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Home My WebLink About5273-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z .63 ...... Date .......... Sal~temh~r. l:?.~.., lgF.3. THIS CERTIFIES that the building located at Pill. J,~le ................. Street Map No.l~o~[~..fll~loek No... XX ..... Lot No...P-bt ............................. conforms substantially to the Application for Building Permit heretofore filed in this office ..~dated ....... ~lay. 3.~ ........ , 19~1.. pursuant to which Building Permit No. ~.273~. dated ....... · .MAT..~.~ ......... , 19...~., 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.r. lva. l;e. o~o .£~m~.l~t. d~e~ ...................................... The certificate is issued to .. gllarles..G,. P~l;el'~o~ ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval It,R, UNDERWRITERS CERTIFICATE No.. Pt#IIlt~il~ ....................................... HOUSE NUMBER ..... 3(~ ...Street...~I.11 .I,a~.e: ................................... ............................................. PeQO~.Q ........................... Building Inspector ~OE~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. EUILDING PERMIT ('THIS PEP~IT MUST BE KEPT ON THE PRF..~ISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5273 Z Permission is hereby granted to: ................... ~.t~..Z~:~l ............................. ..................... ~.~,C~Z~LO .......................................... at p.remises located at ............. ~.~,..~l~ ......... .~',oe~.~..~e~N ...................................... ~ .............. ,_,,. ': .......................................................... '~O~mct"-a~e .......P~!ema$~ ..................................................... pursuant to application dated ..J ............................. }i;l~. ....... ~ .......... , 19..~.~.., and approved by the BuJlding Inspector. Fee $..~[o[.~ ............ Building I nsl~e~ior / FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................. , 19 ........ Approved ........................ .~.1. ............. , 19 ........ Pemit No ............................. ~'/~'/7~ Disapproved a/c ............................................ .............................. .............. '" '" APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. Date .......... b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or- areas.,.god giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. · .-~ Zh._e.,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. 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, ordi nances, building code, housing code, and regulations. .... .......................... (Signature of applicant, or name, if a corporation) het:/~li~ Cy.~ ~CO_._._:~ ~.~~ (Address of opplicon,) State w app 'cant is owner, lessee, agent, architect, engineer, g~neral contractor, electrician, plumber or builder. pp' ' rp , s'g u e o duy authorized officer. ' .................................................................................... (Name and title of corporate officer) ~~'~ 1. Locationoflondonwh~c~proposedwor,kwi,~?]lo_?. MapNo.: ....J..I...7 ......................... kotNo.~...~.... Street and Number ....~.~.~ ......................................................................................... .~I~,.~ /~ILL L,,~',,V~ ~ ~'-0 N ~icipality 2. State existing use and occupancy of premises gnd intended use and occupancy of proposed construction: n I a. Ex s ti g use and occupancy .....v.~~ ..................................................................... b. Intended use and occupancy S/~ )o~ ~_ - 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .......... ~.(~j Removal .................. Demolition .................. Ot~.h. er Work (Describe) ........................................ 4. ,mated ........................................ F.e ......... ................................................................... -~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, specie/nature and extent of ~ach type of use ............................ 7. Dimension~glstructures, if any: Front~....~ ............... Rear ...~:~. .................... Depth .................... Height ......~ ...... ~ ....Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Numbe¢ of Stories ................................ 8.~ Dimensi~l~. of entire new construction: Front ..... ,~) .................... ~:~,eor .......~. ................. Depth ........................ He ghl~ ..~L.*. ~ Number of Star es ~.. ~ .~..~ , , ........ ................................................... 9. Size of lot: Front ..-..~.(~. ................... Rear ..~O:.F. iii~.i:iiii.~ ...... Depth ................................ 10.. Date of Purchase ....,/~.O.U......~..~.. .............................. Nome of Former Owner ..~.. ...... c,.~-..I.....(...~ ................. 11. Zone or use district in which premises are situated ...... A ........................................................................................... 12. Does proposed construct on violate any,z~ninaJaw, ordnance or regu at on? .............. t ........................................ 13. Name of Owner of prem ses . I~ne No.~......~..~..'.~.~.. Name of Architect ...................................................... Address ................................. ~ .......... Phone No ..................... Name of Contractor .~ ............................. Address ............................................ Phone No ..................... ' PLOT.DL~M X '~"t~ clearly and distinctly all buildings, wheth~or proposed, and ndicate all setJaack dimen~ro*~m . p~operty~lines. Give street and block number o~scription ac-"e~lng to deed, and show street names and indiccite- W?ther interior or corner lot. J STATE OF NEW' ,Y. ORI~',., . / ~ S S COUNTY OF .~.~..~...J' ............................. ~..~........~.C,?~..~...~...~ ........being duly sworn, deposes and says thot he is the app cant (Name 6f individual signinc.)"6pplication) above named. He is the ..................... ~...?......~..~C.~. .............................................................. (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 contoined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicatiott filed therewith. Sworn to before me this ................ .,,~.. doy of ........... . ............. ....................... Notary Publ'c,~..~fl¢~ ..... County ~ ~u~q~ (Signature of applicant) ............ ~J~rm [xpires ~rch ~0, ~..~.,~