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Home My WebLink About3944-zFORM NO. 4 TOWN OF $OUTHOLD BUll.DING DEPARTMENT Town Clerk'~ Office Soadaold, N. ¥. Certificate Of Occupancy No. 136'~4~ ..... Date ............. (~t .... ~ ...... ,19~. THIS CERTIFIES that the building located at ][~. ~Ji~l,~ .&W.. - Street Map No. I ......... Block No. l ........ Lot No. ~ .... Fl~J. SSl]~ · · · lion/.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ i~lly' · $" 19~. pursuant to which Building Permit No.~... dated ........... Jtily' ' 8 ' '" 19 ~., 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~rl~te. one. f~ly./weLlt~ ..................................... The certificate is issued to ..... 141's 'St~-wart'R~geh ...... 0~mer ................... ~owner, lessee or tenant) of the aforeSaid building. Suffolk County Depa~-i~ent of Health Approval ..... p~ldix~ ...................... FOEM NO. i TOWN OF SOUTNOI. D BUILDING DEPARTMENTi TOWN CLERK'S OFFICE SOUTHOLD, N, ¥. BUILDING PERMIT (THIS ,PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL 1~? 39~4 Z Permission is hereby granted to: to ..~.~..~.~..~....-.~... ~.e.~,~ ....................... , ......................................................... a, premises ocetedat ~J~....~...~,~.~,~.~i,~L~...~Xe ............ ~i:, ........................................................ ".- ...... ~ ...... ~ ............................ ~.~.~.~. ~.~.e~ ...... :~J,~ ...... ! ............... ~ ......................................... purs~ar~ to applica~!o~ ddted ....~.,..,: .................. ~ ........ ~1~.~,.,.., ]9..J~, and approved by the Building inspector 1 FO~M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, No Y. Approved 19...--...tt Permit No. Disapproved o/c ........e-,~...~z- ;~l~z...~ ............. . (Bui ding Inspector) APPLIGATION FOR BUILDING ^pp,cat,on No. .......... Date ' Jul~ 6 , 19...~.~! .... 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, relatjbnship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn pn the diagram which is part of this application. c. The work covered by this application may not be commenced befor~e issuance pf Building Permit. d. Upon approval of this application, the Building inspector will issu~.a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progr.~ss of the work. e. No building shall be occupied or used in whole or in part for any pqrpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for ~he i~suance ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y~ork, 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 and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genera! contractor, electrician, plumber or builder. Name of owner of premises ...L, ........... ~2C,~,L..,,..~...,%,,,;,c.h ..................................................................................................... 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.: ~(f};~Z~}~f~.~,..q~ ........... Lot No.: Street and Number ...~.~bt.~.¢~l,,r;.,~,;),r~...4~111:g,~,~ ...................... .~.;k~.*~Ze..[.'~..~..~-.~.~.d..~...~.~!~:;'...;.~.~/.~...~ .................... Municipality 2. State existing use and occupancy of premises and intended use anc~ occupancy of proposed construction; a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ....... ~.~:~ ~ .l.~, ~%~.~ ............................................................................................. 3. Nature of work (check which applicable): New Building .... X ........... Addition .................. Alteration .................. Repair .................. Removal .................. DemoIitian .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~.~I.~Q.,.Q.O.Q.,.QQ. .............................. Fee ........ .~.~,D.,.Q,Q ................................................................... (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 ...,1,.0,;~ .......................... Rear...,$.0~ .................. Depth ........................ Height ...3..Q.'..Q~] ....... Number of Stories .................3. .................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ..... .,.Z..gJP,~.,....~9.~.~ .......................... Name of Former Owner ...~.q.b.D...~.l...m..e..r...c].~..n.g ................. 11. Zone or use district in which premises are situated ....... R.esJ.de,~ial .................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... i~.o ................................................ 13. Name of Owner of premises Er.e,n~.es...E~.uc~ ......... Address .Fj.,~er.s...Zala~d ......... Phone No...3.31 .......... 203- Name of Architect ....Al,b.~,,r.t,..Cl~,~. ....................... Address .~.i~n.tic.,...C, onn .......... Phone No.7~9:.:~.9~.. Name of Contractor A,~..oha...Gi~.d~...Gen,...Cont~4.ddress .~.i~hers...Iala~d.,.t'i...Yghone No ..... 231 ......... 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 i'nterior or corner lot. See Attached Plot Plan STATE OF NEW,YORK. ice COUNTY OF..~ ............. ~'~" ................... ~....J.Q~..Gat;1,a~ ......... ' ............ : .......................... being duly sworn, dep~)~es and says that he is the applicant (Name of individual signing application) above nome& He is the ..~r.e~`~j~Q.t...-....Tr.e`i~j4r.~r...9.~..~...~.~D...~...~.~9.~...~.~'~.~9.$~g.¢....~.9g.~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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. ......Sworn to before me this(, h.~..., dqy\ of ...~~: ....... , 19 (~ ~2~ ......... ........ Notary Public, ~t~~,?~':;:''/~~r,, ....... .................... County ,Signature Nc,. 5,~-00~0880 Quc, lJ.~.ed in Suifolk CeunW. Tezm expires Me~oh 30, 19 ~ ~ - 0 ,) L] z~TOF ~P-.AYv~IIq~ i t , I I I ¸LL j' f I~ LAI,,if) , ALBF,:IZT 6, ~LA¥ u~ P~kJ ~ t4o o 0 ,12' 5c~L~ I/4."=l~-o~ 6Lt~&ILT ~, 4LI'Y D L E 'v A 'T I o ~J tg. IIV' , · z? pL + .? I Y ~ L E V,~T IC~l-J 5 k4~, ~ K/IP.,A ~.TE~U~ILT P...AU6~ iL. -t ~out>L~ --2 Ii' .K..] [ ............ ]'iix 1'77'][ .... IF .... I