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Home My WebLink About5352-zFORM NO. 4 TOWN OF SOUTHOLD BUff.DING DEPARTMF. NT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy THIS CERTIFIES that the building located at ....D.e.e.x'...D.r.i.v..e ............. Street Map No..I)?.e.~... ?.a.r..k Block No ........... Lot No.6. .... .g.a..t .t.i.t.u..ck...~ ;.Y.;.. ~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........M~..y. ..... 6. ..... , 197.~.. pursuant to which Building Permit No.. dated ........,T..u~.e....1.1$. ...... , 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 The certificate is issued to ...F.r.e.d...Y..oq .rg.e.s....&..~..f.e .... .o~..e.r.~ ................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval . N.'.~.; .............................. UNDERWRITERS CERTIFICATE No... ~... ~.,~ ? 7 ] 0,~. 0 HOUSE NUMBER ..... .~.bf..~ ..... Street ..... .D.e.e.l'...D.r.~.v..e ......................... ?0 Cindy Lane FOR1Y[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT' TOWN CLERK'S OFFICE; $OUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5352 Z Permission is hereby granted to: · il~a.~au..I,~....a,8~..~.m,a..~ee~t~ ........... .... 3t~..-..~,....X.s.~'~p.-.~l.~ ............... : .................. ......... ~I;"~ ....... ~' ............ ! ................. to .... ~.~.~...n~.. ~w.~,~,~ .'. ~¢~ · · & .. £,~e~, ........................................................................... at premises located at ......~Gt,..~....4~',..;D~k, ..................... i ...................................................... .......................................... ~-~n~J...~,.~...Dee~.. D~' ............ [r,a~t~..%uek ......................................... pursuant to application dated ......................... ~,....~ .............. ,...., 19..~.$., and approved by the Building Inspector. ~O~]j~$ ADpz'e~ed by ]~ A~ealS TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined ..~.....~........~.. ............... . I9..'~...(. A~ No.~ ....... Approved ~ { ~ 19 TM Pemit No. ~'~ ')''~' ~-~ /' '~"~"-~/-'~ '~ D so,),)roved a/c~ ...... ..~......~...,~':" .................... ~./..~' .................................. ~,- --,.,b, &~. ~'~(~ ......... ---- £ ~-'~ ? // ) O~.~")O ~ ...... .......... .............. ......... ~.lJ..~....~.~.....t.~./..~.:....:.~....~t. ....... f..L.Z.L ......................... ' ' '' ................ i~;~;~'~:~;~i ................................ ' APPLICATION FOR BUILDING PERMIT Date ........................................... , 19 .......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin Inspector. b. Plat plan showing location of lot and of buildings on premises, relationship to adjo n ng prem ses or public streets 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. 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 cede, housing cede, and regulations. Z TO .. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . If ignature of du ' ~&"E~"~i[~"Jf"~'~fi~i ......... 1. L~atio o land on whic~sed~ork~ill be ~ne. ~ap No.: ~...~..~. ................ Lot No ....... .~. ............. Street and Numb~ 2 ~ ~ ~ ~ ~ ~Z ~C~ 2. State existing use and occupancy of premis&s and intended use and ~cupancy of pr~osed construction: a. Exisiting use a~ ~cupancy .~ ....... ~./.~..~. ......~Z.(.C.~.~.. b. Intended use and occu~ncy ...~..~.~. ....... ~.~ ~..~.......~.~C~ ~. L~ .(:...~.~..~..~.~ [.C~...~ L ~...~ 3. Nature of work (check whi dicable): New Building '~ Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) .~?R<.~..~.....~...o...~..~. ......... 4. Estimated Cost ............... .,~...~....0'~....:......~.... ................ 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 ....~...7...~. ......... Height Number of Stories ,D . Dimensions of same structure with alteratiOns or =dditions: Front .................................... Rear ............................ Depth ..,~./...'. ................... Height ............................ Number of Stories ........................ ~ ....... 8. Dimensions of entire new Construction: Front ........... ~;.~}...*. ............. Rear ..... ~...~.......~. ..... Depth .....~...../. ............ Height ............. Number of Stories ............................................ . 9.' Size of lot: Front .J ¢~t 7, .~...~:.. Rear ..../~...~. ...................... Depth ................................ 10. Date of Purchase ............... ./. ............ .7..~... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;) 13. Nameof Owner of premises .~.~...e...~..]~.~ .~.....-~.. Address I~£--e.-~ ~;'~,":~',~"7~"~'~ ........................ ........................... ~.~ .......... ..~...~. ............... Phone No ..................... Name of Architect ...................................................... Address ......................... ~':'Y:~'J~.' Phone No ..................... Name of Contractor ~....~_.?..J..~'/'/ /- "['~ ^ddress.~:~.(~ uJ I$./:/'~o &,~, Phone No.~-'~.:.Z.-..~..~....'~' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. / > . , STATE OF NEW~OP-~ ~ j~ ",t5 S ~ I~(,, COUNTY Of ...~/J[.. ........ ~ ' ................................................... : ...................................... being duly sworn, d oses and says that he is the applicant (Name of individuaLsigning application) (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 contained in this application are true to the best of his knowledge and belief; end that the work will be performed in the manner set forth in the application f~led therewith. Swam to be. fore me this _ .............. Nato, Pub,c, Coun o¥ ...................... ~T~cH, AsNtaNte No~f INLeL~w Yor k ~o. §g-81.25850, Suffolk Cot~t,L ~'erm Expires March 30~