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Home My WebLink About5217-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. $b~323 ...... Date .............&~g .... 9 ....... , lg THIS CERTIFIES that the building located at ... WtO~'We~. D, ........... Street Map No. ~st. ~h... Block No.. ~lZ ..... Lot No..70 .... 6reenl~Or~ ... I~.oXo ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........14~eh ....3D19..7.i pursuant to which Building Permit No. dated ............Apr:l.~..?., 19~., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is PF. iva.te, eno .fau-~ly. d,~elt..lng. ....................................... The certificate is issued to . Joseph .~s.~-~o. &..~fe ..... O~nex,8 ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... 1~ ~.o ............................ ........./ '~' "" 'f '~ ~'t~in~' ~.~r' 7"1' FO~ 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) N? 5217 Z Permission is hereby granted to: .......... a'eJJ.lm.. &. ~ e~a...lJlaat~ ..................... ............. W~.tn~eea...~ ........................................ to -.. aa~t:~.-.e,a., a~l~.~t,-~.eiJ -. (..-l~tt,~,,~ -.:p~z,~b .-J~teeir.)...ea.- ~.~ ~.~ ..~1-~ ..... at premises located at .......... ~lr~..~ ...... JJJjl4t~.~JJl~ltlJ~l~ll ....... ;lll~J~..~ ................................ ................................................ 69.~..~s.~eea,..J,a, ........... lt~nl)e~rt, ......................................... pursucu~t to application dated ........................ ~ ......... .~(~ ............. , 19....~:J, and approved by the Building Inspector. .Fee $.5.J~) ............. uilding nspec~r 'TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFK:E SOUTHOLD, No ¥o ........................... , 19 ........ Permit No ............................. Disapproved a/c ....................................................................... ~,~ .................... .' APPLICATION FOR BUILDING PERMIT Date ~',~,~ ~z/' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in d~pltcate to the Building Inspector. b. Plot plan showing location of lot and of buila~ngs On~, premiseS, relationship to adjoining premim or pub c streets or areas, a~nd giylng a detailed ~ril~'lon of layer ofp~ m~t ~ drawn on the dl~gmm:~h J~ part ~f..~l~epp!lcation. c. '[~ework covered by this :application may not,be cammen~d before-mua~e of ~,ldtn~ FemUr.. ~ d. Upon approval of this application, the Building Inspector will issue a Building Permit.to lt~:al)pl i~nt Such permit shall be kept on the premises available for inspection t~mughout the pragress of the work. e. No building shall be occupied or used in whole or in port 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 Bul d ng Permit pureuant to the ~Build!n~.. Zone. O~inonce of the Town of Southold, Suffolk County, New York, end other pppllcable I.awl, Ord nonces or Kegu~at,ons, rot the construction of buildings, additions or alterations, or for remove or demo t on, as herein dmcrlbed. The applicant agrees to comply with oil apl)licable laws, ordinances, building code, houslna code, and regulations. ..................... ,., ................. ~/' (~jJnature of applicant, or name, If a cot1~mtlon) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electric on, plumber or builder. Zi ..... ............................................................ " ........................ If applicant is a corpor6te~, slgnafure'~l~duly authorized officer. '~ .................. ................... 1. Location of land on which proposed w~rk wjU be done. AAap No.: ......... /~.../'..~..~. .............. Lot hie,...., .~,~.. ...... ..... I a. Existing use and occupancy .~ ....................... ............... ~ ...................... ....~..: ....... ~ .................. b ntended use and occupon', .~.~ ............... ........................ ; ........ ' ..................... 3. Nature of wo~k (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................. Rem(~yal .................. Demolition .................. Other W~rk (Describe) 4~...~...7'/~.-..,~..~...~.~ .~..~.?..~..... 4. Estimated Cost .......... xC...I~...~...~.....-T: ............................ Fee ...................... ./....?.....~2. .................................................... (to be paid on fi~ing this application) S. 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 ............................ Rear ................................ Depth ........... Height ........................ Number of Stories .................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear .......................... Depth ................................ Height ............................ Number of Stories ................................ / ............................ Depth ........................ 8. Dimensions of entire new construction: Front .......... .~.../. .................... Rear ~ e / /~ t/ Height .................... Number of Stories ...................................................................................................................... 9. Size at: lot: Front ...................... ~..., Rear .................................... Depth .............. '-'.---"-/"-'-'-~/ I ~ 10. Date of Purchase ...... .~..~./'.~..~.~. ................. Nome of Former Owner ./__~w~e~l~~./- ;~'T..~ ~// I ............. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construc~ti0n 'vic~c~tg-gny zoning~law, ordinance or regulatiop? .~ ....... ~. ......................................... 13. Name of Owner of premises~..-~., .~.~-- ........... Address .~.?...~...'~..~..~..: ............ Phone No.~.~..~..-../.....~....-- Name of Architect ...................................................... Address ..'~ .~.~.'.~ .~../ ............... Phone No ..................... Nome of Contractor .................................................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-book 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. STATE OF NEW YORK, t ec COUNTY OF ...~ ........................ ~' ......... ~,~.'~~....,. ............. ;.. ..................... being duly swoi'n, deposes and says that he is the applicant (~'-~/ (~dame of individual signing application)/ above named. He is the ...................... .~'~ ........................................................ '~L ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and Js duly authorized to perform or have performed the said work and to make and file this application; that all statements contained 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 application filed therewith. Swam to before me this - ........ ...... :.,. ............................. Notary Public, ...~...~..../~......~..~.......~ .................. Cou,h' ~/' f,./ (Signature o~_.gl~licanr,