The URL can be used to link to this page

Home My WebLink About5917-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No~.~.6~0 ....... Date .............. ~T~i~. ~ ....... , 19 .~'~. THIS CERTIFIES that the building located at . lq~l~ .lior.~h. 8o& 1)~ ........ Street Map No...~ ........ Block No. ~ ....... Lot No...~... 8~utho~'~'' 1~.'~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... J~l~r.. ~..., 19 6~. pursuant to which Building Permit No. ~9~1~.. dated .......... J.~e..~ ...... , 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 . .Pri[¥ate. g&rag~ .(. &oee~el'l~ -~t~l~L~g.)..(&ppis®Ye& .by-B4 .&pl~al~ Al~g 6~.' The certificate is issued to D~e.t~..Il. ~[l.~.k~l~ ...... .0~®~. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....l~,l~, ............................ UNDERWRITERS CERTIFICATE No. ~*]~ ............................................ HOUSE NUMBER..'~.~ ...... Street ................................................. f?.. ? ...... Building Inspector ~ FORlV~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE i SOUTHOLD, N~ Y. BUILDING PERMIT N? 5917 (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z Date .............................. ~...~.......~ii :., ~9..~.~ Permission is hereby grar~ted to: ~o...i~:~,;1,¢~.. ~.¢~.. ~r~,~.~.t,~...~..~.~.... '. ....... ~. 1. ~r~o~..~...~..~ ;.. at premises located '~; Building Inspoctor. Fee $....~J.(~,,O~ ........ TOWN OD SOUTHOLD BUILDING !DEPARTMENT TOWN C, :Uc'S SOUTFI~LD, N. Y. Examined ~) Z-- 19 ~r~ ~ ............................ · ~ ........................, ........ Application No. ~' / APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a, This application must be completely filled in by typewri~!er 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 i~e drawn on the diagram which is part of this application. c. The work covered by this application may not be commenfed before issuance of Building Permit. d. Upon approval of this application, the Building Inspector ~vill issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout tDe progress of the work. e. No building shall be occupied or used in whole or in part f6r any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department f,? the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County4 New York, and other applicable Laws, Ordinances or Regulations for the construction of buildings, additions or alteratkins, or for removal or demolition, as herein described. The applicant agrees to comply with ell applicable laws, ordinanc~is, building code .and regulations John 3% ]'~c]',:~a~n A/C .... ~,o~ig.tb~..,~o.F~a~lDzt~ * ........................................................ (~iigneture of applicant, or name, if o corporation) ......... N.~..,S,ea. Dr.~ ........ S.a~tt~zal~ ...................................... (Address of applicant) Sta~e whether applicant is owner, lessee, agent, architect, engineer, g~nerel, contractor, electrician, plumber or builder. ..................................................................... ag.e~t.. ~£,..o~,~z~e ~ ....................................................................................... Nome of owner of premises ..Zto~.o..~a.~..,~¢.]~]BJ~Z~ ........................... ¢ ................................................................................. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be dane. Map No.:; ....... ~..~..q~ ..................... Lot No.: ......~.. .............. Street and Number ~T.,.,.~.ea....D~-9 ....... ~o~f, ho~d ............... i ................ ~..*.,J .................... ~ .................................. ~ Municipality State existing use and occupancy of premises and intended use ,~nd occupancy of proposed construction: a. Existing use end occupancy ............. c~,~;p~.~L.'[£~ ..................... i ............................................................................. b. Intended use and occupancy .............. ,~e..M;L~..pz:J,~.a.t,~re,..~&z'~.~. ......................................................... 3. Nature of work (check which apl New Buildihg' i....,~.~..., en .................. Alteration ............ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ................................. 4. Estimated Cost ............................................................ 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 cars ............... ~. ........................................................................................................................... 6. if business, commercial or mixed occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing strutture~i if any: Front ............................ Rear ................................ Depth .................. Height ........................ Nun~ber of Stories ............................................................................................ ' ..................... Dimensions of same structure with alterations or additions: Front .................................... Rear ........................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ,3,2, ...................... Rear ......... iL2.... .......... Depth ....~.~. ............. Height .................... Number of Stories ......... ,O.D,~ .................................................................................................... 9. Size of lot: Front ....~.QQ ................. Rear ............ 1.QQ ................. Depth ..,3.~.~/.,.,~.KQQ .......... 10. Date of Purchase ................... 1,9.~. ........................... Nome of Former Owner ...................................................... 1 I. Zone or use district in which premises are situated ..... ~...dJ,,SJ~, ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~,~,.~ ............................................. 13. Name of Owner of premises ..DD~.D.l~...~cl~Jah~n. Address ......... ~.~D,~..,ko~d ............... Phone No .................... Nome of Architect ...................................................... Address ............................................ Phone No ................... Nome of Contractor .................................................... Address ............................................ Phone No .................... PEaT DIAGRAM Locate dearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimens property lines. Give street and black number or description according to deed, and whether interior or corner lot. ~ 3ns from names an~l indicate <) D t'tv STATE OF NEW' YORK, } c c COUNTY OF ..~.~tZ~-t'.o~l~ ............. -~ °'~' ................................. ?.,9.1~'..:.Z.~.,.~f~.~0.Q~ ........................... being duty sworn, deposes anti,says that he (Name of individual signing application) above named, He is the ............................ J3~,flZ),~...q,~'..,Q.~/,g.~. ................................................................ (Contractor, agent, corporate of said owner or owners, and is duly authorized to perform or have performed the said work and this application; that all statements contained in this application are true to the best of his that the work will be performed in the manner set forth in the appli therewith. Sworn to before me this ............... 2Z.., of (Signature of Notary Public, s the app,licont )r, etc.) make a~d file and belie, f; and