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Home My WebLink About4114-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMEBIT Town Clerk's Office Southold, BI. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .Wurmewe.ta .Bo~d .......... Street Map No. l~[jeau .Pt. ~e~k No ........... Lot No... 2.~.O. .... .C.U~.e.ho.g..u.e...E. :.~.. ..... conforms substantially to the Application for Building Permit heretofore fried in this office dated ........ Eot,...L~ ...... , 19..6.8. pursuant to which Building Pemit No.. ~.l.~..l~..Z dated .......... l~.c~...~'. ..... , 19.68., 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 0 ra e ....... The certificate is issued to . .'¢.~.hJ..t.e.. ?.a.k.e...l.n.c. .... . .(~..e?. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .E,i~I, ............................. ......... ~'~' ........'~' ''"t ............. Building Inspector 2ouse ~ ~000 ~o~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHO~.D, N. Y. BUILDING PERMIT (THIS PEPJVUT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 4114 Z D~e ...................... ~....k ....... , Permission is hereby granted to: ..~..,~....~..~ ....... ~..~..~,,,~,. at premises located at......~...~... ~ ,~..~'JJJ~ Po~l~t ~ pursucm¢ to applicotion dated .......................... Jilll~,~ ........... .~9. ...... ;.., 19...~J, and approved by the Building Inspector. TOWN OF SOUTHOLD H.'~ BUILDING DEPARTMENT T0~1'4 CLL~K'S OFFICE SOUTHOLD, N. Y. Examined .........~.....~.. ............. , 19.~...~.. Approved ........................................ , 19 ........ Permit No ........................ Application No..~....J...L~..~.., 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 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 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 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 remova or demo ition, as herein described. The applicant agrees to comply with all applicable laWs, ordinance,% building code, housing c~de, and regulations. (Signc~ure of I.J~51icant, or name, if a corporation) State whether appllccjnt is own,er, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ....~.. · .~../..~...L.....~....~..~... ......................... ~ .................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer). ' /~*~'~ ~¢~,~/ 1. Location of land on which proposed work will be done. Map No.: .......................................,. Lot No.: ..2~.....~....O.. ......... Street and Num~9~r .?.?..~.O. ....... ~.~...~.~.~.....~.~ ................. ~.~..~.~ ........................... N.C ~ _ ~ Munici~li~ 2.State existing use and ~cupancy of premises and intended use and ~cu~ncy of pr~ construction: a. ~isti~'"se and ~cupan~ ........... .~ ............................................................................................................. 3. Nature of work (check which applicable): New Building 'Z ................ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .............. ~.:. Other Work (Describe) ........................................ 4. Es. mated Cost ...~..~...~...~ .............................. 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 ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ..................... ~ ......... 8. Dimensions of entire new construction: Front ......... ..~......~/..../. ............. Rear ....... ..~.......~.. ........... Depth ........................ Height .................... Number o' Stories ..... Ziii~.~. ............ ..__.....................,. .................................................. 9. Size of lot: Front ...~...~'.~.~.....~, ..... Rear ..... Depth J../..~,... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction vi~l/at,~ any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of prem se~...~../...~'.~.. ~[~"~'~'~' .~"c~ Address ................................................................................... Phone No ..................... Name of Architect ............................................ ,,......Addres~ ......................................... ;.. Phone No ..................... Name of Contrac~..4~9~.~..~......~.,......~./..~.~..~...Address .....~..~...~....~/./.~....C;?......~... Phone No...~....~..~i...??'..~../ 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 end indicate ., O 'F ~' '~' whether interior or corner lot. ~ F ,'~' ~;/r._, - ggd. ~'~'~"~'' 4'- '~ ~'~" STATE OF NEW YORK, COUNTY OF ................................ .f '~"~' .~.~.....~ ,/..~.~. - ...... · ~...~. ..............................being duly sworn, deposes and says that he is the applicant (Name of individual signin~.~ic_at~) . 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 be performed.in the manner set forth in the application filed therewith. Swam to before me this / .............. .............. Nota~ pub,,:.-..~. ,,,.,:....<....~ ........... County ......................... ~i~'~';f~;~ii~ .................... I~ARION A. REGENT ~OTARy PUBLIC, State of New Yo k No. 52-3233120 Su Iolk Count Term Expires ~arch 30,