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Home My WebLink About5235-zFORM NO. 4 TOWN OF SOUTItOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~.[ ]-]~-5.~" Date ~ ~,, 19v ! THIS CERTIFIES that the building located at , ~ Street ~p No. ~. ~o~k No. ~ ~ot ~o. ~ . .~~ conforms substantially to the Application for Building Permit heretofore filed in this off,ce dated ~ .l ~ , 19~/ pursuant to which Building Permit No. dated'~~ ] ~] , 19 ~ ~ , was issued, ~d confoms to M1 of ~e require- ments of the applicable provisions of the law. The occupancy for which this certificate is (owner, lessee or ~enant) of the afores~d building. Suffolk Cowry Depa~ment of Health Approval ........................ Building Inspector 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) 5235 Z Permission is hereby granted to: .......... ]t.~.. ~?J~:I3,L A~ ..l~,~e~... I~ll~ ..&. '/~e premises located at .............. -tl~,/J~.....]~t~ll'..Allr~ ................................................................................ .................................................................... c-ate~ ....................................................................... pursuon,t to c~pplication dated ........................... .&.~.~.~,.,..;...~.~. ........ , 19.~.., and approved by the Building Inspector. Fee $....~,C)~I .......... lq)BM'NO. I · .ZQ~WN OF sOUTHOLD '~, ,~ ~BuIL'~NG DEPARTMENT TOWN CLERK'S OFFICE Sou'rNOLD, N. Ys Examined .................... , ........ ^ppr~x t~ ................... ~'~' ...... ~...,., ,,19 ...... Peri, It ~o..~.~j~;; ................. Di~ ,~, a/c ............. ~...._....~ ...~ ...................... ~ ,s' .................................................... ~' ...................................... ""~'-"7~' ..........' ~ ' ~" Applic~tion No ............................. APPLICATION FOR BUILDING PERMIT ~-~ ' '%'"~ D~.t~e '~ ~'~ ............................... , I ...... ~ ~. ,..~-'~ ~.X~ ,,~ INTRUSIONS ,-- ~. Yhis ~pplication must be complexly flll~ in b~ ~ewriter or in ink ~nd submitte~ in ~pllc~e to the Buildin b. Plot plan showin~ I~ation ~ I~ ~ o~ 5uildiags on premiss, ml~t on~ p to ~dj~lnln~ pmmi~ ~ ~ublic ~ or ~, a~ glvl~ a 8~aile8 ~ription o~ I~t ~ p~ must ~ ~rawn on th~ 8la,mm ~ ch s ~ ~ thl~ appllc~ti~. ~ c. ~ ~ ~ 5~ this a~lic~tion m~ not ~m~ besom i~u~nce o~ Bulldln~ Permit ' ~ ma~l ~ K~t ~ the premiss ~a.able rot i~ti~ ~m~hout the p~s of ~work / .~.. ,I ro ~llding s~l~ H ~c?i~..or ~d In whole or I~pa~ for any pu~e whate~r-~il a'~j~¢a~ of ~c~ncy sna, n( ~ Peen gmm~ Dy The ~Ullalng insp~tor. . ~ I APPI CATION IS HEREBY MADE to the Building Department for the issuance of a Bu Jir~ Permit Rumuant to the Buildin~ Zone. O~inance~of t..he To..wn .o,f..Southold, Sufl~kE. oun.~., New York, and other e ~llcable Lawe,~OrdJnances or Regula! ~i~Sa, n~r rneco, nsrrucr~.on o.~..Du?,ngs/ad, cl. itl.onl~ or a!.~rat,ons or for removal or dl ~olltlan, as herein ~lelcrlbed. The apl r agrees ro comply wn'n a. app~icaom ~av~s, ordihances, building code, heusk~ ]~i~'e, add reg~atlons. '-~. ' c ~ [ ~' I (Signature cf ap~llc~nt,~ ~me,~l~ a_j~pamtlon) ................ ............... State wi Bther applicant is owner, lessee, agent, architect:,~n'g'lneer, general contractor, e~trlclan, plumber~r builder. If applicant Is a corporate, signature of duly authorized officer. ~ ~ (Name and title 'of corporate officer) 1. Location of ' ,e ' ': ..... land on wh ch proposed work w II be done Map No . · ,um~e '~- -~ ~ /~ ~- F Street and r~ a r ~,~., ..................... ,.,.~.~ ..... ~ ..................... · r- -.