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Home My WebLink About5369-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's OffiCe Southold, N. Y. Certificale Of Occupancy THIS CERTIFIES that the building located at ' '$1~/1~ 'l~ette' D~ ........ street coi~rms substantially to the Application for Building Permit heretofore filed in this office dated ......... Jl~ .2~ ..... , 19. ~ pursuant to which Building Permit No. ~6S~ · ' dated ........... ~/l~e' ~' '" 19..71, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . I~,ob$1'~' '&' ll&~y. ~ ...... ~ffl~s ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . 0~l~.. 2~ .19~.1...by ~. ¥.~ ..... UNDERWRITERS CERTIFICATE No.. ][. ~.~6 ...................................... HOUSE NUMBER..~,~. ...... Street ..... GiL~'ette' ~F ............................... Building Inspector .~ FOF,,.M NO. 2 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? 5369 Z ote ........................... :; ...... .,-..: ......... ~:...., Permission is hereby granted to: at premises located at .......... ~~: ....... ~.,...,.~.~.~.)....o...~ ............ ~...~ ......... :'. ....... ............................... '~7' ................. ' ....... ' pp ovea Dy the Building Inspector. FeeS../ ~'"~ /,/ _,~//"-/,,. , ~-...:~.-.......~d-..../....~~ ............... Building Inspector ,. . BUIL~HG DEPARTMENT ~ ~ ~ __? '-' - ~ TOWN CLERK'S OFFICE R~ ~ ~, ~ ~ : SOUTHOLD, N.Y. ~ ' ~ 19..~ ~ No ......· ~,..~, ........ A~,ca,o. ................................ Examined ........................................ , ~9 ........ Pemi~ No ........... ...................... : ............................................ ~....~ ..................................... ~....~.. ~(- ~ ~/~. (Building Inspector) ?~(/7~ ~- ~ __// .... I ' , ~ APPLICATION FOR BUIL,I~~~~~ ~ ,,..././... : I~TRUGTIONS ~ ~ ~ / Buildin~ ~1 o. This ~pplication mu~t be completely fill~d in b~writer or in ink ond submitted in duplica/~ to th* ~nspector. '"~'; ' ' ~-T b. Plat plan showing I~ation of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detail~ description of layout ofproper~ must be drawn on the diagram which is ~ 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, ~e Building Inspector will issue'a Building Permit to the applicant. Such permit(~ shall be kept on the premises available for inspection throughout the pr~ress of the work. e. No building shall be ~cupied or u~d in whole or in part for any pu~ose whatever until a Ce~ificate of ~cupancv shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depa~ment for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk Count, New York, and other applicable ~ws, Ordinances or Regulations, for the construction of buildings, additions or al~erDtions, or for removal or de~liti~, as herein descr bed The applicant agrees t° c°mply with all applicable laws' °r~c~:'~ ~7~2~ti~s'. (Signatgr/!~of applicant, J ~lame, if a corppr,/ltiqn)., / - (Addressof applicant) \~ ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. ........ .,) .. ............................................................................................................... Name of owner of premises .~.~C~.~;.~a..---,~......~,....~.~..~,,...~. ...... ~/~....~,,.~.,.~ ...................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) -7~_ 1. Location of land on which_proposed work ~dll be done. Map No.: ....~.....~....3~:J ....... Lot N^ ~:~ 2. State existing use and obeupancy of premises and itl~jnded use and occupancy of proposed construction: a Exisiting use and occupancy J~.~ ~''lw~ t~l b, Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building ..... ~ .... Addition .....; ............ Alteration .................. Repair .................. Removal .................. Demolition ......... L~':' Other Work (Describe) ........................................ 4. Estimated Cost ...~..~:~..(-~C~.,...~.. ...... .. ............. Fee ........... .{:...~....*.....~.......(~.. ........................................................ (to be paid~ filing this application) ~ 5. If dwelling, number of dwelling units ........................... Number of dwell~ng~'unifs on each floor ..... .I ..................... If garage, number of cars .....~...~l....(~..l~(~.......~,~..~.'~.....~ ................................................... 6. If business, commercial or mixed occupancy, specify nature ahd 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 ............................ Nu~nber of Stories ................ v .............. ;2, I 8. Dimensions of ~ntire new construction: Front ~.....~..,~ .................... Rear ....~..;~,~ ............. Depth ...... ~ .............. Height ....].C~:.. ...... Number ~f Stories ...... ;.J ........................................................... /, ................................................ 9. Size of lot Front ...../.~).~.., .......Rear ./..~..~. ~. ..... Depth ....... .~.~. .............. I0. Date of Purchase ........................................................ ~,e of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... ]..~ .~...~=~.IL.~...~....~. .............................................. 12. Does proposed construction v,j,'olate any zoning law, ordinance or regulation? ......... ,j~.[~) ........................................ 13. Name of Owner of premises~.'.~...{~')......LS..!...~..,.....i.Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all at-bock 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 'COUNTY OF ........ SJ~: ;S.S ........................... E[e~er~c~..~.....Go.~.c~, ................ be ng duly sworn, deposes and says that he is the applicant (Name of individual signing application) ' 'above named. He is the .............................................. D.Qrk~;~.~;.~Q~. ......................... : ........................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa d w,,ork and to make and file this application;, that all statements contained in this appl.ication are true to the I~e. st of I~s[know edge and be el; and that the work will be performed in the manner set forth in tllip~t3pplicatio~ filed ther_~ith.~,/ J / Swomtobeforemethis II~ll /I / I1 I I Notary lc, ..~.. ...... County of $Uf~ol]¢ (Signature of applicant) ........... , ANN NEVI NOTARY PUBLIC. state of New yo~k No. 52.8125850, Suffolk C~ul~J~ Term Expires March ~O,~tg~..~ '/7 · S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. ~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. Chief of General Engineering Servloee O{IT :~ 6 ~DT!