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Home My WebLink About5395-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No~ ............ Date ........... .li'.~.b .... .~. ......., 19...~. THIS CERTIFIES that the building located at . .~.i~t;~0~i&. D.l~i~ .......... Street Map No..~ ....... Block No...l~X .... Lot No.. ~ ..... I~outhol~..I~,X. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~l~le.. 8 ...... , 1~.~.. pursuant to which Building Permit No. -~39.~ · dated ......... .J..i~. .... ~. .... , 197.1.., was issued, and conforms to all of the require- ments of the applicable provisions o£ the law. The occupancy £or which this certificate is issued is .. Pr.$vate .e~e. Saa~kl~. dw~lli,a£ ...................................... The certificate is issued to l~dwila :H~g ..... 0w~ex' .............................. (owner, lessee or tenant) of the aforesaid building. ]{O~i~ S Approved blt t~1 Suffolk County Department of Health Approval . .l~l~R, ............................. ....... ...... .-t ,. . Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5395 Z Permission is hereby granted to: ........... ~,~ur,..~ae~L~ ...................... , ................. ......... .~,~1~,.~.~ .......................... ~ ................. ................ · ~eaa*.,.~o.~& .......................... ~ ................. to ..... ~l~b~.3~ ..a~.. ~.¢~L~.t~o~.....f,&t ~ae~. ~e~e..,..~/~, ................................................. ....................... ~l~.21~l...A~o~e~...b7 ]a,~, ~1~...8...1.~?~1 ........................................................ at premises located at ........~.~.....~;[~,.~;~;[~,..~.~.~¥~ ...................................................................... ................................................. &e,at~bo-:t.~ ....... ~'~-~ ........................................................................... pursuon¢ to ~pplic~tion dated ......................... ~I~F~..~..~;~ ....... ?..., 19..~.~.., and opproved by the Building Inspector. Fee $-..~,00 ............ E~uilding Inspector / ~ ,/~,~,~o- ~'::::~ .~ ~-~ TOWN OF SOUTHOLD Ic~''' ~ ~ ~ ~ BUILDING DEPARTMENT ~ ~..~'~' TOWN CLERK'S OFFICE ~* ~,~ ~ ~ SOUTHOLD, N. Y. ~rove~ ..~...~"."~.., 1~".~.~ ~e~it ~ ..... ~.~.~,~....~ ~i:opprove~ o/c~ / --~ ............... ~ ......................... ..... ............................ ~U~TlO~ ~OR 8~1~1~ ~l~ INSTRUCTIONS App,cat,on No...g.}.....7..( ............ Date .......... ~ .....~....~'....'...7...~. ............. 19 ............ 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 o 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 Occupanc shall have been granted by the Bailding Inspector. . APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and othe[ gppJicable Laws, Ordinances or Regulations, for the constructioi~ ofnouildings, additions or aj~erations~ or for removal or demdlition, as here n described. The applicant agrees to comply with ail applicable laws, ordinances, building cad__and r_egulations. · (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .Name of owner of premises ....... ~......~ ....................................................................................... If applicant is a corporate, signature of duly authorized officer. .......................................(Name and title: ................................ of corporate officer): ............... '~'--~-" Z fl ' h h sed ork ill be done Ma No Y Lot" 1. Location o aha on w ic propo w w' . p .: ........................................ ~'~o ......... ~ ................. Street and Number ..... ..~.~..'~.....~..~~,~.....~.....~ ................................................... ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......... ~ ............................................................................................. b. Ihtended use and occupancy ........................................................................................................ 3. Nature of work (check whic ): New Building .................. ..................// Alteration .................. Repair .................. Removal .................. ~ Dema4ition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ..-~....~..,...o...o..?. .................. (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~na~re and extent of each type of use ............................ 7. Dimensions of existing structures, ifany: Front ....... ~..... ~ ....~S'-,~.....~. ........ Depth ....~L~.. ~-~, Height ...../~...~...:.... Number of Stories ...e...,/. ............................ : ................................. ~'"' Dimensions of sa~n~e~s~ture wth a terat oos~qr add t OhS' Front ....... - .............................................. Depth ....... ..'~.._.~2_/../~L ..... Height .....!.......~T.!...:......Number of Sera,el ......... ./.. ....... : ............ 8. Dimensions of entrre new construction: Front ...... ~..o. ...................... Re. or ....... ..~..?.. ............. Depth .. ... .~. . './. . /. ......... Height ...... ~/..~. .. Number of Stories ............ : ..................................................................................................... 9. Size of lot: Front ......... /..G.~'.....~ ...... Rear ....... /.q...~...~ ................... Depth ........ /..~..~. .............. 10. Date of Purchase ......... ..~...'.../.:T..~.~ ........................... :Name of Former Owner ...~.:..~..~..~,~ ...................... 11. Zone or use district in which premises are situated .............................................................................. 12. Does proposed construction violate any zoning law, ordinance o.r regulation? ....... ~ .................................................. 13. Name of Owner of premises "~'"~"'~7 ......... 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 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, ~ ¢ ~ ............ ~,- ................ ; . I~eing duly sworn, deposes and sa s that he is th (Name of indivi~g~'~'l~'c~i;~i ................. Y e applicant above named. He is the ........ U..~....:...~...~....~ .............................................................. (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 oil statements contained Jn 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 tlne application filed therewith. Sworn to before me this . ....................... or ........................................ , No,a,- Pub c ' ................................... · , , · ............................ ~ ....................... Coun~ (Signature of ............ HAROLD T. NIF..MIS ~OTARY PUBLIC, State of New York No. 41-8144983 I~uallfied in Queens County ~-emmJssion Expires March ~, 1972