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Home My WebLink About4935-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Cerfi~icnte O~ Occupnncy THIS CERTIFIES that the building located at ...~//S .Grand. ~kve ......... Street Map No....~e ....... Block No... x~ ..... Lot No...XX .... Mat~;$tuek .. N,Y, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Sept. 2. -., 19. ?0 pursuant to which Building Permit No..1~)~. dated ............. Sept-'2", 19..?0, was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... Pr~eat~ .o,~e- .fa~$.l.y · elw®l.l.$ng ................................... The certificate is issued to . 14~, s ' G®o~g®- .Utte~ .... O~lel' ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N.I~, ............................. House ~ ~12~ // ~ ..~ ?:..~:...5::: :':::/ ............. Building InspeCtor FO~ NO. ~ TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRF-J~ISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4935 Z Permission is hereby granted to: ...,.......~..s..~....~...~..~......~........~ ./q......~...........e,, to ........ ~_t~L~..~..~t~a- ~..~t~.-~;l.~ ...................................................... at 9remises located at ............ ~.....0~.~'~ ............................................................... Jfl~.t .t::.,ttmelr,. ........................................................................... pursuor~t to application dated ............................ 8.11~.~ ....... ~, ........... , 19...~0, and approved by the Building Inspector. Building Inspector TOWN OF sOUTNO~D WING D ARTMEN CLERK'S OFFI( Approved ........................................ , 19 ........ Permit No .......................... Disapproved a/c ............................................... -- ~spectorY State whether appllcar Name of owner of pren · APPI, I~,TION FOR BUILDING PERMIT INSTRUCTIONS a. T~Is applicatiC Inspector. b. Plot plan show g location or, lot and of I~uildings on premises, relationship to adjoining premieet or public streets or areas, and giving a de lied desCrll~'l~n of layout ~f property must be drawn on the diagram ~lch is partof thio ~llcation. c. The work cove ~d bY this c~llcatton ma~, not be commenced before issuance of Building Permit. ' d. Upon approval of this app~icJ~i~,$~e B~ildinglnspector will Issue a Building Permit to the applicant. Such permit shall be kept on ~e p emises availal~ j~r~./~pe<Jtion throughout the progreu of the work. e. No building sh ~11 be °Ccupi~hole or in part for any purpoee whatever until a Certificate of O~cupancy shall have been grant by the Building ~ln~pector. · APPLICATION IS F REBY MADE to the Building Der ~rtment for the issuance of a Building ~ ermlt I~rm~nt to the Building Zone Ordina~ ~ce of the Town of Southold, Surf* Ik County, New York, end other appllcoE e Lawl, Or Jinances or Regulations, for the c* ~struction of buildings, additions )r al.terations, or for removal or dem~lltlc ~ a~ hemit delcrlbed. The applicant agrees ~ comply with all applicable laws ordmances,.l~l~i~g~l:c~le, housing code, and regula dres~f~ppllc, iht) is owner, le..sea~gent, architect, englnear,~n general contmcta~/~ e~-'~rlclan~ plumber or builder. If applica'~a corpo ~te, signature of duly authorized officer. .................. i~ ~; ' '-"~e'--o'~f Ice r ) · ~' '~ ~ 1. Location of land on which prgpc~ed work will be done, Map No,~h..,.,.,~ ................... ~'~.~~ ~ ................. Street and ~umoer ...7~.--~. .......... ~ ............................. ;.,.~.. ................... ~...;,.;.~.,~..., ........................... ~ ~unlclpalIty 2. State existing use a.nd occupancy o~intended use and of pmpaeed con,ruction: a. Existing use and occupancy ...~..~...; ................... .'~ .................................................................................................. b. Intended use and occupant ...... ~.~.,,~,..~,.~ ........ .~.....~..,~..,.,..~.'. ............... 3, Nature of walk (check which applicable): New Building ~ Addition ~' Alteration ............ Repair .................. Remova~ .................. Demolition .................. Other Work (Describe) ..................................... 4. Estmated Cost ..~...OOO (to be paid on fhmg this application) 5. If dwelling, number at dwelling umts ............................ Number of dwelling units on each flor ............................ If g~rage, number of cars 6. If business, commercial or mixe~ ~cupancy, speci~ nature and extent of each ~pe of use ............................ 7. Dimensions of existing s~ructures, if any: Front ............................ Rear ................................ ~pth ............ Height ........................ Number of Stori~ ................................................................................................... D~mensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............... Z..~ ............. Rear ........ ~..~ .............. D~th ...~ .............. Height .................... Number of Stories ............... ~ ................................................................................. 9. Size o~ lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name~lFO~er~, ~ ........................................................ 11. Zone or use district in ~hich premises are situated ............ ~.~ ........ ~.gT...: .............. ~ ....................................... 12. D~s proposed construction vio~te any zo~ law, ordinance or regulation~_~_.~_..~ ........................................ 13. Name of Owner of pre~ .~.....~.~.~....Address ........ ~.~ ...... Phone No ..................... Name of Architect ...................................................... A~ress ............................................ Phone No ..................... Contractor .~Z.~...~.~-- ~-- ....... A~ress ..... ~~~ ........ ~ne No .................... Name of ~ate clearly and distinctly all buildings, whether existing or pr~os~, and i~cate all ~ ~k dimensions from prope~ lines. Give street and bilk number or description accordi~ to de~, ~ sh~ stre nam~ and indicate whether interior or corner Jot. STATE OF N~, ~f (Name of individual signin~oppli~at~n) above named. He is the .............. ~.~ ............................................... j ........................................................ (Contractor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or hove perfo~ed the said work and to ~ke and file this application; that all statements contained in this application are t~e to the ~st of his knowledge and beliefj and that the work will be performed in the manner set fo~h in the application timed ther~ith. Swam to ~fore me this ...... ....... ........................... No. 52~585~ Su~k Co~ Term ~pir~ M~rch ~, 19~