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Home My WebLink About5417-zFO~M NO. 4 TOWN OF SOUTHOLD BUILI~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z~Sfi7 ...... Date .......... .(~t,O~r. ~.8.$ .... , 19 .?3. THIS CERTIFIES that the building located at .. ~,~;.e. D~.~,?.e .............. Street Map No. ~'37.. ..... Block No.. Xl ...... Lot No. 2,?.g0,~6,;~7 ....... .~..u..~..o.:l,a.... conforms substantially to the Application for Building Permit heretofore filed in this office '~"' dated ...,TIllS..3,7.~ .......... , 19..7.3, pursuant to which Building Pemit No. .~.1.~. dated ...Jlll~..20~ ........... , 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 issued is ...Pl*:l..~.ate. olle. f~lttl~..Swell~.~lg ..................................... The certificate is issued to .... ~ 2ezLialld. l~ .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...I~.I~ ............................. UNDERWRITERS CERTIFICATE No...NCR, ...................................... HOUSE NUMBER ....1~0~ ....... Street .... ~il~e..D.l~.V.e .......................... ............................................. ~,.u..'~..1.~. ......................... FORM NO. 2 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) 5417 Z Permission is hereby granted to: ............. ~,~.~.. ~l~a ....................... .................. ~,~.'"'~e~z/;h"'"~;ta~"~d~'": ................. .................... &~c'~'~s~i.~.~ ...... ..~.~'~ ~..: ................. to ...~t:Ll~L..az~..e~.~t;~r~..¢~$o~)...o~a..e~.a.t,~..4~e~:Z.l~e .......................................... ot premises Iocoted at ..... ]~,~g~..~.~,~'~ .....................................~... ....................................................... ......................................... 8~r~h~d .......... ~'~'~'~ ....................... ! ......................................................... pursuon¢ to application dated ............................. ~fa~ ......... .'J.~..:...., 19.~..., and approved by the Building Inspector. Fee $..~.Og ............. Building Inspector / App roved Disapproved a/c .............................................................. .~ APPLICATION FOR BUILDING PERMIT ~-~ · ....~...../..~ ..................... , ~ 9..7..~. ..... Date 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 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: ~n ~pproval of this application, the Building Inspector will issue a Building Permit to the applicant. Such perm t ~h~flt be kept on the premises available for nspect on throughout the progress of the work i: e:.~,4~'bulldmg shall be occupmd or used in whole or ,n pa rt for any purpose whatever until a Cart f cate of Occupancy 'J ;lil~a3TIIhave 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 oil applicable laws, ordinances, building code, housing code, and regulations. ~- ~ (~ -"- / ....... ' (SignOra're of applicant, or name, if a corporation) (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, ~enerol contractor, electrician, plumber or builder..~ ................................................Name of of : ......... ~ ................................................. owner premises ~.~...~...?...~...~..(~..~.!~........~.~.~.~.`..z~.~.~.......~'~..~..~/.~[.~.~..~(.~..~.~.~. ......................... If applicant is a corporate, signature of duly authorized officer. .................. ii~;~;";~'r;,:i";~i~TZ;F~';',:~;';';~'f;";;;~i~';';~ ......... -7'._-.-.4~ - ~. Locat~o. of ,and on which proposed work w"'" be done Map No.t~...~. a.~ '7 Ut No~Z' ;~;~" ;~-"/ Number ~'~,:. L(~(~. ~ ~' ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ,:.f, - 3. Nature of work (check which applicable): New Building .................. Addition ............... Alteration .................. Repair .................. IRemoval .................. Demolition .................. Other Work (Describe) ........................................ .~'...~ c~ J Fe . 4. Estimated Cost .......................................................... · ..... .~ ............................................................................ (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 ~/pe of use ........ ,. ................. · . ,.j-- / .j~l t 7. Dimensmns of ex, sting structures, if any: Front ........~ ...... Rear · .~..: .................... Depth ;~,~......~..~..~/ HeigHt ........................ Number of Stories .......... ~'.. ........................................................................... ~ ....................... Dimensions of ~ame structure with o terat ons or add tons' Front .,,.~,,,~ i . R~n, ~--I Depth ....,.~,,,..,,~,,,, ................ Height .................... ~'. ...... Number of Stories ,;.,~, .......................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ............................................................. >. ....................................................... , ././..g....~..../...3....?...' 9. Size of lot: Front ......... ./.~...~..! ....... Rear ..... ./,~.,,~... .................. Depth 10. Date of Purchase .......... ........................ Nme of Fo~mer O~er .~...~.: .................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does propased construction violate any zoning law, ordinance or regu at on? . ,,~.,...~. .......... ' f n f ' ~ ¢~ ~'0 A.('~ £ ~[c~:~,,.?~";'~'Y,'"'"'"~ ....... ~3. Nome o Ow er o prem,ses~..~.~.~.e..~..~....~. ........ ~bres, .]. ................. .~..~... ......... Phon;~o. ~..:~.?? 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 froml property lines. Give street and block number or description according to deed, and show street names ar~e%~li~nt~ whether interior or comer lot. -- oP£/Y DEC/( . STATE OF N & tcc COUNTY OF ..'..t~i.~L.~.~J~ ......... ~'~ ..... *..~....~....-~...~1..'~...r...~.........~...-'~..Z/~...Z~.z'~./..../~....{ ...................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) ~___..~__ ~.~..~ .~-- ~ above named. He is the ...~~ ........................... ~,~..~.~..~....~.~...'.-......~...~.,, .......... (Contractor~, agent, corporate officer, etc.)h of said owner or owners, and is duly authorized to perform or have performe~l the said work and to make bdd file this application; that ell statements contained in this application are true to the best of his knowledge and belief; and thor the work will be peliform ld in the manner set forth in the application filed therewith. Swam to,b~fore me this t ,,, - / .............. of ....................... , / Notary Public~,l~.~..~{~,. ['~'""~A"J';'.'~' ......... ~oC8°E~I~:';;;;;'"~i .............. '~'~l'~'~'t~';;';~';~";;;~;)'~ ................. X.) V~JUV~/ ~ ~\~/,r-~v~lv~ tNotary Public, {tare of New ¥0t~ r~ ~, NO. 30-6604800 - Nassau County d Term Expires March 30~ 197-2