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Home My WebLink About5269-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~3.0..1~. ..... Date ............... AII~, · · · 9"" 19 THIS CERTIFIES that the building located at . .¥:[llage. lame ............ Street Map No.. azr~x ....... Block No .... ~X.. Lot No..~ .... 0r.$el~l;- - .I~ oX.o .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 14ay-. - 3' ' ' 19. ?.l. pursuant to which Building Permit No.. dated ........... ¥~a-y ....'3 ·, 19. '71, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P.~$va*,~ .one..$~a.~.~.y. d~ell-t~g ........................................ The certificate is issued to . Dan~,el. & .DorothF..Dor~ .... 0~mers.~ .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval House 1800 -- Building Inspector FORM 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) 5269 Z Permission is hereby granted to: .... ~ ...... ~.~.~./.~.~ .............................................. at premises located at ~/'t pursuon¢ to application dated ~" ~A~/y~ 'Y' 19..~../. and approved by the Building Inspector. Fee $ ........................ Building Inspector e'o~M ' No. I TOWN M Sou'mOLD BUI~ING DEPAITMINT TOWN CLIRK'S OFFICl SO4JTHM.D, FI. Y. Examined ......... ~......~...*...., 19..7./. ,, Approved ........................................ , 19 ........ Permit No ..... Di~ppro~d o/c ....... ........... ('~ii~'i~ Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This applicotlan must be completely filled In by typewriter or In ink ,,nd submitted in duplicate to the Building Inspector. b. Plot .pi.an sho.w!r~ I.oc.ation. o.f. lot .a.nd Of.buildings .on pre.m?s: mlatlon~ip TO adjoining premiees or public streets or areas, OhO giving a amapea aescnl~,an et layom et propem/must oe arawn on the diagram whlch is part of ~hle application. c. The work covered by this application may not be commenced before i~suonce of Building Permit. d. Upon approval of this appllcatlan, the Building Inspector will luue a Building Perm t to the app cant Such permit shall be kept an the premises available for Inspect an throughout the progre, 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. RB .A..P. PLI_C. ATIO_N .!S HEREB?.MA_DE TO .the B.u. lld. l.ng. Department for. the .issuance of a Building Permit pumuant to the,~ u.alr~.' Lone. urn. Inance of the lawn at :~umola, =uffolk County, New York, and other applicable Laws, Ordinances or'q ~l~u at~..ons, .tar the c.onstructl.an of.bu!!dlng,, additions or alterations or for removal or demo t an, as hem n descr bed. app,cant agrees to comply with all applicable laws, ordinances, bul ding code, housing code, and regulatlans. ....... i'~'~;~;~'~¥ '~'~ii~;~(' a..am.,"'"'""'"'",i'g'~'~'~';~'~i~'~' ...... .............. ........ ......................... (Addres, of applicant) / State whether applicant Is own~, Imse, agent, architect, engineer, general contractor, electrician, plumber or builder. .~.~...,~.~. ~..~_ ~ ............... ....................................................... Name of own.r of prem,,, .. ~.......~.....~...~ ............................ E .......................................... If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Locatlan of land on Which propased work will be done. Map No.: ........................................ Lot No.: ........................ Munlcrpallty ' 2. State existing use and occupancy of Premises and Intended use and occupancy of pmpceed comtmctlan: o. ~lstl~ u~ nnd occul~ancy ................................................. . ............................... b. Intended use ,,nd oc,-upan¢/ ......... ~ ........................................................................... 3. Nature of work (check. which applicable): New Building ~ ................. Addition .......~... ........ Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...........t~....~..~..:...~... ............ ...................... Fee .......................................................................................... (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ........ Z ................ 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 .....~,9..~...[. ...... Number of Stories ......... ~ .................................................................................................. Dimensions of same structure with alterations or additions: Front ........... ~ ........................ Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions,,al entire new construction: Front ......... ~ ..................... Rear ...... ~. ................ Depth ....... ../...~.. ......... Height ...~..~...; ...... Nu~nber of Stories ....~. ........................................................................................ 9. Size of lot: Front ...... .~.). ................. Rear .......... ..~..~ .................... Depth ........ ~...e/~.. .............. 10. Date of Purchase ........................ ~..d~. ........................ Name of Former Owner ....... .~.....~.. ......................... ] 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~, .................................................. ]3. Name of Owner of premises~,~.~.:~..~..~..~.Address .~..~.~..~:. Phone No ..................... Name of Architect ....... ~f~.:....,~.:~_ ................... _r:- \_ '; ............. Address..~....__._. ,_~ .~..._.._.... .......................................... Phone No ..................... Nome of Contractor ...~..~.....T~....,~i~ ........ 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 comer lot. 7J' / STATE OF NEW,,~fOP-~J; ~,.~ tee . COUNTY OF ~ ........... Se'~' - . ............................ ~......] ...................................................... bem~ duly l~om, d~ and ~oy~ t~ h~ il th~ applicant (Name of individual s~ning application) above named He s the .................. ~ '' ~ --~:~.ZL~~ .... , ' ....................... ~ro~;;;'~;] ~;~ '~ ~;;;'~:~ ............... of said ~ner or owners, and is duly authorized to pe~orm or have perfo~ed the ~id work a~ to ~ke ~d file this application; that all statements contained in this application are tree to the ~st of his ~owledge and belief; and that the work will be performed in the manner set fo~h in the appllcatl~ fll~ therein. Swam to ~fore me this ............ : ........ .............. : ....... ....... ....... ....... ............................. NOTARY PUBLIC, State of New York No. 52-81.25850, Suffolk CouJ~,j Term Expires March 30, lg.~gi'