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Home My WebLink About5334-zTOWN OF $OUTHOLD BUILDING DEPARTMI~,NT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No...~6.Q0 .... Date ........0Ot0.b.e~'...~.s ....... , 19..~.3 THIS CERTIFIES that the building located at ...P~i,~.~/oo~ .Tloe41, ......... Street Map No... XZ~ .......Block No... ,K .....Lot No. XX ..... ~l~ollOgl~ ............... conforms substantially to the Application for Building Permit heretofore filed in this office · · dated ........ J.ulle. ~ ..... , 19.7~ pursuant to which Building Permit No..~33.brZ. ,~~~ted ........ J. tlne. 5! ...... , 19. ?1, 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~,tva~e .acae~oz~. z~agz. !~3.~ · ................................. The certificate is issued to ... ~nrx*lr. lg~aw ......................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. I~,R· ............................. UNDERWRITERS CERTIFICATE No...N.,.R... ...................................... HOUSE NUMBER ... ~. ....... Street ........P.~.n..~..o.o.5.. ~.o.a.4. ................... ................................................... .c~..~.~..~. ? .................. ........ ......... FOF, M NO. 2 TOWN O~ SO~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE5 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5334 Z Dote ............ Permission is hereby granted to: at premises located at .................................................................. ~ ......................................................... Fee $ ........................ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..................... ..~...~.~.~, 19.?.../... Approved ." ................ ~ 19..Z./. Pemit No.....~....'~....~.......~....?.~.... ...... Disapproved a/c .......... :...~.. ..... ~ .......... ~ ................ (Building Inspector) APPLICATION FOR BUILDING PERMIT ~ Oa,e ....................... ,,7../.... 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. Nc~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 o 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. · %'- ....... ........ .............................. (Address of applicant) State whether applicant is owner, lessee, agent, arc litect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ ~.~ If applicant is a co.orate, signature of duly auth >rized officer. (Name and title of comorate officer) 1. L~ation of land on which pr~osed work wi Ge done. Map No.: ........................................ ~t No ......................... ' Street and Number ~ .......................................................................................... ...................................... 2. State existing use and occupancy of premises and intended use and ~cupancy of proposed construction: a. Exisiting use a~ ~cupancy I ' b. Intended use and ~cupancy ............................................................. A ............ .~ ............................... ~..~ ...... 3! Nature of work (check which applicable): New Building. ................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Oth.~.~ork (Descr be) ......................... 4. Estimated Cost ............... ~.~'O :::lc:: Fee . ..~.... '" (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 ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ....................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front / ~ .................................... Rear ............................ Depth ........................ Height .......... .~.. ..... Number ~f Stories 9. Size of lot: Front ............ ./.. ............. Rear ............ ~'"~"~' ................... i: ................ .-'~i'"'"~;~' .............................................. .................................... Dep,h .................... ~.. 10. Date of Purchase ............ ../....~....~../... NoN'ne of Former c~n~, 11. Zone or use district in which premises are situated ..................... ]~ ~....~.....~:....~..1 3C) ............. ~'~ 12. Does proposed construction violate any zon na aw ord hence or r u at on; 13. Name of Owner of nremises /'J.~.~ ~'~,~l,v' A~... ~A/ F~P~?- ~ · ........................................... ~ ........ :~.~j:~.~.~. .................. ~none No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex sting or proposed, and indicate all set-bock 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. V STATE OF NEWL'~I:~,s~ tSS COUNTY OF .~...........( ~ ~ · ................. ~'~;'""~:';'"', ........ : .......... ;7'"': ...................... ~,~ duly swam, d~oses and says t~t he is the applicant tmame aT ~na~v~aUal s~gmng apphc~hon) above named. He is the ........... ~.~.~.~..~ ....................................................................................................................... (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e peffo~ed the said work and to ~ke and file this application; that all statements confoined in this appllcati~ are t~ to the best of his ~owledge and belief; and tha~ the work will be performed in the manner set fo~h in the applicati~ fil~ therewith. Swam to befor~me this __ ~ , , ....................... o, ........ ....... ........... , Gl // Nota~ Publi~~~' . ...... ~ U Coun~[*~ ........................... ~~~~' · .7 ............................. ~ ELIZAB~ ANN ~ILLE~ . NOTARY PUBLIC. ~tc of New Ym~ , No. 52-8~25~ S~folk C~n~