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Home My WebLink About4892-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH&LB, N. Y. CERTIFICATE: OF OCCUPANCY No.L.t~O~ .............. Dote .......................... .Dee......lO ............ , 19...~ THIS CERTIFIES that the building located at ........ ~].~[t'l~"[~O&~ ...................................... Street Map No...~:~ ..............Block No..-.-ZI~ ............. Lot No ........!~ ....... 0~lel~ .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. ~ .......... .10 ......... , 19.~O.. pursuant to which Building Permit No.I~89~Z ..... dated ............................ &~ .......... J(~ ...... , 19..rjr)., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ........ · ~,~t~..&&&os ~F~.. lh~l,ld~ ........................................................................................... The certificate is issued to ..J~t~pJ:l~ta..(~l~JlJJl~l.~k .......... 1~3~0~. ................................................... (owner, lessee or tenant) of the aforesaid building. Ho~e ds 380 Building Inspector'1 TOWN OF SOUTHOLD 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) z189~ Z D~,te ............. ............... ~2:.....,~.~/.~., ~..7...-?. Permission is hereby granted to: Building Inspector. Fee $ ................ ' ........ Building Ihspector . o [~ To~. CURK~ OF.CB ~/~ ~ 7o --~ x ~mi~ .............. ,.~ ........... ZT2~., 19 ........ A~ll~tion No ............................ ....................................... : ......................... ....... ........ ......... ~................ ....... ............................................ (Building In--r) APPLICATION FOR BUILDING PIll. MIT ................................. ...... ..., .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted In duplicate to the Building~ Inspector. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premlees or public streets or . areas, and gMng a detailed description of layout of property must be drawn on the diagram whlch Il part of ~hie appllcation.~l.I c. The WOrk covered by this application may nat be commenced blfore issuance of Building Permit. ~:~ d. Upon_ approval of this application, the Building Inspector will Issue a Build!rig Permit to the apl)licant~ Such parmlt..~ shall be Kq)t 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 purpese whatever until a Certificate of Oocupan¢¥~ shall have been granted by the Building Inspector.. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit punmant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, ee heroin described. The applicant agrees to comply with all applicable laws, ord,' ances, building code, housing code, and regulatlonl. ' ~/ (Signature cf applicant, or name, If a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........................................................................................................ ~ .............................. 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.: ...................... ~ Munfclpallty ~ 2. State existing use and occupancy of premises and intended use and occupancX of proposed comtructlon: ~ b. Intended use and occupan::, . ..................../~. .......... ..L~ ........................................................ 3. Nature of wink (check which applicable): New Building .................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe)c~...~ 4. Est mated Cost ............................... Fee ......................................... .~.~ .................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .Z ............... 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 .............. Ri ......... 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 ........................ Height ................. Front (i""~" Number~.~.~..~....p~/_tor es 9. Size of lot: ....... Rear'""'"'"'"~'~"~/~'"'"' '"'"'" .~.~~~(.~..~..~;~..~Dept~./~''''''''''' 10. Date of Purchase ............................. /..~....~'......~.. ........ Name of Former Owner ....... ~..,~1.....~'~..~...~../~. ............ 11. Zone or use district in which premises are situated ...................~... ............................................................................ 12. Does proposed construction violate any zoning,law, ordinance or regulation? ................. .~.~. .................................. 13. Name of Owner of premises,~'TE"PHE~v' C~LU~ .NA~l~re~ ~_"~/. ~q.t~.L~E~ ,/?~ Ph ~0/'7:3~31 -'/-~ ~/.~ ............................................... ~.~f~..~.~.r~. ~)..~. o e r~o ..................... Nome of Architect ................. ~ ............................... Address ............................................ Phone No Name of Contractor ..............-~....~..~.....~.-~.. ................... Address ............................................ Phone No. PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, ond show street nomes and indico?e ~hether interior or corner lot. STATE OF NEW ~RI~/. Z ! S $ COUNTY OF ....~r~4~/~/_~ ........... ~' · - ........ being du y sworn, deposes and says that he the applicant (Name of individual signing opplicbti~) ............... above named. He is the .............................. I~....~.....~.....~....~... ................................ ......................................................... '"X~ ........ (Contractor, agent, 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 contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this -- (J ELIZABETH AN~ NEVILLE ... NOTARY PUBLIC, S(ate of New York No. 52-8t25850, Suffelk County Term Expires Maech ~0, ~9~