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Home My WebLink About5405-zFOI~M NO. 4 TOWN OF SOUTHOLD BUHDING D~PART~'~,NT Town Clerk's O~ce Southol~, N. Y. Certificate Of Occupancy THIS CERTIFIES that the bui]dlng located at Ittl,~ .Rd~ &, I~let. I)v .... Street Map NoCapt .12tdd.. Block No ........... Lot No..?3 ..... I~a.ttituek.. 1/,~, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... .....! ..... , 19. pursuant to which Building Permit No.. dated.......7/30/69 ..... - 7/.1~/7-$ · , 19. ..., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~sued is Private .e~..fl~t.ty. dvell~ ...v~.th. ad~ltions ............... ~ .. · The certificate ~ i.~sued to .. P&squtle.. Ress~. .... Ovne~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . · li,R, ............................. UNDERWRITERS CERTIFICATE No. l~lin~ ................................... HOUSE NUMBER ....... ~0D... Street . :l~ir~,,. 1~ ............................. Inlet ....... ....... l~O~-M NO. ~ TOWN OF SOUTHOLD 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? 5405 Z Permission is hereby granted to: .............................................. C.~.~ .~.. ................ ......... .~ ........ ~.....t......,c: ......... ~.~.~.,~ ..... ......................................... (_(.~.~..~.~....~:... ....... :~...~,,~.~..z~..~........~....:z.~ . . /t~4 '77' / ,/.--.. c.- .......................................................................................... ........ :~..~.. .............. ~.....~.. .................... pursuan¢ to application dated ..................................... /...~.-....~'...~.~..~., 19..~.~., and approved by the Building Inspector. Fee $o_.~. ............. ..... ~..,~ ...... .../...../......./..~ .! .............. Building Inspector BUILDIHG DEFARTMIENT TOWN CLERK'S SOUTHOLD, .......... /,~-.-,/ · Application No .... ,~...~......~. ...... roved ............. ~. ~'"(//~i 1972 . ~'t_/r ~ _~- ~.. PP ...... .....'...~-~, ~..... Permit No ............................. Dilapprovad Q/C: ...................... ~ ............. i .............................................. " ~ ''/ ................................... : ...................................... (Building Inw~tor) APPLICATION FOR BUILDING flRMl"r ,,,,. .................................. ,,.7/....*.. INSTRUCTIONS · This application must be completely filled In by typewriter or in ink und submitted In duplicate to the lauilding a. Inspector. b. PI.at .pi.an showing location of lot and of bu.ildings on premises, relationship to adjoining pmmiles or areas, aha g,wng a dotalled description of layout of preoerty must be drawn on the diagram whlch Ii part ~r~ 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 BulldlngPermlt to the cq)plJcont. Such permit shall be kept on the premises available for inspection throughout the progress of th6 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.P..PLI_CATION IS HEREBY MADE to the Building Department for/~e issuance of a Building Permit punluant to the udd~ng t. one Ordinance of the Town of Southold, Suffolk County,/qdw York, and other apall¢cll)le Lawi, Oldlnancee .~ulations, for the construction of buildings, additions or al.teratio~s,/or for rerlq~al 9r clemolltlon, os ~ dlKribed. · applicant agr,s to comply with all applicabl, laws, ord,no.nc~,/build~code, and regulaflom. · ........ (Address of applicant) State whether applicant is owner, le*~ee, agent, architect, engineer, generaJ controctor, eleotrl¢lan, plum~' ar I~llder. remi .~..~.. S ~.~/~. ..... C .~....~'.. C~ -77-~,q ~ome o~ own,r o~ p ~ ............ ~. ............. ~ ..................... -:. .................... ~ ............. l ..................................... If applicant is a corporate, s~gnoture of duly author~ed officer. ..... .../..~..~. ......... ~'....~.7.. ......... .¢~..w..~ .................. ~/~~ ~-. (Name and title 'of corporate officer) ~ /~A/~t/ ~ . I.Location of land on which proposed work will be done, Map No.: ~ ~' '7~i~, Lot No.: ...... ........................................... ....... 77g ? dun'"'i;';;ii;; ....................... i ............ 2. State existing use a.nd occupancy of premises and intended use and occupahcy of proposed cof~ructlon. b. ~ntend,~.,s, on~oc¢~[,an~.,. ...... ~..~ .......... ~!..T..~ ............. .~.~.!..~!.~..~ ...................................... I _ / 3. Nature of wink (check which applicable): New Building ........... ....... Addition .................. Alteration ............. Repair .................. Rem°Vga, Demolition .................. CJt~re~Desc ribe) ..................................... / 4. Estimated Cost ............................................................ Fee ...................................................................................... · a//~ (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 busings, commercial or mixed occupancy, speci~.~c~re and extent of each type of use ....... i ................. · 7. Dimensions of existing structures, if any: Front ..................... ....... Rear ................................ Depth ~ ...... Height ........................ Number of Stories ................................................................................................ c' Dimen=ions of same structure with olteratioos or additions: ,Front .................................... Rear ......................... . E~pth Height ......................... ; ..Number of Stories , . ............................... ................................ 8. Dimensions of entire new construction: Front .......... : ......................... Rear ............................ Depth ........................ Height .................... Number of Stories .............~"1~'~ .............................................................................................. 9. Size of lot: Front .........../..../~.....~... ..... Rear .................... .C ........... ;.. Depth ........................... 7',5- - (~ S~ 10. Date of Purchase ........................................................ Nome of,, ~-~, --'~e~ ~L."'~'~t'7'~'~ ....................... I !. ' Zone or use district in which premises are situated ....................................................... ~1~"/,2 .................................... 12. -Does proposed construction violate 9ny zgning law,_ordinance or~ay~ti~l~.p, ff.~/?E.~,;~~ ............. ~..~',e~;.~.7~ 13. Name of Owner of premises .....~....~.........~.. ...... .:.~...O.~.~...~Address ........ ...~.~...~....~....j....~..?'.... Ph_ope No ..................... ,J b4 ...... ............ ... Name of Architect ...................................................... Address N~.T.~.~.~.Z~.... ~ Name of Contractor .................................................... Address .............. ).i.~..~7.....L ......... Phone Noog;~;;~L ...... PLOT DIAGRAM LOcate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensio.ns from property lines. Give str~.t and block number or description according to deed, and show street names and mdical'e whether interior or comer Jot. STATE OF NEW YORK, ? ! ee COUNTY A-m o , .......................... ,...~,~L ............................................... ............... being duly sworn, deposes and says that he is the appdcant (Na,~f individual signing applica~i~)E V"/' -- 'J~U I ~ above n~m~d. He is the ........................................ ~i: .............................................. .~."; .............. ~,~ntractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove~ pel~formed the said work and to make and file this application; that all statements contained in this application ar.~ true,, to the b~c of his knowledge and belief; and that the work will be performed in the manner set forth in the ap~gicatJon/filed the~ith. Swam to bei¢9~e me this ,,J'/,,/,i '// ' rhk\ / \1__.~_ II ................. · f'..... ~/~f~y~.~A~~.~. .....,~,,,,~, ,,..~ hloto~! Public, ~~'.~'N ........ : ........................ c-- ''-'- - - "ounh, '"'-~'1 .... ~i~'nature of ..... applican''</''''''''''''' ":'""~'~ ............................. NotaP/ Public, Slate of New Yot'k Swom to be/~e me this CoNm°;iSss2i:n03E4x4pgir6e~ MSaUrcff~lk30C,°l';y I I'"IAP OF mArd:ruo< T'OWN o,r: SOUTi40~ D ,~-- ,f ' ..¥