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Home My WebLink About5757-zFOF, M NO. 4 TOWN OF SOUTHOLD BUr~,nING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupzncy No.. z~28~ .... Date ... ,Tuly..2~ ................ ,197~. THIS CERTIFIEs that the building located at ~,~0. ?~ .$~;F.~et~e..~Jl~9~P.O.l~treet Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore fried in this office dated ...D.e.~..e~n..b.e?...6 ........ , 19.?~. pursuant to which Building Permit No..~.?.~?.Z.. dated . .14a~..2] .............. , 1{~3.., 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~&~..~&Pg~ .JFs.).. ]~l,~.&t,e. ~. 1~.3, ...................... The certificate is issued to ... ~.o~.g$..~.&p~ .J.3', .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... .N.: .R.e .......................... UNDERWRITERS CERTIFICATE No ........... .P.~ ......................... HOUSE NUMBER ...1~0 ........ Street. Building Inspector FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5757 Z Permission is hereby granted to: at premises located at .......... ~t~J.....~lJ.~.~. ....................................................................................... ' .......................................................... ~tzmmx'.t ...... li~.~. ................................................................ pursucmt to application dated ............................... ..~...e~.........~. ........ "...., 19.~..,.., and approved by the Building inspector. Fee $....~JOe~ ........ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Application No ................ .~.......~....:., Approved .~....~...~. ............. , 19.2...~. Pemit No .................................... Disapproved a/c ~4~...,...,~..;,...~.; ...... n ~z~/' .c_ ~ This application must be completely flll~ in by ~ewriter or in ink and submitted in ~lic~e to the Building I~ation of lot and of buildin~ on premises, relationship to adjoining premises or public streets or detailed description of layout ofpr~e~ must be drown on the diagram whJch is ~ of this application. by this a~lic~tim may n~ ~ comme~ed before issuance of Building Permit. ~ d. >royal of this application, ~e Building Insp~tor will issue a Building Permit to t~ ~l~a~. S~h permit shall on the premises available for inspecti~ thr~g~ut the profess of the work. e. No building shall be ~cupied or used in whole or in pa. for any pu~ose whatever until a Ce~ificate of ~cupancy 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, ordinances, building code, housing code, and regulations. (S'g a ~,t applicon~.~, Te, ifa corporation) ' r (Address of applicc/.6t) ..................... State whether applicant is~_o~n_e_r,_~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premiSes ..~'...~..~'..~.....~:.. ......... ~..~.."J~Z~ .................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No.: ~ Lot No. X Street and Number .... ,~. .......... .~.......~ .......... ~t. ............................................................. 1 5 0 · Municipality 2. ,State existing use and occupancy of prxe{nisee and in,ended use and occupancy of/'~oroposed construction: use and occupancy ..... .6/.~~..~..~...~.~,.::..~T~... ............................................ Exisiting 3. haam~e ~f W°rk (check which ble): New Building .................. Add .................. A~e io~ Repair ................... Removal .................. Demolition .................. Other Work (Describe) Estimated Cost ,~ ~e'O, Fee ~ ~ ~ ~~ (to be paid on thing this a~lication) 5. If dwelling, number of dwelling units ......... ~.~ ............... Number of dwelling units on ~ch flor ............................ If garage, number of ~rs ............................................................................................................................................ 6. If busine~, commercial or mix~ ~cupancy, speci~ nature and extent of each ~ of u~ ............................ 7. Di~nsions of existing structures, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Nu~er of Stori~ ................................................................................................................. Dimensi~s of ~ structure with alterations or a~itions: Front .................................... Rear ............................ Depth ................................ Height ............................ Numar of Stories ................................ 8. Dimensions of entire n~ construction: Front .................................... Rear ............................ D~th ........................ Height .................... Nu~er of S~ries ...................................................................................................................... 9. Size of lot: Front ...........~.~ ..... Rear ....... ~.. ................... ~pth ......... ~.~..~ ............ 10. Date of Purchase ...; .................................................... N~eof F~e~n~ ........................................................ 1 I. Zone or use district in which premi~ are situated ..................................... ~ ............................. 12. D~s pr~o~d construction violgte an~ zoning law, ordinance or regulation? ...~,~ .......................... 13. Name of ~ner of premises~..~~. ...... Address .~.~..~,...~. P~ne No. Name of Archit~t ...................................................... A~ress ............................................ P~ne No ..................... Name of Contractor .................................................... Address ............................................ P~ne No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-hack dimensions from property lines. Give street and block number or description according to' deed, and show street names and indicate whether interior or comer lot. COUNI'Y OF .................. ,' ................. be,ng du,y above named. He is the ......................................................................................................................................................... (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 that the work will he performed in the manner set forth in the application filed therewith. Swam to before me this · .. ..... day of .. ~ ~ '~/ ,,- -- .". ....... 2 i',i ....... ...... ...................................... rtotary ~' D 'C, . ............... ~'~'~'~."~J~'6~' ............. Count'/ (Signd~ure at applicant) Nots~ l~olie la tim State of ~Tew York /0 J.~ O ~'E FE ~V-7'H