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Home My WebLink About5166-ZFO~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 2~1~p.~6 ...... Date ..............F4~]r.... 1Q .... , 1g.7.1. THIS CERTIFIES that the building located at ... 8/~... 1~.~. R.e.&~[ ........ S~eet Map No.. ~ ........ Block No. ~ ...... Lot No...~ ... 0r$en~, .~.~. ........ confoms subst~ti~y to the Application for B~ld~g Permit heretofore ffl~ ~ t~ office dated ...........Ea.roh .... ~ 19. ~.1. p~su~t to wMch B~l~g Permit No.. ~6~. dated ............ ~r .... $~., 19~4., was issued, ~d confoms to ~1 of ~e req~ ments of the applicable pro~sio~ of the law. The oceup~cy for which ~ ce~icate ~ ~sued is . ~,~ .. N~t.$.ple ~lSenee...(. A8~.t .~e~) ......................... The ce~icate is ~sued to . Je~. ~e~ .&. ~ebt. ~. ~l~y~. Z~ ..... ~ (owner, less~ or ten~t) of ~e Mores~d b~g. Suffolk Co~ty Dep~tment of He~th Approv& . W,R, .............................. .... ........... B~g ~pecto~ FORM 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) N? 5166 Z Dote t~reh 1 ~ 19. 7t Permission is hereby granted to: ............. Fm~l..~eha~lie. k.....~/C..J~...~d~ & O. ~ ......... I~ ....i~.~t,,tz~! fj..al~......: .......................... LMM'""B~Im~mm .......... I1.,¥, ......................... to ...... D~'Z~...al~ · .a~:d~L't :!.~ n" 'Olz "art · r...:L.$ t:[BS- · ~lwO 'l'~'f~l~...~...~t. · ~ ..... at premises located at ............... ~-/~-.~a.~+..l~.~l~ .............................................................................. ........................................................ O'~ier,~¥..~ ~¥'~' ........................................................................... pursucn~ to application dated ................................ ~ ...... .~..., 19..~.., and approved by the Building Inspector. Building Inspector / / ,~JlllLICAI'ION I10! BUIM)INO Il'II. MI! INSTRUCTIONS ~ e. Thil elaldk:etle~ m~t be ~ flll~ In ~ ~writer or in ink u~ .ubmitt~ In ~pl~e to ~ Buildi~ I~. b. H~ e~ ~ ~ ~ ~ ~ ~ ~ ~ pn~m~ mloti~ip to ~j~l~ p~ ~ ~1~ It~ts or~ a~ ~ ~ o ~m ~ ~ ~ ~p~ m~ ~ a~ ~ ~ di~ ~ ~ ~ d ~ ~lkoti~. c. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~fom i~e of ~lldl~ ~t. ~ d/,. U~. ~1 ~ ~11 ~1~, ~ ~1~1~ I~ctor will I~ a Bulldl~ ~lt to ~ ~l~t. ~h ~it ~, ~ ~ m ~ ~lm ~1~ ~ I~1~ ~h~ the p~ of ~ wo~. e. No building shall be ocou~ied or teed In whole or In part for any purpo~ whatever until o Certlficoto of Occupancy shall have bern gronted by the Building Imixctor. R~Uepp. A..P. PLI_CATI _ON .!S HEREI~.Y.,MA_DE to ~ Building _1 _~..rtment for. the .issuance of a Building Permit ~u~uent to the u,a~n~.. ~.or~. u~..tnan~ o? me i~mtm of Seuthold, Suffolk County, New ~rork, and other al~lk~ble I.m~, Oedlnances or Ior ._mfl~, for rna comtmcti.ofl of buildlng~, oddltlor4 or alterations, or for removal or demolition, o~ herein delcrlbed. licont ogree~ to comply with cfi ol~llceble laws, ordinances, building code, housing cede, end mgulatlom. (Signature 'o~rappllcant, or name, if a coq~mtion) If opplicont Is o corporote, signature of duly euthorlzed officer. (Flame end title 'of corporate officer) !. Lecotle~ of lend on whloh pn:q~med wo~k will be done. Mop No,: ........................................ Lot No,: ........................ - 2. Stote exi~ing u~ o.nd occuponcy of Pmmim and Intjnded ~se _and oCCUlXmCy of pr~ comtructlon: 3. Nature of work (check which applicable): New Building. ................. Addition .................. Alteration ...~ ...... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .'~'.../..~..~.~..r...~...~.. ............................... Fee .......................................................................................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units ........................... ~Number of dwelling units on each floor ............................ If garage,,number of cars ........................................... i ................................................................................................. n ur n t f f ~-/ /'J' J~^'~' 6. If busine~, commercial or mixed occupancyi specify at · a d ex ant o each type o use ,~ . .~., · / / / 7. Dimensions of existing structures, if any. Front ..... ;~..~.. .............. Rear ....1~. ................... Depth ...~..~. ......... Height .....~/..~../. ........ Number of Stories ...... .~. ..................................................................................................... Dimensions of, same structure with olterat,ons or additions: Front ...... .'~'.../.. ................... Rear ....~...~.... .............. &.O.. Depth ......... ............... Height ......~.~K,. ............. Number of Stories ..... ........................ /i / / 8. Dimensions of entire new construction: Front ........... ~ ...................... Rear ......... k~ ............... Depth ..... :/. ............... Height ....../..~...../. .... Number of Stories ..... ./. .............................................................................................................. ! 9. Size of lot: Front .........~..~..~..../.... Rear ..... ./.~....~... ................. Depth ..... ...~...~...~.. ~ 10. Dot, of ,urchase ....... .................... N m, of Fo , O n,r 11. Zone or use district in which premises are situated ..................................................................................................... 12q Does proposed construction violate any ~onlng law, ordinance or regula.tlon? ....~..~._~ ........................................... 13. Name of Owner of premises(~.~....Address .~...~.~J~.~.~)Phon. No.~/.4/4~'.=.z~.~(~// Name of Architect ....................................... .~ ............. Address ...~ ....... ,..,.,._..,...~ ......... ~,.. Phone No ..................... Nam. of ............ No. ~1.07 DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposal, and indicate all set-beck 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. OdD STATE OF NEW YORK, ~ · ~ COUNTY OF ................................ ........................................................................................... ,.....being duly sworn, that he is the appllcont (Name of Individual signing application) above named. He is the ....~..~.~. ...... ~.~..~.~...~..L.C.~.. ....................................... ?; ....................................................... (Contractor, agent, comorate officer, eh:.) of said owner or owners, and IS duly authorized to perform .or- have perfor~hed the said work and to make and file this application; that all statements contained in this application are fmc to the be~t of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the app!lcatlon filed therewith. Swam to befgJ:e-me this · ....................... doy~,of ~...': ................... , 1 · t P'u [ )''-~'~'- -' ' .......... ~~ ........................ r~o ary ua c, ...~~3P~--,a~l~.~. County (Slgnatom at applicant) 6~' I~. 52-6247850 CO . .(~#Md_ in.Suffolk Co~e~ mm~ml ~,xpl~es ~ 30, 19 ~T.,,~ ,.