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Home My WebLink About4908-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at -14il'~' .Roa~ ................ Street Map No. XX ......... Block No..Xl~ ...... Lot No..XI~ .... ~ia.t~it~ck.. N:..~ .* ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ARg...].8 ..... , 19.70 pursuant to which Building Permit No. dated ....... .A.lag .... ~8 ...... , 197.0. ~, 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 .. Priva't;e .l~o.~Iess~1~y. b~.lild:Lng ..... .~..F~..e.e.z.~..&..$$o.r.a. gg. The certificate is issued to . . ~.a. iil~$, tli]ag ........ 0'~e~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Hea~th Approval House ~ 220 E, Mill Rd /' Building Inspec!or FOP,~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~908 Z Permission is hereby granted to: ...... :.....Ja~..~...~ ................... ....: ............ .............. ~t~tae~ .......................... ~ ................. at premises located at ............. ~/~-...,~..J~l~....:~"';'~r~"~t~ ....................... ................................................. l~,t~,~ ...... 1~,~,.:..-. ....... :.,..: ..................................................... pursucm,t to application d~ed .............................. ~.....;....~J~.;~:.~., 19.1~ and approved by the Building Inspector. t Duilding IhSpector / · · O~.M NO. I TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. I¢ i ?o Examined Approved L ~, t 1 19...~.!... Permit No .......................... ' ........................................ , Disapproved O/C ........... -..... ~_......~.. Application No.......~.?...O......c~... .... APPLICATION FOR BUILDING FIERMI'I' Date ......~....~'....~..~.,~..~........./..~. .................. , 19...'~...O.. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildlngs on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn an the diagram wi'deb Is part of thie application. c. The work covered by this application may nat 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 wurk. 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 pureuant 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 apolJcable laws, ordinances, building code, housing code, and regulations. ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ .~..~./2~'~...~..~. ...... ../~'..,.....~./~...l~. ....................................................................................... If applicant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on whlch proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ...... ..~..../../~'........~..(~..q....c~. ................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Ex st n use and occu anc ~..i~ ~'/. ~.~.~. ~. ..~..~..~.~..~.~ o /..~q~s.('.~.~O O. g p y ........................... ...~:~ ,..,, .... :~,(..../..s....../~. ~. ................ b. Intended use and occu,;on:', ....~....~..~.~.~. ~./:'..y ...... ~..~.',. l..~.../....~(~ .~.. ~..~..~...~.... ~,I~.Q Xi....., ,~, ..~.~..I,~....~ 3, Nature of walk (check which applicable): New Building .... ~ ..... Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... Oo ..B 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 ............................ 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 ..... ../..b....~. ...................... Rear ...... ./..O.. ................ Depth ......~..~. ............. Height .................... Number of Stories .............~ ........................................................... ~ ......................................... 9. Size of lot: Front ........~..~..~. ............ Rear ....... .~...~.f....~..g ............ Depth / P .0. ' 10. Date of Purchase ....... .~...~.......~/.O...o~. ......... ~..~... .......... Nome of Former Owner .. b..~.~k.~.. ...... ~ ..... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ...~....O. ........................................... 13. Name of Owner of premises ..~,]'~.~'J¢.~.......~..,......~./'~ddress .~.(/./.....?...o.~...~.. .............. Phone Name 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 oil 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 corner lot. STATE OF N~ YORK, I c e COUN~ OF ................................ J~'~' ................................................................................................. being duly sworn, d~oses and soys t~t he is the applicant (Name of individual signing application) above named. He is the ........................................................ : ....................................... ; ........................................................ (Contractor, agar, co~orote officer, etc.) of said owner or owners, and is duly authorized to perform or hove perfo~ed the said work and to ~ke and fife this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the wo~k wi.l! be perfor~d in the manner set fo~h in the application filed therewith. Swam to ~fore me this N~,~," MARION A. REGENI ~ ~- 52-3233]20 Suffolk Cou