The URL can be used to link to this page

Home My WebLink About5265-zFO]tM ~0. 4 TOWN OF $OUTHOL0 BUILDING DEPARTMENT Town Clerk's Office Southold, N, Y. Certificate Of Occupancy NoZ62.87 ....... Date ............ Ja~... 1.0. ...... , 19. ~ Mill Road THIS CERTIFIES that the building located at . R..O.W..~ .S/S. ~amgtes. D~, · Street Map No. XX ......... Block No. x~ ....... Lot No. ~... l~.l~t~ituek...N oY., ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~p~'it..' 29 19.~.1 . pursuant to which Building Permit No.. dated ............. A~orll.. 29 19.71., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Priv~l~e- ol%e. fa. mily. dw®t.timg, wi-th-an..add.i, tion. .................. The certificate is issued to . I4rS. Nilliam. R,..Killia~ ..... OWner. ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval l~l ,R, ............................ UNDERWRITERS CERTIFICATE No. ~. 92~.6~.7 ..... : ............................ HOUSE NUMBER .~100. Street . .(.R...0.~W,) W.$st Mill Road Building inspector~ FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5265 Z Permission is hereby granted to:/ pursuon,t to opplicotion doted .................. ~..~.(~.....]~:.].~. ............. , 19.. .C /. , ., and approved by the Building Inspector. $ ,~5~ ~ ,Fee .,; ..................... ......... ...~....:.. ............................ ;.2..: ........ J. ............. Building Inspector j IUILDING DEPARTMENT -- '~ ~....~/,~ TOWN CLERK'S OlllCl"~"'~'c'( ~ ~ ~ ~.~.~' SOUTHOLI), N.Y. _-~ ~ ~om~ .......... ~...~..., ,9..E/. /, , ~ ~ .. ~l~tl~No ............................. ................................................ : ............. .............. ..... .......................... 7 ¢' APPLICATION FOR BUILDING PIRMI! pete ............. ~...i .......... , ................. , ~9.....~..,..:~ INSTRUCTIONS This aPPlication must be completely filled In by typewriter or in ink and submitted in duplicate to the Building' Q. Inlpector. b. Pi? el.on shc)??R i?c~lon. ?f. lot a_.nd of I~_lldinga ? premim, relotlonshlp m odjolnlng premlim or public ~mets of a · work covered by this application may not be commenced before issuance of Building Permit. d. Upan ppproval of this .. . ppd.!lc, at. Io~,, .the Bulldln~ Ir4~. ctor .will Issue a Building Permit to the appllcent. Such permit shall be kept on me preml~e~ avapame mr mepectlon mroughout the pragre, of the work. e. No building shell be occupied or u~d In whole or In part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. R~eAPPLI_CATION IS HEREBY MA_DE to the Bu Id ~g Department for the issuance of a Building Permit pumuant to the ulld!ng ~e. O~lnance of the ~own of Southold, Suffolk CouN% New York, and other applicable Lawl. Ordlnancm m La ulat?l, tar the construction of bu Id ngl, addltlonl ar alterations, or for remaval ar demolition, el ~mln d~eHbed pppl.cant agrees to comp y w th all applicable lay4, ordinances, building code, hauling code., ~nd ._._r~atl~.-- ---' ~r~ ($1ln,tun of oppllcant, or name. If (Address of applicant) State whether applicant Is ~Vner, lo. Ge, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prom .e~ ............................................. ~ .... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) !. Location of land On Whlch~...O.,L~.prppceed w~k~[ ~_~. ,4// ~,,'////~/l/'~wlll ~1 done. Moo No.: ............ ~ ...........~.: ...{~, ............... 2.State ~xlstlng u~e a.nd occupancy of Promises ond Intended use and occupancy of prap~d aomt~uotlon: a. Existing ule and occuaancv .......... .~....0..~..~. .............. ' ~1. Nature of work (check which applicable): New Building ~ ............... :: Addition ......... ~ ........ Alteration .................. Repair ........... ~""7,: Removal .: ................ Demolition ...... ,...., ...... Other Work (Describe~. ................. ~ ..................... 4. Est mated Cost '....'.~..,..~ ......................... Fee ........ .~'..:.:.~j...o..._~.. ~ .... ' (to be paid on fi~lng this appliCation) 5. If dwelling, number of dwelling unJt~ ............ ~.-~'.. .......... ~Number of dwelling unit1 on ea~,l flOOr ........ ~ .............. If garage, number of cars . ..~." 6. If business, commercial or mixed occupancy/ spec fy nature and extent of each.t~1~e of use ......... ~ ...... · ---~ Ifany.' Front/-/'~-" Rear~.'/ ,.,:..,...~ ~. ' .... ~" 7. D, mensio~. ?~ e,xlsting structures, ..... ~./.....~ .......... ......... ........ Depth ............ Height ...... ~'--'...'~.. ............. Number of Stories ....,....~'... ............ , .......................................... , ............................ ~ .... Dimensions of same structure with alterations or add tons: Front ......~.....~... ....................... Rear ....'.~.~.. .................. Depth ...:.~..! ..................... Height ...~. ...................... Number of Stories ....~ ...................... Dimensions o~.entire new construction: Front .................................... Rear .......... .~..~. ............ Depth ....~.,7. ............... Height .....~..~.... ........ Number of Star es . . ./. ........................................................................ Size of at Front /.?...;~ .......... Rear ./..~.:.~.3.. .............. Depth ....~.../..~..;..~..~. ............... Dote, of Purchas, './...~.~/.;~ ........................... Nomo of Fame, ~---,. t~,~/,~ -~o~,Z~ ~ . Zone or use .distKict in which premises, are situated ...................................... ;;..', ......................... ~. .............................. Does proposed construction v o ate any zon ne aw ord nonce or r,~ulat on? ..... , ,,, , -~ ,o?~A.;~,..~..// ....... ~ ........ , ..................... Name of Owner of premses ?...'..;.~...' ./~..!.//./.e.../s. Address.~;(.:...~..I.~.2~ Name of Architect ...................................................... Address ............................................ phone No.~ ................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex sting or proposed, and Indicate all set-back dimensions from p.ro~..rty I!nes... Give street, and block number or description according to deed, and ~ho~reet names and indicate (Signature of applicant) ~ .o,f. said .o.wn.e.r or 9wner,s: and is duly authorized to perform or have per~ --'~*~u~!~O,z~on; that a, statements contained in th s app cation are true ?~.,~,, ,~- ,~t~. Ill b~.,l?ePfe~:,in the manne~ set forth in the application · 3worn TO oeTore me mis ............. ..yda of ............ ........... , Nota Pub c ................ ' ............. ry , · ....... ~ ........................... County ed the said work and to make and file the best/of his knowledge and belief; and there~m, ~ STATE OF NEW YORK, , I e e. ' ' couN'w OF . / ' ................. · ........ be,,,, du,y.wo.., d.pa., and.ay. 0. h.,.,4 app,,cant krqame of/Ingivlduaf qnl~ t// / . , / obove named. He is the ................ ~',~:,,,.:~ ........ ~...~....,/~.':; .................... L ............. 1. ~", '~ (~ntractor, ag"-/~'"¥"~'"'T'~nt, corporate officer, etc:i ...............