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Home My WebLink About5362-ZFORM NO. 4 TOWN OF SOUTHOLD BUrr.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z..1~+..19.~. ..... Date ........... .0.c.t. ..... 1..2 ...... , 19.7.1. THIS CERTIFIES that the building located at ~/.S. ~.v.e. B ................. Street Map No.. X3C ........ Block No .... X,X ....Lot No .... x, xx...Fishers. Island.. t~.,Y · conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~;~... 2.1+. ......, 19.. 7.1 pursuant to which Building Permit No... ~3622~ dated ........... Ju.rm.. 18..., 19. ?.t, 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 .. Pr. ira.tm .one..family. dwelling ...................................... The certificate is issued to .D. onl~ld. ~k .V. iola .l~alr. er ......~w~ers .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....N.../l[: ............................ ... :~f':.,:.:., ~ . . .......... 1~'O~ NO. 2 TOWN OF SOUTHOLD EUILDIN~ DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5362 Z Date ..................... J~. ......... .'~ .......... , 19.~J... Permission is hereby granted to: .............. l)~:t~...&..~,to3~.....lte~,ee ............... ................ · $~5-"'~mh'"'~ .................................. ................... Wem~! ....... IN~'.'"etJ~ ....... to . ~$~..aa..e~l t~,f, ea.....(..~leek.~ .-eh.. ezS.et~. ~t~e.~:j~. ...................................... at premises located at ..... J~Ji.. .. ,J, ....................................................................................................... ......................................... J'&~he~...~.$.~em~. .............. !1.~.~" ............................................................. pursucm,t to application dated ..................................... e~jlf.....sJS..., 19.~j.., and approved by the Building Inspector. Building Inspector / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y.- ...... ....... - A~raved .......... ~/.~......~?.; Pe~t No; .... .~..,, .......... , ..... D sapprOVed a/c . ..~'.....L~.. ............ · .~....~..d. V ¢:f'~ ...... i ........ .......... ............................ ................. APPLICA_T_ION 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 port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this app. lication, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises avadabte for inspection throughout the progress of 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 been granted by the Building Inspector. APPLICATION IS HEREBY NLADE to the Building~Department for the issuance of a Building Permit pursuant to the ,Build!ng Zone. OrflJnance of the Town of Southald, Suffolk County, New York, and other applicable Laws, Ordinances or · Kegu~atJons, tar the construction of buildings, additions or alterations, or for removal or demolition, as here n descr bed. The applicant agrees to comp]y with all applicable laws, ordinances, building code, housing cqcle, and regulations. 'g pp ' , or name, if a corpOration) ' . ........ ~.es.~wmeA, ...."., ...~.,...~.7..67~ .............. ,i ...................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plurhber or builder. Name of owner of premises ............. .DIIII3,1L.,I,J&...V..I,~&...I~lct~. ................................................................................. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) ~a~eel X 1. Location of land on which proposed work will be done. Map No.: ~.'ti}.e..W...[~6~,~0&... Lot No.: ........................ Street and Number ........... &9'~J~"~ ............................................ ~..~.l~.l..,[~.,...JJ.e..~[, ....................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~e~:L..~,~ta~C~t..~...~..~l~;[..,e~.~.~. .............................. b. Intended use and occupancy ...................................... ,~a~ ................................................................................. 3. Nature of work (check :h applicable): New Building:r..,........ Adclition ................. : Alteration ................. Repair ' RemOval .................. Demo it on . : .. Other Work (Describe) ......(~...t,...a..[...d:..e....~.~.?..~.. ....... 4. Estimated Cost ~}00.00 Fee ............................................................ ............................................................................ . (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 ....... '..-. .................. I # 7. Dimensions of existing structures, if any: Front .,.~..6..~..6.~. ............ Rear ...... ~1..6.....~. ................ Depth ..~.2..[.0...~ ....... I · Height ....~.5...C~ ........... Number of Stories ........... ~. ............................. ~ ..................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ...........~.~.e~...~.. 8. Dimensions of entire new construction: Front ..... 201 . Rear ........2..~. ................ Depth 3-61 Height .................... Number of Stories ................................................... ~,~.t, bettl~l,...c~. ..................................... .. 88~ De_,.~. ~est;bettl~d 108t 9. Size of lot: Front ...... 1.0. 'iT~{J Rear .................................... ~,, ................................ 10. Date of Purchase ........................................................ Name of Former Owner i~l. tb~l~,...~i.,...~.lr,~J~a~,]l,1 ....... 11. Zone or use district in which premises are situated ..................... -..-. ............................................................................. 12. Does proposed construction violate any zoning law, ordinance o~.]L.~l~u~n~~. ....................................................... 13. Name of Owner of premises .D.~l~8,]L~l,....~...[.?.~,~.].fL..~..q~'~oss .~1.~.~..~.~.~....~..:..~,.-. ......... Phone No...2...0.-]-m.~..6.~.-. 07675 8231 Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... 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 whether interior or comer lot. STATE OF NEW YORK,., ' tee COUNTY OE~ ............ ..~...:...~ ....,_.I ~,''~' ................... '..'~/.~.~..~...;....l'....:....I[[.I...~f...l....~..[.~. ............... b. ing duly sworn, d~o~, and says ,~, he is the applicant (Name of individual signing application) above named. He is the ............ ~.~ ........................................................................................................................ (~ntmctor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~e ~d file this application; that all statements contained in this applic~ion am true to the ~st of his knowle~e and belief; and tha~ the work will be ?rformed in the manner ~t fo~h in the opplicati~ filed ther~ith. Swom~.~to before me th,Sof ..... ......... ....... . ........... ....... ............ : ........................ ...... ,o.a S anot re of ...................... ~ ' ~ () ~ , ~A~E~pA~ -- ~'