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Home My WebLink About4575-zFOBM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. z '3?97 .... Date .............. ~1' .... ll .... , 19. ~ THIS CERTIFIES that the building located at W&okha~ .Ave .............. Street Map No. xx ..........Block No..Xx .......Lot No...~m ..... Mat.t~.t~ek · · · ]~.,¥, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........Dee ......3'", 19 '~9' pursuant to which Building Permit No....b~.~.~Z dated ........Dee ......3 .... , 19.69, 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.l,$vate .one .f.a~'~y. d~ell.$1~g. ..................................... The certificate is issued to . .. A':J ;I~'s'~l .......... ~ ............................ 0~wner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... N ~B'.' ......................... ............. Building Insp~tor TOWN OF $OUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4575 Z Permission is hereby granted to: · ~t ¥..lij:tta~;J,e~.....,t~/.g*...-.,J.. ,-.Ir, J,J.~e3,. ........... ........... ~,.e.~.,.~. ............................................ to ..... ~ . .~ ~ . .a~ d,fj, t ;Zml, . .o ~ , . ar~. . ~ ~ ~ '~ :~J3g. . .itJm l,3, ;t, J.f~. ................................................ at p.~mises Io~ot~ at ................. ~ ....... '~;~j~e.~..4,~e, ........................... : ............................... ~ ..... ............................... : ..................... .~t,.t.~:l;u~-. ........................................ , ............................... : .......... pursuan¢ to application dated ........................... ~ .............. ~i ........ , 19.:..~ and approved by the :B~'ilding Inspector. Building Inspector / I~OB~ NO. I TOWN OF SOUTHOLD BUll:DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19...?... Permit No. Disapproved a/c ................................................................... ......... APPUCATIOH FOR BUILDING PERMI*r Date ................. ....... ............. , ..... iNSTRUCTiONS ~" a. This applicatim~ ~nust 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 thie 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 Iq shall be kept on the premises available for irapection throughout the progress of the work. e. No building shall be occupied or used in whale or. in port for any purpose whatever until a Certificate of Occupancy · shall have been granted by the Building Inspector. B .A..P. PLI~CATIO~N .IS HEREB. Y.MA_DE to the Building Department for the issuance of a Building Permit pureuant to the ~u,a~ng Lone, ur.ainance of the lawn of Southald, Suffolk County, New York, and other applicable Laws, Ord nonces or Kegulations, tar the construction of buildings, additions or alterations, or for removal or demolition, as herein descr bed. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing co~.e, and regulations. . c.o ....... ........ (,ilg urea app ,cant,,~or h~rne,i, if a ~¢l~rof~n) /' . ......... b'x.. ,4~..... ,.e",.e.~.. ,.q.~,....Re...m., .e.p.b...e. ,, ............. (Address of applicant) . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ e~n.t~&e .?~ ~. ........................................................................................................................ A Name of owner of premises ...................~...e.~........~.~.lR.e.~ // 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. Mop No.: .............. ~ ..................... Lot No.: Street and Number ........ I[t~....l~.~.lr, l~ll~. Av~ ......... ~.t;:~.gl.t~lr....~t,Y~ ............................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... d.¥~.ZSL:l. Zlg .................................. i ..................................................................... b. Intended use and occupancy ~me 9/:t.t,h &T~ &ClCltt;:I. OI~. 3. Nature of work (check which applicable): New Bu Iding .................. Addition ~ ........ Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..........~.~,1.~[0(1 .................................... Fee ...~...e...0~... ...................................... s ...................................... (to be paid on filing this application) §. If dwelling, number of dwelling units ..... .O..~...e...: ............. 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 .2,~. .............................. Rear ........... ..2.~. ............ Depth ...23~..J~ ........... Height .................... Number of Stories ......... Q~ ...................................................................................................... 9. Size of lot: Front ............. ~J .......... Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ........... ."..A..."...~:~.S...t. ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. ..~..O. .......................................... 13. Name of Owner of premises ..... As..~&~J~.e.~,], .......... Address ....... ...J~....t..t..i.t....U~....~. ............... Phone No ..................... Name of Architect ................................. ~ ................... Address ............................................ Phone No ..................... Name of Contractor ~/~J~.....~....~....J~~Address Remsellberg ~J.¥o Phone No ..................... ~.~.~ DIAGRAM Locate clearly and distinctly all buildings, wF~the~ ex sting or proposed, and indicate all set-back dimensions from property lines. Give street and block ~ription according to deed, and show street names and indicate Whether interior or corner lot. · mee filed ....................... ~'.~.....~ ............ ~ing duly sworn, d~es and says t~t he is the applicant (Name of individual signing ap~ication) (Contractor, agent, co,orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke ~d file this application; that all statements contained in this application are t~ to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application fil~ ther~ith. Sworn to ~fore me this Notaw Publi ~.....~ ..... (Signa~re ~ARY pUBLIC, State oJ New ~o. 52-323312~ Sutlolk ~erm ~ires ~tch ~, b ................... ~-- ~ I, I II +- 4,- + F ARCHITECT ~&t.~ 14..r, / / / / W&LL OUTk t"'T. OUT L,~T, L ARCHITECT PLAN NOLO-, o'Z. -- '2 OF. SCALE; !/M -I"O~DATE Iii / / / ARCHITECT - 4%. _7-_ ?_L PLAN