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Home My WebLink About5205-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~:.h00 ...... Date .. $.e. pt .. 29 THIS CERTIFIES that the building located at . &~ ,~re .. Map No.pee,. ~h . Block No ......... Lot No.l+ · Pe¢or~i¢ ......... Street .N .Y., ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~p~'i]-"' 1~.., 1974 pursuant to which Building Permit No. .~20.~. dated .......... 4~pr- ~ . , 19 ?i., 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 one. f~taiLy..dwe~llng ............................. The certificate is issued to . ~lr ,- John:' .(,xee "~)~mer ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....... ~., ......................... Building Inspector ~ FOR1V~ NO. 2 TO~N OF $OUTHOI. D TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5205 Z Permis-~ion is hereby granted to: .lel~-.~t~t~. -.~....~.~-&..#l.te at premises located at ...; ...... TMI~{J,-4~- ...........~-.IJl~ttl~-iHli ..................................... : ................. ...................................... ~..a~m~.A.~m .......... l~me~e ............ ~. ................. : ................................ pursuon~ to application dated ..............t ....... :.---~ .~ .......~-: .......... Jg...~l~, and approved~by the Building Inspector. ~ ~....~.,~ .......... FORM NO. I Approved ........................................ , ,_TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. 19 ........ Permit No ......... Application No.....'~...'~.....?.~... ....... Disapproved a/c ..~~-~..~..~...,~..~~ -~- (Building Inspector) APFLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Buildi, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is p~rt of this applicatio 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 o Building Permit to the applicant. Such pert, 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 Occupan shall hove been granted by the Building Inspector. APPLICATION IS HEREBY/V~DE to the Building Deportment for the issuance of o Building Permit pursuant to t~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordirmnces Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with oil applicable lows, ordinances, building code, housing code, and regulations. ..... ............. (Signature cf applicant, or name, if o corporation] (^~,~qress of applicant),'~/' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build- Nome of owner of premises ...~,.~ ..... : ..... ~, ............ ~.....~ ....................... ~ ................................... ~ ..... ¢ .......................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which prop~osed work will be done. Mop No,:~,~.~,,~.~ot No,: .,.',.X:,..,: ...... Street and Number ........... ~ ......... ~; .......... :~ ......... ~..,,-~~ ............................................. Municipality 2. State existing use and occupancy of premises and intended use .and occupancy of proposed construction: o. ~:istin§ use and occupancy ........... ~..,.~..~.~ ................................................................. b. Intended use ond occupant',', ......... ~......~....~...~.... ~ ...................................................... 3. Nature of wink (check whici~ a~plicoble). New Building .................. Add,tlon .................. Alteration ..... Repa r RemovaJ Demoht:on , .,._,Other Work (D~scribe 4. Estimated Cost~(.....~...~..~..~.....: .................................... Fee ............ ?.!..E...c. ...................................................... (to be pa~d on fi'rog this apphcatlon) 5 If dwelhng, number of dwelhng umts ........... ./... ........... Number of dwelling units on each floor .................. ~ ...... If goroge, number of cars ........................................................................................................................................ 6. If business, comme-c,al or mixed occupancy, specify nature and extent of each type of use ....................... 7. Dimensions of e).bt~ng structures, if any: Fron~. .~..,,}..-..~.~,~L~.. ...... Rear ....~...~..~..~.....-~.. ........... Depth ..~...~. ~..'~... Height .../.~... ........... Number of Stori.s ................... ~ ...................................................................................... D~mens,ons of same structure with alterctions or additio,~s: Front .... .~....~..~'.~....--~.. .............. Rear :~, .~...:.......~- ..... Depth ..~..$. ....... ..~ ............ He,ght ...../..:.~..;....~... ....... Number of Stories ............................. 8. Dimr~nsions of ent,re new constructian: Front '-- - Rear ...~....~......-~.. ........... Depth ..~..~:.~ .......... Height ..~.~.'..~...,.-~..... Number of Stories ............... ./. .................................................................................... 9. Size of lot: Front ..... .............. P, ear ..... ................. Depth .... ~..../...~..7.~. .......... 10 Date of Purch=se ..................................................... Name of Former Owner .................................................... 11. Zone or use d~strict in which premises are s~tuated .................................................................................................. 12 Does proposed construction ~iolate an~,~zoning law, ordinance or re~gulahon? ..................................................... 13 Name of Owner of prem~.se~..:...~..~.'..~..~.~....~..-...Address .... /.~:,.~ ' Phone No 7~/:;--- J~f'~ Name of Architect ........ ....; .......... ......... Address .......................................... Phone No .................. Name of Contractor ...~..~..~....'!~....~c.x .~.~~...'.' ~; ........ Address ..~:'~:~..-:z. ............... Phone NoZ. Z../...~.~..'..?'..¢ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fron property Iines Gwe ~treet and block number or descnpt~on according to deed, and show street names and indica,, whether interior or corner Jot. STATE OF NEW YORK, ~¢ COUNT~/~OF ........................... :....~'~"~' .......... ./.L".¢../~.~Z .~:-...~......~..:.....J'...~,¢...'~....~../..~ .............. be,ng duly sworn, deposes and says that he is the apphcam (Name of individual signing apphcaHon) above n~med. He ms the .......................................... J.'.~t~/.~¢,,~./.~ ................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the so~d work and to make and th,s application; that all statements contafned 'm this application are true to the best of h~s knowledge and belief; ant ti,at the work wdl be performed in the manner set forth in the apphcation filed therewith Sworn to before me this _ - . /~ __ ~ ......... ........... ............. No 52-8125850, Suffolk County. Term Expires March 30,