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Home My WebLink About4536-zFO~M NO, 4 TOWN OF SOUTHOLD BUILDING DEPAHTME. NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z.l~22 ....... Date .............. Oct ..... 12..., 19 2.1. THIS CERTIFIES that the building located at . .l~Vt. 2.0~1. ~./.. Or.i~D.t~l.. Street Map No..F..~.,~s.t... Block No .... XX .... Lot No.. XX... F. lsb,e.r~. ;[.s. laDCl..~..~.... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~et-..30..., 19.~. pursuant to which Building Permit No..~36Z. dated ............. 0c.t.. ~.~.., 19.6.9., 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 ... P.~,iva-te. one -fami. ty. d~el.ling. .................................... The certificate is issued to ~Hobext. L....Ger~.y .... (~w~er ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N. ,~... .............................. ...... ........... Building Inspector FORM NO. 2 TOWN O~ $OUTSOLD BtJ!LDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4536 Z Permissfon is hereby granted to: pursuan~ to application dated ............................. ]..~J~.~ ....... ~.....~., 19...~., and approved by the Building Inspector. IPOB,M NO. I TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE EXamined ...... ........ ! ....... , L~ ^pproved ........................................ , 19...~..... Permit No. Disapproved a/c ........................................................... ~ ......... APPUGA~T~ION ~R 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 c~pmenced 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 sh~ll be occupied or used in whole or Jn 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 issuanice of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, .~and othe~ applicable Laws, Ordinances Or Regulations, for the construction of buildings, additions or altFTqtions, or for rdmoval or demdlition, as herein described. ' The applicant agrees to comply .with all applicable laws ord/~an.c.~s building c~ode, housing code, and regulations. ........... ........................ (Signature of app~[[cant, 0r n.a ,me, if a corporation) ~ !Addre_ss of~ _applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~........~....; .......... ~...~ .................................................................. ~ ......... 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. Street and Number .......................... ~ .............................................. ~ .......... .~.. .......................... Municipality 2. State existing use and occupancy of premises and intended ~ and occupancy of proposed construction: a. ~x~shng me and occupano/ ...................................................................................................... ; ........................... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .................. Addition ..~,../~. ..... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .... ..~.,l....~...~.....'~.. ............................ 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, Jf 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 ........... Z,..~... ................. Rear ..... ..~....~. ................ Depth ~L~""~ ~-- Height .................... Number of Stories ...........~ ....................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ......................... ~.~... 10. Date of Purchase ..............L...~...~.. ~ Nome of Fgrmer Owner .......... ..~.......~....0.. ., / ~/'x II ~'~. ~, ........... f ........................ 1 I. Lone or use district in which premises are situated ....... J~ ........ .~.~ ...................................................................... at on;~. 12~ 'Does propcYsedjL,constrJ~cfioa_~o~te any~J ,----z°ning Iow, ordinance or re~u, ...................................... .................... / phone No 13. Name of Owner of premises ...~.::..~.~ Address Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor ...... ~...~.....~.. .......................... Address ......~..'....(..: ......................... Phone No ..................... PLOT DIAGRAM .......... -- ocate clearly and d~stmctly all buddings, whether e¥~stmg or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or describtion according to deed, and show street names and indicate whether interior or corner lot. .--~-~ ' ~ ,J~ C/~ _ STATE OF N.EW~YOEI(,. /2 t S.S COUNTY Of ..~..~......~ '.---- ~, ........ ......... ;';;~ ....... :.~...C~...;~.~. .......... j ~.~...c. ....... - .~...~ ......... be, ng duly swam, deposes and says that he s the app cant above nome. d. He' is the ...... ; ............... ~.~'.i .................... ;..';. .............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or-have perfomned the said work and to make and file this application; that all statements contained in thi~"appliCation ar& th Jo t~ the best of his knowledge and belief; and thor the Work will be performed n the-manner set forth in the application filed therewith. Sworn to before me this - .................... ............................................ ,,:: Notary Public, . ........................................................... unty .......... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICI'~rY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Date Application No. on file T.,~CE.',~A~Z. ~'7~ ~:Z.0:Z.~ N 112538 Henry A. Gerry, Halyco~ Fishers Island, I,.I. ~.~.m~.~o. August 29, 19'f3 a~d found to be ln complia~e ~ith the requirements of this B~. FIXTURE ~ INCANDESCENT FIXTURES OUTLETS ECEPTACLES SWITCHES FLUOf~ESCENT / ~T-,S.w. I o,, 'u".".t':E ,,,~o~:o,s .. ,. ItUT, A"'"..'o,C, 1 '~/~ SERVICE DISCONNECT I NO. OF S ! 15~ ,~CB METER RANGES SPECIAL AEC'PT, COOKING DECKS I OVENS DISH WASHERS AMT. K. W,I AMT, K.W. ~,MT, K, W, EIIIt!L;2 TIME CLOCKS BELLUNIT HEATERS UL I T A.,..',. ~,,~. TE,,,,,E. .~ 'NO'fEo',E"','. E R V I C EXHAUST FANS DIMMERS AMT, WATTS OF CC. COND. NO. OF HI-LEG NO, OFNEUTRAL NEUTRAL OTHER APPARATUS: ~4otor/$: !-F ^. John ()ada General ConsPactinF~ Drl~le r B Fishers island, L.I. 36370 GENI~AL MANAGER Per "-' ,'?'--' COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.