The URL can be used to link to this page

Home My WebLink About4282-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~..3~.0. .... Date J~ ¶~ 19. ?O THIS CERTIFIES that the building located at ...R$1eY. ~.v0 ............. Street Map No. ~. ~ .& ~ No ........... Lot No. ~ ....... ~.~t~tu~.. ~.,~, ...... confoms subst~tially to the Application for Building Permit heretofore filed in this office dated ........... ~ .... ~ , 19.6~ p~suant to which Building Permit No..~2~ .~ dated ........... ~... ~..., 19. &9, was issued, and conforms to ~1 of the require- ments of the applicable provisions of the law. The occup~cy for which ~ certificate is issued is .... ~ate. ~e. f.~$1~ .d~l~ .................................... The certificate is issued to ... ~r~ .[~g~ ........ ~$~ .................... (owner, lessee or tenant) of the afores&d building. Suffolk County Department of He~th Approval ..... N,~ .......................... ...... ....... Building Inspector / ilouso f ~ ~/le~r Avo FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .a,,~.,.D...t .. 2.2~.....11~,,~.. Z,a .................... ........ at~z~..~.~.....~*~. .......................... to ........... ~.~....a.~....~.$..t..s..o...,... ~...~...,.~,...t.~.l....a_~.~.l ............................................ at premises located at ............... ~t,...~......G..-JJ~3-~',.ztr~..O~,t~3~l ................................................... ...................................... · ~15y..~s ........... 3~tt~tuek ....... ~[o~e ................................................. pursuanrt to application dated .................................. ~ ......... ~ ...... , 19.~1~.., and approved by the Building Inspector. Fee $....~.~1~ .......... Building Inspector BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. -amined ......... ~... 2 .... 19.. L Approve~ .................... ,19 .... Permit No .................... Disapproved a/c ....... ~ ........................... Application No. APPLICATIQN FOR BUILDING P~RMIT Date ...... ....~.....?. ................ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitte,d in duplicate to the Building Inspec~er. b. Plot plan showing location of 1,at and of buildings o n premises, relationship t~o 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 applicath~n may n,ot be commenced before issuance of Building Permit. .d. Upon approval ,of this application, the Building In spector 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 shall be occupied or used in whole er in pm-t for any purpose whatever until a Certificate ~of Occupancy shall have been granted by the Building Inspector. APPLICATION IS ~.F~y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S.~atho ld, Suffolk C~unty, New York, and other applicable Laws, Ordinances ,or Regulations, for the construction .of buildings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to com ply with all applicable laws, ordinances, building code, h.~using code, and regulations, ia/?^'pi-~~~'a~~~-' ~l~rati.on) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ........... ~. ~..'~'.~.~..~. ~../-. ..... .~..~.'Y~../.--~A'~7..C/~.O.~'~ ................................................... Name .of ,owner of premises .... /A~..~.I~.T.(.~.. .... ~..-....'t~..l-.,~]...'~..~..~'r..'~....'f~. .................................. If applicant is a carpo.rate, signature of duly auth,orize d ~fieer. (Name and title of corporate officer) C~ ~'. T. ~/~.t.-'~c~ ..,ri I~rTtT~,,'o( tV,,/ . . Z ......... 1. Location ~of land on which prqposed w,ork will b e done. Map No. ~er-~.. fi);[g./.'. Lot No. Street and Number .... ~.I.L.I~)(. ~ Vc'~''' ~ .............. ,.Z~.,4. ZTt.F/.~.C-.~..<, ................ ,~/-- ..B~:'~'t ....................... Municipality 2. State existing use and ~ccupancy of premises and intended use and ,occupancy of proposed eonstruction. a. Existing use and occupancy ..... ge--~;t~)~.~"J- c~ ~ ~'/~//t~-'~d--~-- ~:~,,w/ t~. b. Intended use and ~ccupancy .... ~.k~..t,~..~.~5..(-~., .o..~. .... .~./7..~..~..~..~..~,.~. .... .~...~.t. '~'V ........... 3. Nature of work (check which applicable): New Building ........ Addition ....~... Alteration . .~...'.. Repair ......... Remo_.yal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated C,~st .... ."i.~.o, .O. ..................... 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 ~r 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 ..... ~.o. ...... Rear ....~..~. ........ Depth ...... .~..~. ...... Height ..... .~...O ....... Number of S~c~ries ..../. ................ 8. Dimensians of entire new constructien: Ft<xnt ........ ~. ........ Rear ...... .~. ...... Depth .. ~. ........ Height .... /...~. ....Number of Sfaories ........ /. ' 9. Size of iot: Front .... .~.~'. ....... Rear . ..~.~.~ Y..~, ..... Depth .l,~...~. ....... 10. Date of Purchase ..... .ff~/5 ...../.~...~.."~. ......... Name of Former Owner ~.C~.4f......~..o..~,.L.¥-/~.. 11. Zone ~r use district in which premises are situated .................................................... 12. Does proposed construction violate any zoning law, ,ordinance or regulatiqn? /~' ~2 . , 13. Name of Owner,of premises ~'T(~...~..c~<..~..~'A-'.. Address f~..~ .............. ~'tL~. f~..~ ' ~;'J~'Phone ~/~"£'No~;4~;-~ ............ Name of Architect ............................. ~ddress ...................... Phone No ............ Name of Contractor .,~.o.~/~.....~.. ~,,~ ...... Address gg.~.~.~..~..~z.c.~...L..~. ..... Phone No. 7.~.~..':..o. eE'.o° PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or 'proposed, and indicate all sat-back dimensions from p~x~perty lines. Give st~cet and block number ~r description according to deed, and shew street names and indicate whether interior .or comer iot. L STATE OF I~ yO~, )S.S. oO NT ....... ~..~:-~ ........... , ..........being duly sworn, ,deposes and ~ys that he 1s the appli- ,2Name o~indivi~allsigning ap cat cant a~ve named. He i~ the ........ ~. 7~ ~ .................................................... (Oon~a~or, agar, ~ate officer, etc.) of said own~ ~ owne~, and ~ duly authorized $o p~orm or have pe~ ~e ~id w~k ~d ~ make and file this application; that all statements oontain~ in this application ~ tree to the best of his knowl~ge and belief; and that ~e ~k will be peff~ in the mann er set fo~~ in the application filed ~erewith. Sworn to befo~ me ~is ed in ~,miolk Count7_ - l: , ~:.~;res March 30, 19~Z~