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Home My WebLink About5096-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy Date ............. Sept...17 ..... , 1973.. THIS CERTIFIES that the building located at . S/$. Cedar. Pt. Dr..East ·. Street Map NOCod~l~. Boh~PI~lock No ........... Lot No. '~05; ..... 5euthold-..I~.¥, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Dec-..? ....., 19.70. pursuant to which Building Permit No..~096Z- · ~-,.~d.~ted ............ Daa .... .7.., 19. ?.0, was issued, and conforms to all of the require- -'"~-~ll!~/nts of the applicable provisions of the law. The occupancy for which this certificate is issU~d/i~ ?r~.vate .one. ~ami~..dweJ. l~n8 ........................................ · h~certi.ficate is issued to .6~-Ol~.:l,&. F~£fir. e~ ......074~...er / (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval . .~...R.: ' UNDERWR/ITERS CERTIFICATE No. p~ld:~l, ........................................ HOUSE NUMBER ..... 6~0 .... Street... ~r. P.o:Ll:tt. lit. oa~,t ....................... TOWN OF $OUTHOLD BUILDING DEPARTMENT 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.o 5096 Z Permission is hereby granted to: ........ ~.~.~...~.~.,....L~.....~...~?.~..~ e,rf~ ............ ..c. ~.,..h..o...~.~. ............................................. to pursuc~' to application dated ........................ ~D, ......:...~. ................ , 19.~.., and approved by the B~u ilding Inspector. FeeS. ~ ............. TOWN OF O T#OLD BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Approved f~ '( 19 70 Permit No. ~'0 ~ ~ Disapproved a/c ...................................................... r' (Building Inspect~f) APPLICATION FOR BUILDING PERMI'r ' ~'~ Date ................................ ........ 2 ........ ,192.0. ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted tr~ duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premisas or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram w~¢h It part of thle 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 port 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 issuance of a Building Permit pureuant to the Building Zone Ordinance of the Town of Southold Suffolk County, New York, and other applicable [.awl, Ordinances or Regulations for the construction of buildings, additions or alterations, or for removal or demolition, al herein described. The app icant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ............................................... (Signature ~f applicant, or name, If a corparatlon) .................... Cmtcho~u~ ....................................................... (A~dress of applicant) State whether appllcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................... ........................................................................................................ Name of owner of premises ....~,],~.:;I, ilk..~i~l~l,:~.~. .............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) Location of land on which proposed work will be done. Map No.: Cedar B. Pk. Lot No.: Street and Number ...... ~./.J~......~.~,~'...~fi...~),l~9:.e..~l~.~.~ ...... ~ ~ ~ ~O MunJcl~ll~ State existln~ use ond ~cu~ncy of promises ond intended use ond occupancy of prop~ ~. ~istin~ use ~ ~cu~oncy ..... ~ .......................................................................................................... b. Intended use and ~cup~n~', S~e v~ ~o~ ~ 3. Nature of work (check which applicable): New Building ~ ................. Addition ...~IC .......... Alteration .,Z;Z ......... Repair .................. Ren~Val .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ......... .~.,~OOO ................ a, ................... Fee ........ ~.,D.Q ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... OZle. ............. 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 ..~ ............................... Rear .......... ~ ............... Depth ....... .1.0 ............ Height .................... Number of Stories ...D,I~Le ............................................................................................................ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of P:drchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ....... !!~!~...C].~L~.~; ........................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ n~ ........................................... 13. Name of Owner of premises ..G..?.....~..a...~.~.e.~ .............. Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .D.A..Re~.be,..&..E~ ...................... Address .......... ~:~t;olaog. u~ ........... Phone No .................... 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. ,~'-~-- . / ~D~C~ STATE OF NEW_YQRK_ ! Se COUNTY Of ...~,~'.Q],~....:. ....... ~, '~' ................................. ~:L~i~..Re~b~ .................................. being duly sworn, deposes and s~.~ that he is the applicant (Name of individual signing application) above named. He is the ................ .~.g.O,~'.~,g.t,;.O,T. ....................................................... '~,,.<: ................................................... (Contractor, a~t, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contoined 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 application flied therewith. Swam to before me this ................ ..... day of ............ ........... ; ......... , · t' Pu'h /~/'): _l.~/)[/.__ '~')...:/]/]_ ...--,.,,~..~--.g~'.~ ......... ~ ............................. r~o ory o 'c, ~.1~./..~/1/,~./~ ..... Coun.ty/h/~,, #/,~ gnature of applicant) NOTARY PUBLIC, State of New 'J~k /· No. 52-8125850, Suffolk Cou.~t'~ . Term Expires March,30, 19,~