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Home My WebLink About5292-zNO. · TOWN OF $OUTHOLD BIJ~.r~ING DEPAR~ Town Clerk's Office $outhold, N. ¥. Certificate Of Occupancy THIS CERTIFIES that the building located at ~bb&t. La;ae .............. Street Map No.. ~ ....... Block No... ~X .... Lot No..v-,-,....l~&_-...~ .l~a~l~o~ ....N~Y',- '" conforms substantially to the Application for Building Permit heretofore filed in thi~ office dated ..... mS..eb.o.'~ ......... , 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 ~sued ~ . P='_v~e. cr~ .f~ ", y. d~ell/n~..~it~ ad~.~.ti~n& &. aLte~a~.om~ & .Aee~. b The certificate is issued to ... St~z~?.e~y. ~,'olfe ..... O~rner. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N.,I~ · .............................. UNDERWRITERS CERTIFICATE No..penA~g ..................... ~ ............. HOUSE NLTMBER .... 8.~.~ ...... Street . RabB~.~;..Le~,e ...... ~..~t,. ~,~,~£c~u ........ Building Inspecto~ FORM NO. ~ TOWN OF $OUTHOLD 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? 5292 Z Permission is hereby granted to: ............ ~zt ~,,~;,.~...~.~,...,~ P4,~, ;k~ ...¢ ~, ~,. .............. .............. &~.~....~.~.....~.~.~.....~e~..~...A~ ..... ................... · i,~e'4..?~er~ ....... .~i~ ...................... at premises I~ated at ................... L,./~'-'i~J}~t~'~:t:..'~ .......................................................................... pursu~¢ to application dated .......................... ~,~ ........ ~ ......... ;....., 19.,.];4., and opproved by the Building Inspector. Fee $.~.r~.~.~ .............. Building Inspector APPLICATION FOR BUILDING PERMIT "' Date ............................................... , 19.21. ...... 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 port 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 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, ordinances, building code, housing code, 'and regulations. ................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Location of land on which p~.,oposed work ~,ill be done. Map No.: ............ :~ ........... ~......;... Lot No .................. ' ....... ~ Street and Number ......... 'J~ll~.et.~l.~.~...~..~.....~. ............................... .....~.~, ,~,,?,....~./~.~...~..~.~..a~.. ...................... : ............ ~ ~a~ ' Municipali~ State existing ~cupancy of premises and intended use and ~cu~ncy of proposed construction: ~. Exisiting use a~ ~cupancy ............ ~:~.~'~' ~ : b. Intended use and ~cupancy '"' : I Nature of work (check which applicable): New BUilding ...... : ........... Addition ...... Alteration I:~epair .................. Removal .................. Demolition .................. Other Work (Describe) ........ · ................................ Estimated Cost ........ $.....~....~...0..0...!....": .................... Fee ............. ~...~..'..~..~ ..................... i .................................. (to be paid on filing this application) If dwelling, number of dwelling unit~...~.~..{l...~...~......;.Number of dwelling units on each floon~..~-.e.~.6..~,~ ........... If garage, number of C~rs ............................................................. ~ ........................................... "~ .................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........................... Dimensions of ~isti.ng structures, Jf any: Front ...... ~...~....~....~ ...... Rear ........ ~..~.t. ............... Depth ....~.'.0.~ ...... · g ................ · . ........... }. ......................... .................................................... Size of lot: Front ..... ..~....0.. ............... Rear.~......~....~. ..................... Depth ..... L....~.. ................. Date of Purchase ....... .......... .............. Norne .of Former ,Ortner ~.....~,...~.?..~.~.....,.~...~...~..~.../.-- ............... Zone or use district in which premises are situated ........ '~.~....#.....R.~a~.i~.~...~..?..~.9. l...'..~.~...~.*..?..M..~.~.~.~ ............ Does pr°Posed-- construction violate any zoning law, ordinance or regulation? ..,....~...~. ............................................ Name 6f Owner of premises~....~....~...~'.~..e...~..e....~.~!.~..Address .~../~.~.'~.T..~.~..~...~~-- --"- '' '-- "~ ~ '~ ......... Phone Name of Architect .......... .~....~...~....~..z, --Address ............................................ Phone No ..................... Name of Contractor ....~ .~.....~....~......~. ........................... Address ............................................ Phone No...: ................. ' 10. 11. 12. 13. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from proPerl~ lines. Give street and block number or description according to deed, and show street names and indicate Whether interior or corner lot. ST^TEOF NEW YORK, .! ~t le~ ........................... .~.~..~.~.~..'"'.'..~.~.S ............................F ~ing duly ,om, d~o~s and says t~t he is the applicant (Name of individual signing application) above named. He is the ....................................................................... ;;...~...~.~. .................................. ~; .............................. t~ntmcTor, ag~t, co,orate otticer, etc.) of said owner or owners, and is duly authorized to perform or h~e perfo~ed the said work and to ~ke and file this application; that all statements contoin~ in this applic~i~ am tree to the be~ of his ~owledge and belief; and tha~ fhe Work will be Performed in the manner set fo~h in the ~plicati~ fil~ ther~ith. Swam to before me this ~ ~ . ........ J.~.~ ........ ~y of ...3.:~..., ................. , ?.Z~.. ~; ~~ -- - .... ........... ....................................... Nota~l~,~~~oun~ (Signa~re of applicant) No, ~0~989475 ~ ~alified in Nassau Co~ ~. filed in New Yozk C~ ~ expels Mczch 30, 197~