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Home My WebLink About5425-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z~+929 ....... Date ............ Oo.e.... ~. ....... , 19.72 Bay 1~ THIS CERTIFIES that the building located at . N~me~ata. & .Lft~;le. Pe~ Street Map No. Nas., .Pt .... Block No ........... Lot No.. ~.b~ .&:lb.%... Cutehogue.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ J~uly · · · 26 19.71. pursuant to which Building Permit No: . .~.2.~Z. dated ............. Ju~y....2~ 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 . Pr.~.vate. one..£.a~ity .dwe.~.1~g. &. aeee~sory. ~uil~ .............. The certificate is issued to . .E~lwal~cl. D.:l,®~n ........ ~e~ ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N oR, ............................. UNDERWRITERS CERTIFICATE No ...... ~I~. :.P,.: ...................................... HOUSE NUMBER .... ~:~01 ~[ ..... Street ....L.~.ttle. ~e¢on.i~ · Bay .I~! .................... 3~75 ~eweta ~oad Building Inspector FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5 25 Z Permission is hereby granted to: .............. ~1~.~....~Lelmlme. ........................... ................ Jl~jma~.i~t, ......................................... to ~i3,4..~.&eeesse~..¢$te~m.~..b~l~! ................................................................. et premises ~ocated at ......... ~. .................................................. ~1~. ............................................. ............................................. ~t~..& ..l. tt, tle.. jleee~.. ~e~.. M ................................... pursuant to application dated ............................... ~ ....... ~. ....... , 19.,~., and appr~ by the Building Inspector. Fee $...~.o.0l~ ........... lVOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,ned .... Approved .................... ! ....... ?. ......... , 19.J./. .... Pemit No ...... .~.....~/.....~...~.......~.... Disapproved a/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ...... ...~...~'..~.._~i......~......~......~.~.,19.Z./..... INSTRUCTIONS ~ This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin~ 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. cl. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permi~L~ 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 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, ordinan building code, housJ /~/'~L~',,~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ' ' ti n of lan' on W~icL ro osed ork ill be do e Ma- No /x.~"~, . Lot" h coca o o Nrizcp p p w w ooj~ . v .: ....................................... i-~o ......................... Street and Number ~-4~....,~..~..../~...~..~ ~,v~' ..~.../.._/~..~..~.. ~...~(t~..~i~'~~ ~' ............................ .:: .......................................... . :.....:',x. ............................ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occu anc ....~....~....'~......~..~-~ "~::~'~-~"'~'/~:~"'~:' b. Intended use and occupancy ............................................ :.~... ............................................................................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Rerg,ovol ................. ? Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost ................. *-~/-'~,r.~.~. ........................ Fee ...................................................................................... .... (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 c~rs .......................................................................................... ~ .................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each t,/pe of use ...~ .............. 7. Dimensions of existing structures, Jf 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 .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... · - ·: ..................... ....... 12. Does proposed construction viola~g.~ls~g~law,_~ _~'~. )~,~-s~°rdinance ' :~ ' 13. Name of Owner of premises .-~...:..Z.:..'...~~.~...Address ..Z~..~...'~'..~..~....~.¢~.~/~.. 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 NEWt~IjJ~//,~ i.,,. ,. ......... ~....~...~ ........... being duly ~om, deposes and se~s that he is the applicam (Name of indhfiflual ~igning application) oboYe named. He is the ...... ~ ........................................................................................................................ (Contractor, agent, corporate of~f_icer, 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 all statements contoined in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the appl_j.ication filed therewith. Sworn toJa~qre me this _ -- ~ - , ..... ....... c? Notary Publi~.L~ ... County re ;~'[~l~[i~';;~i ............................. I~o. 52-8~258~0, Suffol~_e~e Term £zp res March 30~