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Home My WebLink About5961-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at]~S~ .~Ly.e. ................ Street Map No.D..ok~$.V;~.e.¥.. Block No ........... Lot No. 9 ..... C.B.t.c.h.o.g.u~.....Ii...](.; ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... .~. Y.... 9 .... , 197.~.. pursuant to which Building Permit NOv ~.6.~.Z... dated ........... .J..U~....2J .... , 19.~.2.., 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 . P.~::Lvate. gs2age...&.//,toraga l~ldg .......................... : ......... The certificate is issued to . .J..a~.e..s..D.e.a..n ....... .(~...e.r ............................. ~: (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .l/.,.R.., ............................... UNDERWRITERS CERTIFICATE No..N..~.0..8.8.~.0. .................................. HOUSE NUMBER . ] .~ ~.0. ........ Street .D.e.$~...D.r. $.v.e .............................. I~'ORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORI, ZED) 5961 Z Building Inspector. ~o~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ...... ~........~....., ............... , 19..,. .... ~pphcohon No..~ .......................... .~ ...... ........ , ..... ..... ......... ........................... ............... .............................................................. ~ -~ ~ · ..................... ~ .............................. ..~ ................................. a. This a~lication must be com~lotol~ filled in b~ typewriter or in ink and submitted in triplicate to tho ~uildin~ Inspector, with 3 sots of ~lan~ accurat~ ~lot ~lan to scale. Fee aceordin~ to ~chedule. b. Plot plan ~howin~ location of lot and of buildin~ on ~remi*es, r*lationship to adjoinin~ premises or public ~tre~t~ or areas~ and~ ~ivin~ a d~tail~d d*~cription of la~out of pro~rW mu*t b~ drawn on diagram which is part of this a~¢lication. Th~ work co,or,d bg thi~ ~lication mag not ~ commenced b~foro issuance of Buildin~ ~ormit. d. ~on a~pro~al of thi~ a~plication, tho 8uildin~ In~ctor will i~*ue a 8uildin~ P~rmit to the a~plicant. Such ~rmit ~hall be k,pt on th~ promi~ a~ailabl* for in~ection throughout th* work. ~. ~o buildin~ shall b~ oceupi*d or used in whole or in ~rt for an~ purpo*o what*uor until ~ C*rtific~t~ of Occu~anc~ ~hall ha~ b~n ~rant~d ~g th~ Buildin~ In~ctor. 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, Suffo[~ 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. ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. James Dean (Signature of applicant, or name, if a corporation) ..... D.~,~..D, nL*~e ........ .C.n:~c.h~ gue ...................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~ .......................................................... .9~':.~ .e.~ .......................................................................................................................... Name of owner of premises ........ ~..~..m..e...s....D..~..~. ................................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .D..OS~.~.Y.,~..WLot No ............ 9 ................................ Street and Number ........ ~r.~..~...~..~.~.~l~..~.~'~.~'~ ....... .Q~ttCkog~.e ........................................................................... ~'! ~ //,~- 0 ~-~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~...'~....~..~;~,g. ........................................................................................................ b. Intended use and occupancy ................. ~a~e..~.~.~h..~:~&.~a.t.e..~a~e ........................................................ o o 10. 11. 12. 13. 14. 1 Nature of work (check which applical~ New Building ...~...?. ...... Additk ° ..... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 1; 000 + Fee 10,00 Estimated Cost .................... ~ ......................................................................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ...~...o. .......... Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ Dimensions of entire new construction: Front ......... .1..5 ........... Rear ............. )..~. .......... Depth ......... .2.~ ................... Height ................................................. Number of Stories ..........~. ........................................................................ Size of lot: Front .........~0 .......................... Rear .......... ~ ........................... Depth ......~(~0 ..................................... Height .................................................... Number of Stories ...................................................................................... Date of Purchase ..................................... Name of Former Owner ............................................................................ Zone or use dmtrmt ~n which premises are mtuated .......... .~.;.....~..[.s..~.. .......................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ............ y~s ......................................... Will lot be regraded .......G.0 ......................... Will excess fill be removed from premises: [ ] Yes [3:] No Name of Owner of premises ....~T~rn~...~.e.~.~ ................................. C=l;c~o~.~e ..................................................... {Address) (Phone No.) Name of Architect ..................................................................................................................................................... {Address) (Phone No.) Name of Contractor same (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 wheth- er interior or corner lot. ~ .: 'ATE OFNEW YORK, )UNTY OF ....... . .~..~1,~.. ~'.~ ,~ ........................... ) ) SS Mrs. James Dean ....................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contractJ ; is the ................................ (~W~. ....... ~tZ.~..]:.~.e.z~ ........................................................................................................................................ (Contractor, ~ent, corporate o[~cer, etc.) of said owner or owners, and is duly authorized to ~rform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be ~rformed in the manner set forth in the application filed therewith. JUDITH T. BOKEN ......... ..................... r . uot, ....................................... · I0'= 0°' ' Ptrc, .