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Home My WebLink About5270-zFO~M NO. 4 TOWN OF SOUTHOLD BU~,BINC. DEPARTM'k'~T Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy 73 No.. .... -Date . .".'. .................. , 19 THIS CERTIFIES that the building located at 13~0 P/~ue Tree Road Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore fried in this office dated . .HAa..Y..~. ............... , 19.7.~.. pursuant to which Building Permit No.~.2.7.0.~... dated . .!~..y..~. ................ , lg?~..., 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 Aaeesmol'y BuS. lding The certificate is issued to Enid Ii, Bol~ . (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval ........ N.: .R.: ........................ l~oRo UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER 13~0 Street Pine Tree Road FORM NO. ~ TO~N OF $OUTSOLD BUIL~N~ 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) 5270 Z Permission is hereby granted to: & Mw J:> ..........................~..~.~ ~....:..;~*/., ............................ >~ ~,'~..~. ~ ~ ~- ~>~= ~ to ............ ~ ~./L¢...'~. ................. ~...~.~.....~. .................. ~.~..~ .................................................... at premises located at ................................ /..~.~...~. ................. .~..(M..~. ......... ..-~.../.~..L- .k~ ....... ......................................................................................... .~....~....~...i.~.v..5...~...~?. ............................. pursuon* to opplicafion doted ..................................... .~J~...~...~..~...~., 19...~./.., and approved by the Building Inspector. Fee ...... ............. Building Inspector FORUM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved, o/c ............... ...~,...~ .................................................................. ( 'd' ......... lng Inspector) APPLICATION FO~ BUILDING PERMIT Date .................. ,~J~T.... ~. ~. ................ 19.~..~. ....... INSTRUCTIONS a. This application must be completely filled in by typewriter 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 adjoining premises or public streets or areas, and giving a detailed 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 Jn whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. 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 a terat ohs, or for,remova or demolition, os herei.rt described. The applicant agrees to comp y with a applicable laws, 0~'dinances, I~uilding ~:c~le, housing cOde, and regulations. ......... /~ , _ _ ( iig, o u e of applicant, pr name, if o co~;;;~i;~i ....... ~ ~00 Piae Tree ~,~t~h~e, ~ XX~3~ . ~ ~j ~ . (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer~ general contractor, electrician, plu~er or builder. o~e~ Name of owner of premises ....~.~..~,..~J ............................ . ....... If applicant is a co~orate, signature of duly authorized officer. "~ {Name and title of corporate officer) pa~t o~' 1. Location of land on which proposed work will be done Map No lJ.~.9. ....................... Lot No. ~.....~...,~..~. ....... ~'~ Street and Number ........... ~lne..~-~e..ltcL ......................................... ~teha~a,~ 1~ ~ Municip~'l]-t~ ................................ 2. State existin~l'~s~"'~n~J occ~Jpancy of premises and intended use and occupancy of proposed construction: a. Exist ng use and occupancy ..... .r...e..B..t..~.e...~..o..e. ...................................................................... b. Intended use end occuponcy ...... ~.~.K~.i[I~.~ .................................................................................................... ateel utility shed $. Nature of work (check which o~ficob~e): New 5ui~di~ ./.. .............. A~dition ................. ~ A~teration .................. Re. ir .................. Removo~ .................. Demofitio~ .................. Other Wo~ (~escri~e) ..[ ..................................... 4. ~stimated Cost .~.~.~0 ............................................... ~ee .......................................................................................... (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 ...... 2~../'.t;, ........ Rear ..... 2.8..J~U~; .......... Depth .~.../~.eO. tL. Height'~...~.qtO.~ ....... Number of Stories ...O~e ................................. ~..~.~ ............................................ Dimensions of some structure with alterations or additions: Front ...... ~&~..&~..,~l:~4~rdRear ..~.~..~.~...~...~' Depth .;...~ll~e ................. Height ..... ~ ............. Number of Stories ....... .~...~. ................ 8. Dimensions of entire new construction: Front ...... 8...:~, .................. Rear ..-.8-..£.~,e ............ Depth ...~'.~6...~,~. Height ..~...£.~.. ...... Number of Stories ..0~# ............................ 9. Size of lot: Front ....~.3~6...~.~ ..... Rear ..~e~.....£.t ............ Depth ..~'0~...~.t, ............. 10. Date of Purchase mhi~:[e...19.~.0 ................................. Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..~,e~,d~tJ~,..&..~,O~ .................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... Ji~. ................................................ 13. Name of Owner of premises ~P~,~..tl~]~l]~Zt......Address .--P~..~:L'~..~:[ ............ Pbene No. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....... gtlRD&lZ'. ................................ 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. STATE OF NEW YORK COUNTY OF ~ll~f~L~ ............. ),S.S Rothleder) Bnld. R. BellBan (nOw Enid ~. .............................................................................................. beJ..,, c[ul¥ sworn, deposes ond soys that he is the oppJJconf (Name of individual signing application) above named. He is the .................................... .~....~.....-~...~.~.f.~. ......................................................................................... (COntractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicati°n aretrue to the best of his knowledge end belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before-me this .... of .......................... ..... ./ ELIZABLrrH A/IN NEVILLE NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk Term Expires March 30, .