The URL can be used to link to this page

Home My WebLink About5087-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..7~.7~..2 ...... Date ....... ~-ngtlst; 9 , THIS CERTIFIES that the building located at Delmar .Dr£~e .. Street Map No. La~L~:~I Gty ~)1~kNo ...... LotNo..~ ..... lia~re3.' NoY, " conforms substantially to the Application for Building Permit heretofore filed in this office dated . . Dec 2 , 19 ~.0 pursuant to which Building Permit No.. dated . . D.e~ 3 ., 19.70., 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 Private olle family .dwe.~.t. ir~[l ......................... The certificate is issued to · ~O~ Tel~l Ir~e ..... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No N ~066 ltOUS}: NUMBER126[ Street De3.~ar Drive · Aug 1. 197'2.. by R,..Villa .,,3 ':., f,r'. Building TOWN O~ SOfT, OLD ~U~LD~NG DE~T~ENT 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°. 5087 Z Dote ............................ ]J~$ell~...~..., 19..,~0 Permission is hereby granted to: ................ l~rt .~et'rer~ ....... I~Z ................ to ...... ~,t~. ~.. eom .. faml,~ ..~l~ .............................................................................. at premises Io~oted at ....... ~t..~..9....~amra:t..C~mat~'..E~tat~es ......................................... ........................................... ~eaaa~..~l~. ......... ~m~eZ....~,Z., ........... /..:....: .................................... pursuan~ to application dated ................................ ~s~,$.....~ ............. , 19,...~1~ and approved by the Building Inspector. re~ $..t0,,00 .......... BUILDING D~ARTME~ A~d ............................. ~.~ ........ , ]~.,...;.. P,~it No~...~.~...~..~.. ....................... ............................................ , ......... BUILDING PE~IT ~t APPLI~TION FOR , ST U ,O S ~. lhi~ opplicotion m~ b~ completely fill~ in by ~writ~r or in ink b. ~lot plan ~howln~ I~otion o{ lot and o{ buildin~ on pr~ml~, r*~ion*hlp to ~dloinin~ pr~mi~ or publi~ nr~s, ~nd ~ivin0 ~ d~t~il~ ~rlptlon o{ I~yout o{ pm~ mu~t ~ dr~ on th~ dio~mm which i, ~ o{ thi~ ~pphc~t~. . c. Th~ work c~ ~ th~ application m~y not b* comm*nc~d b~fom d. Upon ~r~l o{ thi~ ~pplic~tion, th~ Buildin~ In~clor will i~u* *boll b~ k~t on th~ pmmi~,~ ~wil~blo {or inspection throughout ~h~ p~r~ o{ ~h* work. ' ~. ~0,buildin~ s~ll ~ occupied or u~d in whol~ or in p~ for ~ny pu~o~* whiter until ~holl h~* b~n ~ront~d by th~ Buildin~ ~n*p~r. A~LI~TIO~ IS HERfiSY ~Dfi to th~ Buildin~ De~m~nt for ~ i~u~nc~ o{ ~ 8uildinfl ~lt pu~nt ~o th~ 8uildin~ Zon~ Ordi~nc~ o{ th~ To~ of ~uthold, Suffolk C~n~, ~ York~ *nd oth*r ~ppli~bl~ ~, ~i~c~ or R~ul~tion*, {or th~ construction o{ building*, ~dditi~* ~ ~t~mtion~, or Th~ ~pplicont ~r~ to comply with o1~ applicobl* I~*, ordinance, buil~n~ ..... ~~.~......~,.~: ............. "...~ure of ~plican~, or na~, if a co~mtion) State whether applicant is owner, lessee, agent, ~rchitect, engi.n~r, general contra~or, el~triclan, plu~r or builder. ............. ~.~.~6.~...~.~.~;Co.~ ............................................................................................... ;....; .......... · If applicant is_ga co~porat.q, sign.atur, e of duly authorized officer. ~-~ .......... (Nome and title of co~orote officer) 1. L~otionof ,and on which p~ed work will ~done. MapNo.: ..................................... ... LOt No.: .:~ ................ s,,,. and N.mb,r ...~.~...).~.g~. ....................................... ~.~.~-- .................................. ~ ~ ~ / ~ ~ ~ Munici~li~ 2.State existing u~ and ~cu~ncy of preraises and intend~ use and ~cu~ncy of prop~ con~m~n: o. E~i,ting ~ o.a ~upon~y ....~.R~..~: ...................................................................................................... b. In~nd~ u~ and ~cupancy .;..~.I~.~L~.~.....~ ...... ~.~ ........................................................... Repair ......... ¥...~... Removal ......... U ....... Demolition .................. Other Work (Describe) ..~....L .............................. 4. Estimated Cost ..........'~...~..,.~ ................................. Fee .......... ~ ..................................... ~...: ................................ (to be paid on filing this~al~plicotion) 5. If dwelling, number of dwelling units .......... ~ ................ Number of dwelling units on eochLfl°°r ............................ f I · If garage, number o 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..:~..~..*...~. ................. Rear .....~Y~.?.~..~...~.. ....... Depth .G~..T..~.. ......... Height ...~/..T...~.. .... Number of Stories ..... ~;.'.,~... ....................................................................................................... 9. Size of lot: Front ...... ..... Rear ..... ~.~a~...:..~...~ ............ Depth ....... /..~'~...:....C)... ........ 10. Dote Of Purchase ..... ~,,0.~...'~..~..~.. ..................... Nome of Former Owner ~.~...~....~....~...T...~.....~1..~..~ 11. Zone or use district in which p~re, mises are situated ..................................................................................................... 12. Does proposed Construction violdte on~, Zoning Iow, ordinance or regulation? ....~.~.. ............................................... 13. Nome of Owner of premises ~.~.~'..~..'~..~...Address ~.~.~!k..~.l~.,~...~.. .......... Phone No. ,~.~:;..D..~..~..~'. Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor ~.?Jr~Z.Vk,4~-.....~...ar..'~......L~.. .......... Address .~.(~...~...~..~..~....~.~.:..S.~.~t Phone No. ~..~.~.:..~..?..o...~' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW, oYO~.RK, . I ,, ,. . COUNTY OF ...~SXl~.~..~,.t..~.. ........ ~3'3' 9 .......... 4~....~. ...... I.:~ · ./g*:~,~.t~- ................................. being .duly sworn, deposes and says that he is the applicant (Name of individua! signin~opplicotion) above named. He is the ...,.i.,;i.,..(~.l~...~t~...-~..~...~...¢...~.~....~. ........................................................................................ ~ .... (Contractor, agar, co~orote officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed thee'Said w0~E and to ~ke ~d file this application; that oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be performe~in t~ manner set fo~h in the application' filed therewith. Sworn to before me this / . ~ ~ ....... ~ ............ day of ........ ~.~.~.~.~ ......... , ........ Coun~~ (Signature of applicant) Nota~ Public, ~,~-~ ~- ~ '~ ~ "'T ~¢ O. ~.~