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Home My WebLink About5392-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z~328 Date Ju]4r 27 19..7..~ 1~20 Pine T~ee Road THI~F~at the building located at ............................ Street Map No. 1179 Block No .... Lot No. ~!) E. 1/10 of loi; ~0, ~8~ E.1/10 conforms substantially to the Application for Building Permit heretofore filed in this office dated . .J..~....6 .............. , 19. ??. pursuant to which Building Permit No..~..~.9.2.~.. dated .f..~... ? ............... , ~9..~.L was issued, and conforms to ~ll of the r~u~ ments of the applicable provisions of the law. The occupancy for which this certificate is ~sued is ....... .~??.W~..~.°..~...~..~S ........................................... The certificate is issued to....~.?...A~...~...o~r...1}.:..I?..~. .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... NoRo UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER 11~20 Street Pine Tree Road~ Cutchog~tev ..... Building Inspector~ FO~ NO. ~ TOWN OF SOUTHOLD i 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? 5392 Z Permission is hereby granted to: .................... &~¢,:}z¢~;~......~:~ ~...Z ~.~....~ ................. ................. ~'~,..b ~ ...~......rl~e ...~ee.. ~ ......... ........................ ~¢a~e~ae .................................. to ...~.(:,],4,.&~fl%~...P~¢.R~.~Z.%~'~Z...(.~.i,i~:Z.;:~'.).~lia~.... .......................................................... at premises located at ....... ~..~...~.~.?~...~..~z~+-....,~g.....~,S~,..~,%'~l~ ............................................. ............................................... ,P. ,&~ ~...~ z:e.~.~ ...~ Lc¥:',¢, ............ ¢.~.t;,c~t~,~e ............................................. 19...~..I., and approved by the .,~T~+ ~ pursuant to application doted ................................. .~..~-~. ....... ~..~..,.,, Building Inspector. Bu Id ng Inspector FOKM NO. ~ TOWN~)F SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No ............. Date ................ J~"16", 19. ?$ THIS CERTIFIES that the building located at ...FI~..~'eo .l~mlt ........ Street Map No. Jl&lJl~..Fl"alS Block No ........... Lot No.. p~. ~8. & .p~ -~9 .... ~;OhOftlO. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... July' · · · ?' ', 19 .?¶. pursuant to which Building Permit No...~"~9~ dated ........... July'... ?..., 19. ?.1., 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~'vate' '&eetssoT~' ~ stox'ago). :b,u~ld.i.~nf ............................ The certificate is issued to . .~n.t. ho~y..Izze .... Owno~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....]{,pRo ........................ .... " ' - "/ ...... FOB~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT T~WN CLERK'S OFFICE $OUTHOLD, N. Y. · ~proved ........................................ , 19 ........ Pemit No ........................... Disopproved o/c ............................................................................ -- APPLICATION FOR BUII~DING PERMIT ~, Dote .......... J~ 1.Y. ......... .6.. .............. , 19..2,1, ..... - INSTRUCTIONS o. 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, t~e Building Inspector wJJJ 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 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 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, ordin'ances, building code, housing code, and regulations.. - .................... ........ B~x 44 I ~ ~;/ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................... .~gg~t...fo~...crwner. .................................................................................................................... Name of owner of premises ....... Anthon~...R,...Iz~o ........................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) E. 1/10 o~: lot no. 58 Nassau Farms E. 1/10 of l. Location of land on which proposed work will be done, Map No.: ...11.7.9 ........................... Lot No. 1~t~..~.....,5.9 Street and Number .l~2.Ch. Rin. e..Tve_e..Roar]..~s/.s~.,...=u~chmgu, ee..lg~w..vork .................................... Municipality = 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ..... ~a~:iv.a~e...cln~,..f~m~ 1 .~...c~.e3_~£ng ..................................... b. Intended use and occupancy ...................... .~...w£t~..~r'c~.s~.ar.~...hu~lding...~:lr.,QOl..~.~,). .......... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (DescrJbe)c~CC~.~.Q~...~.~l,~^ ..... 4. Estimated Cost ............................................................ Fee ..... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~. .............. ~.Number of dwelling units on each floq? ............................ 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 Sfories ................................ 8. Dimensions of entire new construction: Front ............ I~.'. .................... Rear ..... ~.~ ................... Depth ......]...0..'. ............. Height .................... Number of Stories ................................................................................................ 9. Size of lot: Front ......... 6.0.' ............. Rear ~ ' ..... ~0 .......................... Depth ... ~.D.Q ..................... 10. Date of Purchase ..........].9~.~ ..................................... Name of Former Owner ..~o.~.e~.C~ ............................. 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance~or~'~u~_~c~.~g_~c .............................................. 13. Name of Owner of premisesAD.thO~...~,...Z,~.Q.....Acldress ~D~_~-~I~j_I.Z~,~..Z.s.~... Phone No ..................... Name of Architect ...................................................... ^~clress ............................................ Phone No ..................... Name of Contractor .......................... ~! ......................... Address ............... ~ ............................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or preposed, 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 YORK, ~,SS ' COUNTY OF .~U££O2-~ ........... ...~ ' ............... L~-~.~¥. ~...,T,~ .................................................. ~ng '~uly ~om, d~es and says t~t he is the applicant (Name of individual signing application) above named. He is the ...................... ag~..f~...~W~ .......................................... ' (~n~ctor, ag~t, comorate officer, etc.) ~ said ~wner or ~ne~ and is duly authorized to pe~orm or h~e perfo~ed the said work and to ~ke and file is application; t~at ~11 statemems cont~n~ in this applic~ion are tree to ~e best of his knowledge and belief; and that t~e work will be perfor~d in the manner ~t fo~h in the ~plicatl~ fil~ the~ith. Swam to before me this ............ ....................... .................. ~OT~LIC, State ~ Hew Yor~ , NO ;r ~'~25850 Suffolk Co~ ~ Term Expires March 30 ]9~