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Home My WebLink About5377-zFORM NO. 4~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Zq]+06 Date Oct 6 19. THIS CERTIFIES that the building located at .~ng..¥iemt .Lane .......... Street Map No~l'.~. ~;a~;er~lock No ........... Lot No...62 ..... ~nu~;hold.. I~...~, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... June .... 21+ ....., 19. ?.1. pursuant to which Building Permit No. ~3. 7.7Z · · dated .......... June ... 2~.., 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~.~.vaZ2. on~ .family. dutelling ....................................... The certificate is issued to . Walter. ~mli;h ...... ~.wner. ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... I~ .~,, .......................... House ~ 1~+~0 /~ / ~ .......,.,.. ~,~.:.,. :..../. ~ :...t ........ Building Inspecto~ FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5377 Z Permission is hereby granted to: .~..,.~.,....~.~...¢....~.~..~...~..~1..~.~.~.... ~tt~ ~.~m.~..:~ ................... ............................................ .~g...~ri~r~r..~ .......... ~t~ ......... ~,~, ................................... pursuan~t to application dated ............................. ~Jil~....~,~.....L...., 19.~RJ..., and approved by the Building Inspector. Fee $..~,,1:~ ............. Building Inspector TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥o Examined ...~.~...; ....... ,19..71 Approved ........................................ , 19...~.(... Permit No. Disapproved o/c ........... : .................................................................................. APPLICATION FOR BUILDIN~ I'[ ......... INSTRUCTION~"~ . a. This application must be completely filled in by typewriter or in ink und submitted in d~plicate to the Buildmg~ Inspector.. b. Plot plan showing location of lot and of buildings on premmes, relationship to adjoining premlee~ or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whlch is part of thie 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 wlfl i~ue o 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 port 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 pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable I.ov~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein de~rlbed. The applicant agrees to comply with all applicable laws, ordinaries, building cede, h,~slng code,~and regulations. (Si~l~atur~.~ cf applicant,,,~ or~ name, if a corporation) State whether applicant is owner, Iossee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premise~ ....~..~~ ........................... I, applico~ corpo,r~,e, sl~ature ~o, d~ authorized officer. ......... ' ...... (Name and title'of corporate $,re. ond .......... ............... ................................................................. b. Intended use and ~cu[anc ,~ ................................................................................ 3. Nature of work (check which applicable): New Building ~ ................. Addition .................. Alteration ............. Repair .................. Remova~ .= Demo t on ... Other Work (Describe) 4. Estimated Cost .......................................... Fee ....~ ............................................................... (to be paid on fi!lng this application) 5. If dwelllng, number of dwelling units ...... ~ ...... Number Of dwelling unitson 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 Z~/' Height ........................ Number of Stories ...~i?:K..,~ ................................................. -/ ;. .......................... Dimensions of same structure with alterations or additions: Front .....~....~... .................... Rear _,4...~... Depth ~.~... ...................... Height ...../...~.. .............. Number of Stories ..... ~ .......... 8. Dimensions of entire nevf, construction: Front .,...~....~...~ ................... Rear ..... ~...~ ............... Depth ...'~....~:.. ............... Height .................... Number of Stories ...................................................................................................................... 9. Size o~: lot: Front .../.4~..4~. ............. Rear ...... /..~'.~. ................... Depth ....J..~'~.... ................. 10. Date of Purchase ........................................................ Nome of Former Owner ....................................................... 11. Zone or use district in which premises are situated ...~....'~-r~J~ ................................................................................. 12. Does proposed construction violate any zRning law, ordinance or regulation? ...~,~.. ................................................. 13. Name of Owner of premises~.~.....Address ..... ~....-w/ ............. Phone No ..................... Name of Architect/2,~,/~/? ~ ~'~.-~-~ ~~'~'~, ..................... Address .....~ ............... ~ .................... Phone No .................... PLOT DIAGP~M locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from properh/ lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot. STATE OF NE~I~/]~ t$.S ~.~ ......... being duly d~es and says t~t he is the applicant ................. ~'~~~ application) sworn, above named. He is the ................................................................................................ ' ......................................................... (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or ~ave pe~f0rmed the said work and to ~ke and file this application; that alt statements contained in this applicati~ are tree to the best of his~nowledge and belief; and that the work will be performed in the manner set fo~h ~'~he application fil~ therein. // Swo~re ~ ~is , // ~' Noto x .... ............................. ~eo. 52-81~ ~ ~nt~