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Home My WebLink About4905-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ~1~ .1 .~. ..... Date .............. J...a~. .... .~. ..... , .... THIS CEBTIFIES that the b~ding located at ~. ~ .dl~ elf. E~. ..... Street Map No. ~0~g~. P~. Bio& No...~ ...... Lot No...~ .... ga~.~!tue~.. N.,~T ...... co,ores subst~ti~ly to the Application for B~ldMg Permit heretofore filed in this office dated ......... A~...10 .... , 19.70. p~su~t to which B~ldMg Pemit No..~90.~. dated ............ A~.. ~..., 19~0., was issued, ~d confoms to ~1 of the r~re- ments of the applicable pro~sions of ~e law. The occupancy for wMch this certificate is issu~ is .... ~i~.~te. o~e. f~ly..dve~$~{ .................................... The certificate is ~sued to ... ~a~ .L.. G~bl~ ..... ~ ...................... (owner, lessee or ten,t) of the afores&d building. Suffolk Co~ty ~p~ment of Health Approv& ...... N,~e ......................... Reuse ~ 810 ~t Rd .... :..:...:..: ............... B~l~g ~spe~r FOP. M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 905 Z Permission is hereby granted to: .................. ~.$~..Omml~..lt. ......................... ....................... ~.~,l~e...../,dl~ ...... to ........... ~...,~l,t~r,.tg.e~...&. ~14&t ~...ea..e~tt&~ .~l~ee~ ......................... at premises located at ............ ~l~l~.JJlll~..~f..~l~B~..~-~.m-.]~tl~....~t,-.~..~. ................................................ II~tt~Ltaelr, ...... Mo~. ......................................................................... pursuanrc to ~pplicotion dated ............................... ~'ll~t,....~...., 19...~), .nd opproved by the Building Inspector. Building I nsp~'~'~' f ' 'TOWN OF'SOUT~OLD .. BUILDING DEPARTMENT · TOWN CLERK'S OFFICE SOUTHOLD, N.Y. L Disapproved a/c ..... ?~ ............... '' ' (Building InspeCtor) INSTRUCTIONS (~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to 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 applicatic~n. 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 have been granted by the Building Inspector. ~'~ APPLICATION. IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of 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 ........ ,~.<~..~.&P~.~.....L,........~,...I..~l..~..p....,~.... ........................................ ' ................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed.v/ark wilJ be.,dgne. NJepj.blcl~./.9.."~...x~.......'T. ........... ,....i..."Lot Nm.: ..'...-~..: ............. ;.. ~ Street and Number ............ .,.~/~/....~.~........,.4~../.,*Z..~t~,~'..~,,.~..f'...,,.~.~c..../.~,~..7~.~...T..~..~..~.-- .. ........ · OJ~e (~(' /~)~-C-[(. J~Z.~ Municipality /~,/ .~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ...~......~.....~J...O/$..~...~ .......... ~..~..~..~ ................................................. b. Intended Use and occupancy.. .............................. -~.X'J~..~. ............................................................................ 3. Nature of work~..heck which applicable): New Building .................. Addition .................. Alteration .~... Repair ....~ ...... ,Removal ~. ................. Demolition .................. C)t~her Work (~scribe) .... ~"'~'~.....~ ......... 4. Estimated Cost ..... ~,~,0. ............. Fee. . ,,,~,...,.~,,.,.-~, ~.~ -- ~to be paid '~'-i-~i~-'~'l~'l~Oii~) .............. 5. If dwelling, number of dwelling units ....~ .......Z...: ........ Number of dwetling 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 ....... ~..././..~ ................................................... ~ .................................... Dimension~9~sa.~me s~u~r.e wi!h_ alterations or additions: Front .................................... 'Re~,.r ............................ Depth ........... :...'~:.......~ .................... Number of Stories ................................ D~mens,ons of entire new construction: Front ~....;......./....~.~...F.~..~...~¥ Re, ar ........... ~ .............. Depth ~ .......... ~c~.....~. H~-igl~t ................ Numbm ~ Stor ee .~ .~.,..~... ~,.., ,.~1~,....,~.. Size of lot: Front ......... ..7....'Z...~..~... Rear ...... 7...~....~...~... ........... Depth ....... ~/~ ............... ~ Date' of Purchase .......~...~...~.i.~. ................................. Name of Former Owner ~..~....~......-~.~.....~..../.~...~.~..~.~..... Zone or use district in which premises are situated ............................... .~-'-~..~..~.../....'~....~...~-Z~. .......................... Does proposed construction violate any zoning law, ordinance or regulation? ............ ~ ................................ Name of Owner of premises ....~-~-.:.~...~.~.~.~.~.....Address ~../.r~....~/O~.~.~.~./...~..~..~one No. Name qf Architect ................. ~. .................................... Address ....~.~...t~...~..~..I~Z.~....~....C~.... Phone No ..................... ~j -- .Name ofContractor ............................................... ~ ~ ~ ............ Address /.I..~..O~' ............... Phone No. · I10/0 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. //~// ~ ~ 9. 10. 11. 12. 13. STATE OF NE~Y. ORK, ! ~ S ........ ~'~-'¥-'~-~. ............ ~..~~ ................ being duly sworn, deposes and says th°t he is the applican~ (Nome of indivlduol signing opplicotion) above nomed. He is 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 make and file this application; that oil statements contained in this application are true to the best of his knowledge and belief; and tha~ the Work will be performed in the manner set forth Jn the application filed therewith. to before me this Nota,¥ Pu~~ ......... ty o~.._.-. ( 'g ~l~re of applicant) .......... ~,;,~.~' r.~b'son~~ ~s/s !Bu~;a~o,Rd. 300~ e/o, Ho~b~Ook ~ l~t FI ' ~ 2nd F i out side ~°~"'~ ~he New ~ork Boar~ of ~re Underwriters ~Jm BUREAU OF ELECTRICITY N798512 ~5 JOHN STREET. NEW YORK. NEW YORK 1OO3~ ~hts ~e~tfies. Edward L. Gibson, s/s P~Ivate Rd.,E/O Mill Rd. Young's Point,Mattltuck, L.I. EIXTURE FIXTURES RANGES COOKING DECKS OVENS OUTLETS SWITCHES FtUORE$CENr :)ISH WASHERS EXHAUST FANS DRYERS SYSTEMS NO. OF FEET E OTHEK APPARATUS: R V I I 1/0 IqO. OF HI.LEG NO, ~ NEUTRALS A.W. G OF NEUTRAL 1/O Electric Room Heaters: 2-2.5kw Mattituck New York STAT~i SUPERINTENDENT Per~ D This certificate must not be a~tered 'n any monner~ return to the office of the Board if incorrect, InsoecTors may 3e identified by their credentials.