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Home My WebLink About4508-zFOR3~ NO. 4 TOWN OF SOUTHOLD ~ BuILr~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..~..~...~.. .... Date ...........J.~.. .... ~ ....... , 19. THIS CERTIFIES that the building located at .....1~..~...&y~ .............. Street Map No.t~.. ~{&ey. & ~lock No ...........Lot No. p.a.~ .t. ~..? ..... .~..t.t.~, .t~.~. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........0~t ....... 9' ', 19.69. pursuant to which Building Permit No..~.~0~. dated ........... .0~t ..... ~6.., 19. (~9., 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 .....~.~Y.~..~...0~...f..&~lY..5..~1~ .................................... The certificate is issued to . .¢ka~,. ~l~e.~Je ...... o~me~. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ioue d' 36S l~1¢~' ~' ' In~ector /Building FO~ HO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 4508 Z Permission is hereby granted to: a,..ae~:~..&..$....a/L~..Setam~e ..... .............. ~s~ael~ ............................................ to ......JJlJlJ~..ti~.~:Jd~IOll..~a~l..~i~,l~.tl~..l!Jtatell~ ....................................................... at premises located at ................. ,]dJit~..J~jl~ll)...~ ...... .J~,aJ[~,~qLl~..JJL,~t~.el~qJJ ...................... ; ........ ............................................ 36~...,atte~...~ ......... ~t~tm~ .................................................. pursuan~ to application dc~ed ......................... JJll~....~ .................... , 19....~ and approved by the Building Inspector. ........... IN~B~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~N CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ //:::> 19~.~ Approved ........................................ , 19 ........ Permit No ..... Application No...~,.,,-~.....~.....~... ......... Disapproved a/c ................................................... (Building Inspect6r) APPLICATION FOR BUILDING PEPJ~II' 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 ir~pection 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 taws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for re~oval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~:/4/ ~ ~ ~L='//-~.~ ¥ 1. Location of land on which proposed work will be done· Map No.: ........................................ Lot No.: ................ ~..... Street and Number .......................................................................... , .......................................... ,..~....,.......~...,..~_ J Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and ,,,.,.,..~...,,~, ................................................................................................................................ b. Intended use and occupancy ....................................................................... Nature of work (check which applicable): New Building .................. Addition .................. Alterotion .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................................................ Fee (to be paid on filing this application) §. If dwelling, number of dWelling units ......... ~ ....... Number of dwelling units on each floor.........~............. If garage, number o ca:rs ....................................................................................................................... ...................... 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 olterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories .......................................................................................... g. Size of lot: Front -? ~ Rear '~ ~ Depth 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ ....................... Address ............................................ Phone No. Name of Architect ................. ; ......... ~ .................... N e of /~r-~ ~ .............. .-.~..~ ....... Phone No ..................... am Contractor ............. ......................... Address Locate clearly and distinctly all b~ property lines. Give street and block whether interior or corner lot. PLOT DIAGRAM. .......... ~ildings, whether existing or preposed, and in6"ma~e all set-back dimensions from n~l~mber or description according to deed, and sh't~treet names and indicate ,~ ~ ¢ I .? STATE OF NEW YORK, COUN~ OF ................................ ~ , ~ ., A~ 7 HAP I~b k ................. 7~; ............ ~ ............................ ~' ........... ~..~.~..~..~ duly ~,~ ,,u ~, ~,~e s t e app cant t~ame of.,ndividual signing, ~plication) above named. He is the ................................................. ~.~ ...... .......... ~Co,~;E~t;~, ,,~t, oo~o~,t, om~,~, et~.~ of said owner 0r owners, and is duly authorized to perform or have performed the said work and to ~e and file this application; that all statements contained in this application are tree to the be~ of his knowledge and belief; and that the w~rk will be performed in the manner set fo~h in the applicati~ filed ther~ th. Swo~t~fom me this ..... J..t o, / - · ....... ~ ~:.. ...... ..... ......................... ............................ ~ora~ ru,nc, ..6 ................................ ~:. ............. Coun~ (Signa~re of applic~t) ~kRION A. REGENT ~TARY PUBLI0, State of Hew Ye'~ ~. ~2-3233~20 Suffolk CounL