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Home My WebLink About5889-zFORM NO. 4 TOWN OF $OUTHOLD BUHDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~.~.~..~.~. ..... Date ......... Qqt.o.b.e.r. ~,~., ...... , 19. THIS CERTIFIES that the building located at ...1~ .n~..e~..a~a...B.~.v.d.~ ....... Street Map No....X~. ........ Block No. ~ ....... Lot No..~.. .... ~.u.~;.h.o.],¢ ................ conforms substantially to the Application for Building Permit heretofore fried in this office '~]ated ...... . .~.y..1.7.! ....... , 19.7.2.. pursuant to which Building Permit No.. dated ...... . .~.Y..~.9. t ........ , 19.7..2., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . .U.t..~.~.~.t. lr..b..uJ, .~.d..~.g..(l~.tl~p. house) .................................... The certificate is issued to ...L~g.h;i,l~g. ~At;er. ~ropex. ty..Otrners. As~oo~ .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... N..R .......................... UNDERWRITERS CERTIFICATE No..P.~411~ ................................... HOUSE NUMBER .. ~. ........ Street ...... ~:~m.e,ha.h~ .Blvd.,, ................. ................................................. .out p;l ..................... FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5889 Z Permission is hereby granted to: ............. .a...e.~..o.l,.a,.. ......... 1~.,,~.,, ............................ at premises located at ..........~;J~ilhJ~..~.~J. .................................................................................. ..................................................... ti~utl~l.& ...... ~..~;.. ........................................................................ pursuant to application dated ................... ..~?..?. .......... .1..~. .............. , 1~........, and approved by the Building Inspector. Fee $.?..0..?...0~... ........... ~FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. ^pproved ........................................ , ]9 ........ Pemit ~o No. '~'~'--dc ' '~ Applicotion ............. ~ .............. Disapproved o/c ............................................................... '('l~'~ii~t'i~' ' J ~'l~tfr) ............................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~l a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi1 :3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, a giving a detailed description of layout of property must be drawn on diagram which is part of this application. 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 Building Permit to the applicant. Such permit shall be kept on~ the premises available for inspection throughout the 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 beel~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance 'of a Building Permit pursuant to the Building Zo~l Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable law~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections~ % . (Sig'Tmtu~of applicant, or name, ff a corporation) ~' (A~ress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................... ............................................................................................................................................. owner of premises ........... ~.t..~j.....~...~.'~..1¢~....,..~.~-!~...~ .......... .................. ; ....................................... Name of If ap/c/~cant is a corporate, signature of duly authorized officer. ..... .................. (l~lame ~hd ti~fb~corporate officer) 1. Location of land on which proposed work will be done. Map No.: ..................................................... Lot No ............. Street and Number ................ ..~..l~N..~....~:~...tila......J'~....~.~,~.. ........ ...~....u..'1['~...F,,~ ....... ..JV.:..l~..,. ............................................ -~' --~ C) Municipality 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... u ~ F~ .~ ........ b. Intended use and occupancy ............ ~..:..~. j~ .....:.~ :...~ ~.~......~.: .~......~... ....... ~.. ......................................... 3. Nature of work (check which applicable): New Building ................... .~.. Addition ..................... Alteration ............... Repair ............. ..-.-m ..... Removal ......................... Demolition ...................... Other Work .................................... f~ ~ ~ / ~ (Description) 4. Estimated' Cost ............................................... ~'~ Fee ................................................................................................. /o (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 ...... ..-:... .......................... Height ............................................. ~ Number of Stories ............. ~ ........................... ......*..... ................... Dimensions of ~ame structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ........-- '~..~.... ..... Rear ........----.~..~... ......... Depth ....~..~....: ................ ...................... Number of Stories' ......................................................................................... 9. Size of Int. Front . .~ .................... Rear .......................................... Depth .../...~.. ....................................... 10.. Date of Purchase ..................................... Name of Former Owner ......... ~...'. ........ ~.~C. KLt/~.....~I. ............................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 131 Will lot be regraded ........... ~...O.. ................. Will excess fill be removed from premises: [ ]Yes [ ] No 14. Name of Owner of premises ...,~.~/..~,~..~.~.....-n.O;~....~.~,~...fL'~ .......... N: .................................................. ' ~ ~J ~ (Address) (Phone No.) Name of Architect .......................... ~ ...................................................................................................................... (Address) (Phone No.) Name of Contractor ................ ,~....~. .......................................................................................................................... (Address) (Phone No.) I:.ocete clearly and distinctly all building, whether existing or proposed, and indicate all mt-back dimensi property lin~. Giv~ ~m~t and bilk numar or d~i~tion ~eordin~ to d~,d, and ,how ~m,t n,m~, ~nd indie~t~ wbe~- er interior or corner lot. · n ~..~..:~ beln dui s rn n ........................................... ~ ............................ ' g y wo , deposes a d says that he is the applicant above named. (Name o.f JndhYdual =Jgn#t~ o~.pjttract) He isthe ................................. ~~ ................................................... i ............................................. (Contractor, agent, corporate officer, 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 contained in this application are true to the best of his knowledge and~l~..aCfl~l~._t~work will he performed in the manner set forth in the application filed therewith. No, 5~-0830410 ....... /. Z .,,.~... · .day of -i-.~ .............. 19 .,~.~, -7 [ lift /~ / ($i~nahtre ~f applicant}