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Home My WebLink About4530-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ~..38.0~. .... Date ............. THIS CERTIFIES that the building located at 0C.e.a.l~..l/leW. A~e ........... Street Map No..~ ......... Block No ..... ~ ....Lot No. conforms subst~ti~ly to the Application for Building Pemit heretofore filed in this office dated .......~¢~ ..... 2~..., 19 ~. p~su~t to which B~lding Pemit No. ~.. dated .........~.~... ~O ...., 19.69., was issued, ~d conforms to ~1 of the r~u~e- ments of ~e applicable provisions of the law. The occup~cy for which t~ ce~ificate is issued is . .Pre,ate. one. $~ily..dwe.~.~g ...................................... The ce~ificate is ~su~ to .... Da~.id. b~CalX .......0~er .................... : .... (owner, lessee or ten,t) of the afores~d b~ld~g. S~olk Co~ty Dep~tment of He~ Approval ...... ~.~, ......................... Buil~g Inspector BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4530 Z Permission is hereby granted to: at premises located at .................. ~JiJlJJ~..~jdJ~..~.~lL ........................................................................ ............................................................... ~J..;~:J~ ............................................................... pursucm¢ to application dated .............................. I~ ...... J~t .......... , 19.~j~l., and approved by the Building Inspector. ~F'ORM ,NO. I TOWN OF SOUTHOLD BUILDING D~PAR'FM~,NT TOWN CI,~,R~r'S OFFICE $OUTI~OLD, N. Y. Application NO. ~/~-~ O Disapproved a/c ........................... .. ........ ~ .... Date ~ ~-'~ 19.~..~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate tothe ~Building InspecWr. b. Plot Plan showing location of lot and of buildings o n premises, relationship to a~oining premises or public streets or areas, and giving a detailed description of lay out 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 B~flding Permit. d. Upon approval of this application, the Building In spector will issue a Building Permit to the applicant. Such permit shah be kept .on the premises available fo r inspection throughout the progress of the work. ei No building shall be occupied or used in whole o V in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspec/~a'. APPLICATION IS H.e~.l~y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soathold, Suffolk C~unty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to co0~y-w4th all applicable laws, ordinances, building code, housing cede, arid regulations./ - ] ' ~ .~'~x~ ISignatu~e of applicant, or name if~a corporation) (Address of applicant) State whether applicant i~nt, architect, engineer, general contract~, electrician, plumber or builder ~~ ......................... ................. Name ,o; ~1~;'~: :~iie~' i i .~. i~ ~ i ~i~'.'.'..' .......... [ ............................. If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location ~f land on which proposed work will b e done. l~l~No ................. Lp.t No .............. Street and Number..~ ..~J..~. ~ .... ~.~~.. ~; .~.~.. ~ ........ . Municipality 2. State exlstmg use and occupancy of,premises and intended, us~ al/~cc,upancy of proposed cop, structlon. a. Exlshng use and Occupancy ....... . i..."r~-~.... ~. ;R... ~ ;! ............................. b. Intended u~ and occupancy .............................. 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... Removal ........ Demolitinn .. ...... Other Work (Describe) ...................... 4. Estimated Cost ...... ..f, .~..O..O. ............... Fee ................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....~. .... Number ,of dwelling unit~ 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, ff any: Front ...~.~ ....... Rear .... c~..~ ..... Depth . .~..~ ....... Height .... L..7../~..~.... Number of Stories .Z .................................................. Dimensions ,of same structure with alterations or additions: Front .... .~..O ...... Rear .... .~..O.. Depth . ~ .~ ~... Height / ~ Number of Stories ...... 8. Dimensions ,of entire new construction: Front ...-~-..~. Height .... ~./. ..... Number of S~ories ........ ~ ..................................................... 9. Size of iot: Front ................ Rear ............... Depth ............... 10. Date of Purchase ............ ./..~.(~.~L ...........Name of Former Owner~ .~..~. ~'- 11. Zone or use district in which premises are situated. 12. Does proposed con~tructior(-V~ola¢e any zoning I~W, ordinan.~r regu]ation? ../.~..Q ................... Name of Architect ...... ~.(. p./y.7~ .............. kddress .................. ~ .... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property line~. Give s~eet and block de scription according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, )S.S. COUNTY OF .............. ) }.~.; ~"~ ~0 .~.~°-~ ... being duly sworn, de~s~ and ~ys ~at he is the appli- c~t a~ve rimed. He is the ................................ ~ .~ ~W ......................... (~ontra~or, ag~t, ~ate officer, etc.) of mid own~ ~ ownem, and is duly auth~z~ to p~orm or have pe~m~ ~e ~id ~k ~d ~ m~e ~d file th~ application; ~at ~1 statemems contain~ in this appli~tion ~ tree to the be~ of his knowl~ge ~d belief; and ~at ~e ~k will be ~.in the manner set fo~ in the application filed ~e~with. Sworn to belo~ me ~is .... ................ ..... .... ,... ~o. 52-9509185