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Home My WebLink About5258-zFO~M NO. ,1 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~2~ ..... Date .............. jgl3r .... 1~.., 19. '~t THIS CERTIFIES that the building located at . .1130. · -Peq~ash. A~e ...... Street Map No..~Z ......... Block No .... ~a~ ..... Lot No. ~1~1~.. g~tehe&~tt® .... I~.Y~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .............AI~I'~i' ~.~19.71. pursuant to which Building Permit No. ~.. dated .......AI~.$1 .... 2~. ., 19.?~l:, 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 .PA'iv. ate. aeeeale~..(crew-age), i~tlA~al ............................ The certificate is issued to . .gl~elte~. Ee~alelk~ & .~ife ...... 0~nerl ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ N. :.R.,. ....................... Building Inspector ~ FOR~ NO. ~ 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? 5258 Z Permission is hereby granted to: ............. ~ ....... ~ r././~L d.L.~:..~.~./.:....~...?../:~ premises located ot Building Inspector. Bui d ng Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................... ...~....~....~, 1~.../..... Approved .................... ..~.....~......~i, 1~.'.~.".. Pemi, No ..... ~' ..~.....~'....?.......~... ..... D~sapproved a/c ......... ~ ........................................... ..................................................................... ........... .... (Bui[din~ Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. ~''~ a. This application must be completely filled in by typewr ter 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 adjo n ng prem sas or public streets or~ areas, and giving a deta led description of layout ofproperty must be drawn on 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 have been granted by the Building Inspector. j~ 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, building code, housing code, and regulations. (S gnarure at applicant, or name, ir a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises If applicant is a co~orate, signature of duly authorized officer. (Name and titb of (o~orate officer) ]. l~ation of ~nd on which pr~osed work will be done. M~p No.: ........................... ~ ............ Lot No ......................... Street and N3mber / ~ ~..~ ~ F ~ g.~.~.~ .......... .&.~ ......... d U ? ~ H O ~ U E Municipali~ 2. State existing use and ~cupancy of premises and intended use and ~cupancy of proposed construction: a. ~isiting use a~ ~cupancy ~ D b. Intended use and occupancy ~ A ~q ~ ~ I ~H ~ ~ ~ ~ L~ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alterotion .................. Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost .................... ~ ..O..O....-~..... . Fee ........... ...,~...,o~.~... ................................................................ (to be paid on filing 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................. I ................. Rear ............................ Depth ...../..Z...?~.. ........... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 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 ~ ~01~/~I.,ESI~ .~Af~/[~s .~..E.~U~SH AV ~U.~. Phon "7~/ ~1,~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................... ..~..~...~....~.~. ................ Address ............................................ Phone No ..................... 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 show street names and indicate whether interior or corner lot. . ~1~ ~ STATE OF NEW YO~[,,. ~ · t - ~ COUN~ OF ..~J[. ......... ~3'3 ............................................................................................... ~mg duly sworn, d~s and says t~ he is the applicant (Name of individual signing application) above named. He is the .... ~.~..~ ~ ~. .................................................................................... .......................................... ~ (Contractor, agar, co~orate office~;';tc.) " of said owner or owners, and is duly authorized to perform or h~e performed the said work and to ~ke and file this application; that all statements contained in this applic~Jon am tree to the best of his knowledge end belief; and thor the work will be performed in the manner set fo~h in the ~plic~J~. fil~ ther~ith. Swam to ~fore me this ...... .... Nota~ vublic, ~~~~.. Coun~ (Signa~re of applicant) NOTARY pUBLI~ ~ate 0f New Yo~ N0. 52.8t25850, Suffolk C~ Term Expires March 30, ~