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Home My WebLink About4266-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .. Bay. kv.e ................. Street Map No..xx ......... Block No...xx ...... Lot No ..... xx ..... I~at:~Ituek.. I~.,Y, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... April. 29. ~919 .... p~suant ~o w~ch Building Permit No. ~266z.. dated ......... ~P~i$.. 30..., 19.~., 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~.t~ate. on~. ra~it~ .dwe.lling. ~tth. ~ttached. garage ............. The certificate is issued to ...Ger. t~de..KooD ....... ~er. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N,R,. ............................. UNDERWRITERS CERTIFICATE No..pend~g ................................... HOUSE NUMBER ..... 1260 .... Street ... Bay. Ave .............................. --~uilding mspec~or 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) N? 266 Z Permission is hereby granted to: ........................... ~a~.~'~l~ ............................... to .................... ~LI.d,. ~m..~4:i,~Loz~..~n..a~ ..e~.s.'~ ..t~.~ ~,~L{[~..~,~O.~l...~.a..~.~ ge ) at premises located at ........... .~.~t.....~,~r...lk.~.O ................................................................................... ............................... lg~a.~z:Lttml¢ ....... I~,~.~ .......................................................................................... pursuan¢ to application doted .......................... ~t;~t. .......~ ......... , 19,..~.~, and approved by the Building Inspector. ~Fee $....~.t.~. .......... Building Insp~/~tor INSTRUCTIONS Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoinina premises or aublic streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whi-ch is port of ~nie 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 inspection 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 hove been granted by the Building Inspector. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building B .A..P. PLI~CATIO~N .IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to ~h~- ~uim!ng Lone. ur.aJnance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Kegu~ations, tar the construction of buildings, additions or alterations, or for removal or demolition, as here n described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (S'gnature of ap~ant, or name, if a corporation)' ..................................... ................ (Address of applicant) State whether applicant is owner, lessee, agent, architectl engineer, general contractor, electrician, plumber or builder. .............................................. ....................................................................................................................... Nome of owner of premises ..~..,,,~'..~.t......~...¢..~..~....~'..¢~.~..,~.. ....... ~...~...~....0.~....~ .................................................................... 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.: ........................................Lot No.: ....... : ................ Street and Number ..... .~...~......,~....~...e:...: ............................. ..~...~..~.:...~....~;...c...f...~'..~.....~.,...~...;.~..~ .~...,. -- /2 6d Municlpdlity -- 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....................... ,; ................ t ........................................................................................ b. Intended use and occupancy ...~..~.~ .~..~...~....~n. .................................................................................................... 3. Nature of work (check which applicabl'e): New Building .................. Addition .................. AIterotiofi .................. Repair ......... ~..~;.. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost~'.~.**~...~,~..~.~..~ .................................. Fee .......................... (to be paid on filing this application) ,5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... /..~ .......................... Rear ...... ~. .................... Depth ...~.....~...~ ............ Height .................... Number of Stories ..... /.. ........ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Dote of Purchase ....F~: ....... /'~"*~-Z ....................... Name of Former Owner 1 I. Zone or use district"'m which premises ore situated ............................ . .................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? .......... ~....~.. ;. ........................... 13. Nome of Owner of premises .~.'...L....~.~ ...... ~..fl.~......Address ~,~***'**..~***.~**;~...~T .............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor ...,~..~.~'.~...~...-..,~**a..~.,~.**.Address .,,~'~/~**~.'22..~...c**.~... ................ Phone No. ;~.~.~.**~...'~..~.~ PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate oil set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. I I I -. . __ J sTATE OF N~ ~R~ ~ ........................... ~..m.r,~.[, sioni~;;;;~i- ............. duly ~worn, d~oses ~nd so~s thor he is the ~ppficont (Name of individual ~--~..~-,- above named. He Js the ......................... ~ ...... ~ ........................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applJcat on' filed therewith. Swam to before me this ..... .......... . ........................... ............................. ~OI~R~ P~B[I¢, State o~ ~o. 52-8233120 Suffolk