said ~ner or owners, and is duly ~zed to perform or h~e perfo~ed the said work and to ~ke and file this application; that all stotement~ in this application are true to the ~st of his knowledge a~ belief; and that the work will ~ performed in the~'~ forth in the opplicati~ fil~ therein. Swam to ~fore ~ ~is ~ ~ .......... ..... ................/ / ,~. ~. ~. ~ %~%4 ~ ............ ~ ........... ~.:..~...~ .................... hlotoe/Public, ~.~/.~./~ .................. ~.~( ~ ~ (Signa~re of applicant)/