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Home My WebLink About5391-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . F~ .ulT. d.e.r.s.. Pgt. h ........... Street Map No. Founders. ~s~v~aNo ........... Lot No.. ~.S&l+~ .... ~outhold..No~-.,, ..... conforms substantially to the Application for Building Pemit heretofore filed in this office dated .......... July ..... l., 19.71. pursuant to which Building Permit No.. dated .......... ~lt].~' ..... 7", 19.71., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pr;iv. ate..garage. ( acce s .cry .bl~ig ) ................................. The certificate is issued to . .Herbert. J. ones ....... .Uwner ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .E.: ,R: ............................... House 13o0 Building Inspector ! FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5391 Z Permission is hereby granted to: ~]A~ml.~.. '~ ....~/o- ....]le#l~.. Jaa~... to .... ~n,-',-~,i.. a~a~...])~,vata..~..~ ........................................................................................... at premises located at ......~..~ ......... ~'~l~11~e~a..~,~lll~llt ....................................................... ......................... ll,~ · #e~l,e~... P.e,t,~ ......... ~e~t,~..e.';'.-~. ....... N,,.'J, ................................................... pursuant to application dated ......................... ~1~ ....... ~J ................ , 19..~.'t.., and approved by the Building Inspector. Approved TOWN OF soUTHoLD .~'~'. ~ ~ ~,~- ~ t'/'7 ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~/'/~' ~'~' ~ ~UTHOLD, N. Y. ~ .... ...... Disopproved o/c .~~ 'lB I I '( uiding Inspector) / APPLICATION FOR BUILDING PERMIT Dote ......................... , 19..~..~. ..... INSTRUCTIONS 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 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. 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 port of this application. 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 Ppplicoble Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with oil applicable Paws, ordinances, building code, housing code, and regulations. (Signature of applicant, or nome, if a corporation) (Address of appllco, l~5' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... ~.~~.. ....... ~"'~1~,~....~., .................................................................................... If applicant is a corporate, signature of duly authorized officer. ....... oma and title of corporate officer) - 1 Locat,on of and on whch rosed wor.k w be done Mo No · ' ' pop ' , p .: .....]1~..7._. .............. : .................................. Street and Number ...~.J~...,.~....~.....~..~t~...'~.. ............... ~.....: ..................................... /.~ ,~ 0 ~ Municipolity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ..... 2~'~,.~,~.~'////////~',~<.~....]'.'.' .................................................................................. b. Intended use and occupancy ...... .-......~.~......~~..... ...................... 3. Nature of work (check which applicable): New Bull lng ition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. 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 ................................................................................................................. 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 of Stories ....~.. ............................................................ ~ ................................................ 9. Size of lot: Front ..... .~/~....~... ......... Rear ............ ~? .~.~...~. ........... Depth ..~...~..*....?..~.. ......... : ~.~--,~. v.~,~ ~ 10. Date of Purchase ..~'.~.~dC~...~..~.....'~.. ...................... Name of Former Owner ......'~.. ................................................ 1 1. Zone or use district in which premises are situated ...J~'~a~V,Z~...~.~... ............................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation.;> ../~...~....: ................................................. 13. Name of Owner of premises ~..,.~...~.. ............ Address ...f,~'~/?~;~,~/'~....-~... ........ Phone No. 2.1~ ...... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor~;~'.2~...../,'..'./~....~-........~'..~.Address ..s~.,?-~.~'~....-~... ........ Phone No. ~.~...~..~P,-~..~J~ 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(~O~(I~/]~ COUNTY QF ..'~}~'(,~,~ ........... .... ~..~./~....~.~r/,"~.~.44~...~.Z~.. ............................being duly swam, deposes and says that he is the applicant (Name of individual signing applicatiog) · above named He s the ..~....~.~.., ~'~ ....................................................................... (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 app jcation are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the ppplicatio~ filed therewith. Swam to before me this -- .. pp' · ......... NOTARY PUBLIC, ~ ~ New York NO. 52-8125~0, ,lllmllmlit County Term ~p~rel