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Home My WebLink About5372-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~...i~.3.~.6 .... Date ............. &U..~.~g .... 2.~.., 19.?}. THIS CERTIFIES that the building located at . .~o;r.'ch. R;~l.e¥. ~,Ie ........ Street Map No. ~.X ......... Block No..:lt~ ....... Lot No...:l~l; ....l~tt, t~ttlpAt.. 11.,¥o ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Julr~ · · 23., 19.. 7.1 pursuant to which Building Permit No...~.~. dated ........... ,}'m~e... ~., 19.7.], 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 . Plg.:].¥a~;8 .~¢~a~o1~. { 8t, orag® )..bl~l..~ d,~.ng ............................ The certificate is issued to .. 1.41'.1t ,. K.o..l}I. 11.t;J, oy ...... 0~l~.,~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....~...1~? ............................ .... :(' .: ........... FORM NO. ~ TOWt, I OF SOUTHOLD BUILDING DEPARTMENTi 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? 5372 Z Permission is hereby grunted to: : to bl~,.~&., en..eA&~.~,~,~.. ,~.. e~- .a.t~ .. eeo e s ~ .. ~ui. ld.~. ...................................... at premises located ut ........... ~.~...~,~...~i],e~..~r~. .................................................................. ........................................................... I~.a~ i¢..~ ~.....~% .~..~ ....... ~ ......................................................... pursuon¢ to application doted ................................. J~.....,~........, 19...~.~[., and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined ....... .~ ....c~..~.,, ....... 19..~Z.,l Approved ........................................, ,9 ........ Pemit No ...... .~.~..?~.....~. ...... Disapproved a/c '.'. .......................................................................................... ( ui ding Inspect~fr) ~ APPLICATION FOR BUILDING, pERMIT 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. 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 /V~DE 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, Ord nantes or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os here n described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. · (Address or applicanU Stat~ whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . Na~'~ of owner of premises ........ ~.~..(~.....i~'. .......... ~~.: ......... ~:~._~ ........................................ i ...... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which ~)l~posed,woz~. will be done. Map No.: ........................................ Lot No ...................... · ' g c p cy or premises ar~ intenaea use aha occupancy of proposed construction: a. Exisiting use ood occupancy .......... ,~..~'.~..~.. ............. , ........................ .... ·b. Intended use and ~'--'//~/// ~/~(~ ' ' .............. occupancy ........ .4.~ ./..;~...~ ...... ~-.,4 .~........~.....~; ......................................................................... / 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. ~/ ....... .~...~-:-/x Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost ..... ~~...~.~ ................... 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 .................... ~ ................................... 7 .................................................... Dimensions of some structure with alterations or additions Front · ../....~. ............ Rear .....~...~....~. .... Depth ........ ./.~.. .................. Height ....: ....................... Number of Stories ............../. ............. 8. Dimensions of entire new construction: Front .......... /....~...../. ............. Rear ....... /.~......./. ........ Depth ...... ./..~......x. ....... Height .....Z. ........Number of Stories ................. /. ..................................... 9. Size of lot: Front ........... ~.~....~. ..... Rear .............. ~..~..,...~..,../'...../.. Depth ............... l.z~..~...:./... ' .......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violatekl,~ ~l/,.,~/~'any/z°ning law, ordinance or~./__ l,,. ~/~.://regulati°n? .............. ~.~./...~' ........................... ~ ,~,~///~--~ ........ 13. Name of Owner of premises ./~.././..~zT.../~....~ .................. Address ./t~/....~/...,EZ..~....../?.~-~..~..~..~. Phone No. ~..~..~..i..~.../.,K'.~' Name of Architect .................................................... Address .......... .~:.;~ ......................... Phone No ..................... Name of Contractor ..~...~../....~....~... ..................... Address ../~'./~...i/~9./'..~,./~..~..ZYJ~;~/phone No..~..,~.~..:...~.f PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or descrip,tion/a, cc~ording,~to deed, and shew street names and indicate whether interior or corner lot. ..... · .7~-~.~'~..~ ............................. ~ ............ "... ............. ' g d ¥ worn, deposes ond says thru' he is the app can~ / ' '(~)~me of individual signingppplica, tion) above named. He is the ....... ~'~.~t'~/5~..~T........H ............................................................................ , ............................ (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; and that the work will be performed in the manner set forth in the application, filed therewith. Sworn to before me this Notary ¢ ............................ [I ELIZABETH ANN rio. 52-8[25850, Suff01t Cou~ Term Expires IVII~I~