~'~,~-~,,k,~ ~ ....................................... 2. State existing use a,nd occupancy of premises and Intended use and occupancy of proposed construction: b. Intended use and occupancy' ..................................................................................................................... ~~~ 3. Nature of work (check which appl,lc~l~ New Building .................. Addition ....~ Alteration .................. Repair .................. .~val ...... ~ ........Demolition ......... j~_~.Other Work (Describe) ................... ..................... 4. Estimated Cost ~....~.....~. ............................. Fee ~..~.'..~.. .............................................................. (to be paid on fi!lng this application) 5. If dwe~llng, number of dwelling units ........ ~ ....... Number of dwelling units on each floor ............ ~. ......... ~ .... If g ge, numb f 6. If business, commercial or mixed occupancy, specif~ nature and extent of ~each type of use ............. .; ............. 7. Dimensions of existinn s~'ructures f am,' Front ~. ~ 30 ~ . ~ , . ..... ~. ................. Rear ................................ Depth ...e~.../.......~...:.. Height .....~..~...~ .....Number of Stories Dimensions of sarne structure with alterations or additions: Front ....... . .~..g~..~.......-~.. ........... Rear ..... .~...O..~ ........ Depth ....... ~../...:..-,~.... ........ Height ' ~ ...... ~.. .................. Number of Stories .........../.. .................. 8. Dimensions of entire new construction: Front ...~..~.. ....................... Rear .....~.. ............... Depth .../.,. .................. Height ...~...~. ........... Number of Stories ' - '" 9. Size of lot: Front ..~..~.~.~.... Rear ............. .~.~.. ............... Depth ...~ ........... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1~I. Zone or use district in which pr~emises are situated ...................................................... , .............................................. 12~ \NDoes proposed constructlo~l~ ~je~ibi~n~y~z~,n ng aw ordnance or regu at[on? .....~'..c?... ...................................... 13. Nome of Owner of premise~.¢¢~.......~...~......~...;.; ........ Address .. ~ Phnnn ,,7-~Y~'~OZ-~ Nome of Architect ....................... ~ ....... .~ ................ Address ......................... --~~.... ................. Phone No ..................... Nome of Contractor ....... Address .~ ........ PhoneN PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions from property Give street and block number or description according to deed, and show street names and Indical'e whether i corner lot. p~ ~-77'-- STATE OF NEW YORK, tee COU N'I'V-~ OF .............................. ..$ e.e. .... L : ' ......... '/'"'~'Z:~'""%':'"~":~;"'",.~'~' ............................ being duly ,~rn, d~es~a~ says t~t he is the a~-Ii nt u~ame 0tjnal~pua~ ~ng'~ppHcation) ~ · , .~ ~ ~, ~.¥ , ,~ ca above named. He is the ......................................... ~. ~ ................................. (Contractor, ag~t, co~omte officer, ~c.) ~hf said ~ner or ~wner~ and is duly author zed to. ~rm Pr'~e perfo~ed the said work and to ~ke ~d file is application; that all stetem~ts contained in' t~s ~cb~ tree to the ~st of his ~owl~ge a~ ~lief; and that the work will ~ perfor~d in?h~ m~?r ~ fo~h i~e application flied the~lth. Swam to before me this ~ ~ l ~ ~ day of . ............. .......... hlota~ .Public, . ........................................................... ~oun~ (Slgna~TM of applicant) ......