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Home My WebLink About5720-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~b'].~ ...... Date .............. &l~...~ ...... , 19. THIS CERTIFIES that the building located at . ~t; .~0~. l~X'~Ve .......... Street Map NOF~;. t/~'$f~t · · Block No..~ ....... Lot No. x,~... I.~.mll®r~ .Irate. - I~,¥,..- conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. l~.~b ..... 2[~9. ~2. pursuant to which Building Permit No. dated ............ Fe;b... 2~., 19.72, 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 . l~'t&~;¢~ 'onz' .£am~r .¢lw~'lAn£ ....................................... The certificate is issued to . .~Ll-t~.~tm .R.. ~ood. J~ ...... 0~l' .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .1.~,R., ............................. UNDERWRITERS CERTdFICATE No... 1~.,11~ .......................................... HOUSE NUMBER.. I:1,~ ...... Street ................................................. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5720 Z pursuant to application dated .................. ....... ~....~.. ............. , 19..~.el~'and approved by the Building Inspector. Fee $/..~, ................. "~'~ Building Ins~ .............. NO. 1 TOWN OF $oUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ ~9 ........ Permit No. ~'"7~)~ Disapproved a/c .......................................... ~......_....~ ' V (BuHdinglnspector) ( APPLICATION FOR BUILDING PERMIT 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 of property 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 Buildirlg 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 progress of the work. e. No building shall be occupied or used in whore or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY/V~,DE 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, ordinances, building code, housing code, and regulations. (Signature cf applicant, or nome, if a corporation) Fishers Islancl~ New York (Address of applicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................. general...~)Xl .t;~..~..t,.~..r ....................................................................................... Name of owner of premises .....~3Ll. l:Lam..H,..woo~,..~r~, .............................................................................................. If ap~D~cant is a corporate, s[gnature of duly authorized officer. ' ............ .. ........... -- (Name an~ title'of corporate officer) 1. Location of land on which proposed work will be done Map No.: ID].~l,..~lr~..~.~,. ........ ~Lot No.: ............ : ........... Street and Number ........................................................................ .F~[l..~..~..~-,g].~l~..~le~l..~or.,~ .................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................ ~'~8~¢~1~e ............................................................................................. b. Intended use and occuponc, . ............. ['.~.~..:l-..~..tt.~.~.el ............................................................................................. 3. Nature of wo~k (check whici~ applicable): New Building .................. Addition .................. Alteration ..~ ...... Repair ................... Remora! .................. Demolition .................. Other Work (Describe) ..... D...e..~...k ......................... 4. Estimated Cost ............. ~,~.~g.~0~ .............................. Fee ,~.~.~.0.0. ................................................ (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ...1 ...................... 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 exist!rig structures, if any: Front'. ........ 40 ............... Rear ....40 ........................ Depth ..~.Q .............. Height ..... 30 ............... Number of Stories ..... .~.~ ....................................................................................................... Dimensions of same structure with alterations or additions: Front .... 4.0 ........................... Rear ....4.(~ .................... Depth ...,~0 ........................ Height ........................... Number of Stories ..... ~,.~ ...................... 8. Dimensions of entire new construction: Front ...... ~Q ......................... Rear ......2..0.. .................. Depth ...2..2. .................. Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front .~..DLo~'..~l-~l~ar ................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in ~hich premises are situated ........ ~e~l.~ll~jl~l, .................................................................. 12. Does proposed constructlon ~iol~te any zoning law, ordinance or regulation? ...... I~.O ................................... 13. Name of Owner of premises ~,~,...~Q(~,,...~TJ~,~......Address ~l.~..~j~'..~.~.~.~ ............ Phone No....T. ............... Name of Architect ..... TL~..n..~. ....................................... Address ............................................ Phone No ..................... Nome of Contractor ~,..~T~t~..G.a~,& ...................... Address ~.~.11~.~...~..~.~...~..f~. ......... Phone No..?..8...8..-.?...2..3...~. 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 ;nterior or corner Jot. see ~lot ~lan STATE OF NEW YORK, COUNTY OF ................................ $ '~"~' .......... ~..~.~r~.....G..~.~.~....d....~..,~ .............................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) above named. He is the ~d~.l[l.~.~.9..t~....~. ...... (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 belief; and thru the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..... ......... day af ........... , .................. ........... ....... Cou ty W (Signature of applicant)~ ................. Notary I ..... Commission Exprres March 30, 5, gZ~ TITLE N~W yO~ ~T~T~ LAND WI LLI A.k/1 ~ N,(A~ Y I, I. WOO[::).,,]' F-_,. L_. M,/oo ~