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Home My WebLink About5398-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...~. ].8 ...... Date ...... .&]~..26 ........... , 19~.. THIS CERTIFIES that the building located at . .1~11~...~..~;....1!,~. J[ ....... Street Map No.. ~ ....... Block No.~ ...... Lot No. ~ ~.~,SI~I~8 .~8],~ .... ][e]~, · conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~ll]~. · .¶~ ...., 19. ~. pursuant to which Building Permit No..~. dated .......... ,~1~. · - - -~2.., 19~[.., 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 ...I~.V~I~O. 0~O. f~Ltl~'. ~Sll~ ..................................... The certificate is issued to .Nl, m .~l~er. O~ke8 .... 0¥n®l~.... ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. p~ltl~t~ ......................... UNDERWRITERS CERTIFICATE No .... pol~d~t,~ ...................................... ttOUSE NUMBER .... .~. .... Street... ~8~'11~' IIO~, ........................... Building Inspe~tor~ ..... FOF,.M NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5398 z Permission is hereby granted to: .... .1~,.....I,~ ~,~t,~, ..~4~ .................................. to ....... ~: '~JA .e....r~:~....~.~.~...~J~...~,~ ............................................................................. at premises located at .......... ,~.,~...~.~.~.,~¥,~..~'.-~,tl~.~..~ ...................................... ................................................... $~'~..~-~;~i ...... ~,~ ............................................................ pursuc~t to application dated .............................. .~:~.~ ....... ~ ........ , 19..~.~., and approved by the Building Inspector. Fee $.. J.&.o.L~. ......... IFOBa~ NO. ! BUILDING DEPARTMENT TOWN CLERK'S OFFICE ' SOUTHOLD, No ¥o ^ , · , pprovea ........................................ , 19 ........ Permit No ............... ~.. .......... Disapproved a/c .......... ~ ............................................... ,....~ ............................ Application No. 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 of property 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 sholl have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Bu Id ng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ord nonces or .~gulati.o. ns, .for the c.onstructi.on of buildings, additions or alterations, or for removal or demolition, as here n described. e app,canr agrees ro comply with all applicable laws, ordinances, building code, housing code, and regulations. State whether ,pplican~i,:e. ssl~ agent, architect, engineer, general contractor, electrician, plumber or builder. Nomeofownerofpremlses.....'/~L...~'.'_'_~. ~.~..~....~....~..~l~--/-~ If applicant is a corporate, signature of duly authorized officer. I. Location of land on ~¢nlch proposed work will be done.. Map No.: ...-~....~..~..~..: ....... ~"~: ............. Lot No.: ..~. .................. Sr. d Numb ~2/.. ........... ~ / .Munici~li~ ..... T' 2. State exi~ing u~ a~ ~cu~n~ of premiss and intended u~ and ~cu~ncy of pr~ constructi~: a. ~i~i~ ~e and ~cu~n~ ....... ~~...~ ................. , us, ...... ....... ...... ...................... 3. Nature of work (check which applicable): New Building..................u/' Addition .................. Alteration .................. Repair .................. Removal .................. , Demolition .......... .e ..... Other Work (Describe) ........................................ 4. Estimated Cost ...~'....~...~..o..~..o.. .................. ; .................... Fee .....~./..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, ~ify nature and extent of each type of use ............................ 7. Dimensions of exi~ructures, 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 .....~....5..~. ........ Number of Stories ..... ~ ............................................................................................................. 9. Size of lot: Front ....~.:..~...~...~.. Rear .................................... Depth ................................ 10. Date of Purchase ..~...~...j~..b~.. ........................... Name of Former Owner ...~..~....~.~...~)......~.. ........ 11. Zone or use district in which premises are situated .....~.....~.f..~...h~...~ ........................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation> ..~..O. 13. Name of Owner of premise~s' ...~-Z.~,~..e..~.....O~-.~..Address ...~/~..o.~......~..~..~..~ ................ Phone No ..................... Name of Architect ...~....~....?.....~....~..~ .................. Address t~/z./,u#J~s'~J ~ No.9~ ,,U~a~..,,~ff~....~e~.... Phone /w,~o ~,~'~1 ...~,,..~.~.....z~..~......~..,~,.,.... Phone No~i/~''''~ ............ Name of Contractor .................................................... Address .................... PLOT DIAGRAM Locote cleorly and distinctly oil buildings, whether existing or proposed, ond indicote oil set~b~ck dimensions from property lines. Give street and block number or description according to deed, ond show street names and indicate whether interior or corner lot. STATE OF NEW['I~I~J~.,.//~ )'$S COUNTY~ ~_ ,'///, A ~e/--Jw-OF ~......,~'~.~_~.. .......... ~IIC:~,~/3~.....~.?...Je~o.I......~ ........................ being duly sworn, deposes and soys that he is the applicant /~ (Name of individual sig'nra~g application) above(/nomed. He is 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 mc~ke and file this application; that all statements conto.ined in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth Jn the application filed therewith. Sworn to before me this ~ ,~ ' .../o~....~, of .~:~...~..:..._,,/]~9.~./....~ Notary Public ~. L,,~,~,~ ..~unty' ~" ' '"i~i~;; ' ;~ ';;;ii~';;;~ ............................. v ELIZabETH ANN NEVILLE ~' NOTARY PUBLIC, State of Now York No. 52-8~.25850, Suffolk CoulL[Y~. T~r,~ ru~ires Ma~¢h ~ \ \ / fl ! l soUTH N Ot~TH. ~ 0 N TE_N"'F,S; FOUNDA'I"I ON PI,..AN 1~OO i~ F~LAh,.i ~J-~vA'I'R ON5- NOI~.TN ~-5OUT1H