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Home My WebLink About4938-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. '.Z~.~9 ...... Date .......... Febu~.ar~y .... 8 .... , 1972. THIS CERTIFIES that the building located at . P.%~t :Rd..~7. N/. Pet,. BaT .l~[t~tet Map No. D. o. S.tack. Block No ........... Lot No. t~&.5 .... .~;re~ - · t~.,.~ .......... conforms substantially to the Application for Building permit heretofore filed in this office dated ........... S.ept. 2 ..., 19.T0. pursuant to which Building Permit No. dated ........... .~.qt.'.t...~..., 19 ?.Q., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... N~R~ .......................... Building Inspector FOF, M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. EUILDIt4G PERI~/dT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4938 Z Permission is hereby granted to: at premises located et ............. ~.{~....~..~..~.....~.,..~t~..~. ............ , ....................................... ............................................... ~.O.~W.~.... ~/~...~.eeon~ce..~..~.~ ......... ]aam~ ............. ~ .... pursuan,t to application dated ....................... ~.e.D.~ ......... 2. ......... ,...., 19..~., and approved by the Building Inspector. TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CL,RK'S OFFIC, ,, , ,, ,, Approved ........................................ , 19 ........ Permit No ....... Disapproved ale .............................................................................................. APPLIP...,ATION FOR BUILDING PEKMI'I' Date .......................... .8..e. ~..t., ,e.m .b..e.F. ....... .2...,, ] 9...~..0.. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building~i~ Inspector. b. Plat plan showing location of lot and of buildings on premises, relationship to adj~inlng premises ~ I~u~llc streets or'~ areas, and giving o cleeailed description of layout of property must be drawn on the diagram whlch Is part of mia application. c. The work covered by this application may not be commenced before issual~e of Bulldlr~g Permit. U al~;roval this i d. pon of application, the Building Inspector will Issue a BUilding Permit to the al~llcant. Such permi ishall be kept on the premises available for inspection throughout the pragreu of the work. e. No building shall be occupied or used in whole or in part for any pu~oee 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 pumuant to the_~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and ather pppllc~ble ~ Ordinances or);. Regulations, for the construction of buildings, additions or alterations, or for removal ar demolition, al heroin described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatlans. Candle L~ht Home.s. ......................... (Signature cf applicant, or name, if a corpamtlan) Riverhead (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plun~er or builder. ..................................................... ................................................................................................................... Name of owner of premises ...... ..J...°...s..e.P..h........L~..~lLl..t...~. ....................................................................................................... If applicant Is a corporate, signature of duly authorized officer. ~ 1. Location of land on which proposed work will be done. Map No.: 81~&Cir t~ ~.. ........................................ N. ......... ............ Street and Number ........... ~...~.~.~gXllg...]~]~..]~lF.~ ........... ~111~. ......................... ~ ..................................... 2. State existing use and occupancy of premises and Intended use and occu~x~ncy of prapaead comtructlon: a. Existing use and occupancy .......... ~.~.~Jlg ....................................................................... i .............................. b. Intended use and occupant, .....~q.l~,~eh..~Lt, J~..&~l.l~l~Z'~,.t~ot~..~..ILd.dJ.l~lZI. ................................................ 3. Nature of work, (check whicl~ applicable): New Building .................. Addition ......~ .......Alteration ...... ~,,z,.. Repair .................. Remova~ .................. Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost .........~.e~OO......'h ................................ Fee ..... ~,~.QO ........................................................................... (to be paid on filing this application) S. If dwelllng, number of dwelling units ........ OM ............ 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 ............. .'1.6 .................. Rear ....... 1~ ................ Depth ...... ~,~ ............. Height .................... Number of Stories ....... O~ ........................................................................................................ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated .......... ~,.....di~ ......................................................................... 12. Does proposed constructlon violate ~ny zoning law, ordinance or regulation? ............. Z~e .......................................... )3. Name of Owner of premises ....~.......~/~)~t~.~.~ ........... Address ....,lvr,~.t,~:L~11C,~ ................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor .0....a~.~.~,~.~,~Lt~...~,Ql~,e.~ ........... Address ......... ]ti.v. erhead ............. 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 corner lot. STATE OF NEW,YODK ! _ _ ~ OI ~ COUNTY OF .... .~...1~.. [.~'~'.6...~.. ........... ~. b.~. ................................ ~..~eS~ ................................. being duly sworn, d~ses and says t~ he is the applicant (Name of individual signing application) above named. He is the ...................... -~e~. ........................................................ ~ ........................................................ (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowl~ge and belief; and that the work will be performed in the manner ~t fo~h in the apPlicatic fjl~ therewith. Swam to ~fore me~is ~~~ ................. ....... : ......... , ~ E[IZAB~H ANN NEV[~ . . I-~ ~TARY PUBliC; State d New ~erK ~-: 52,8125850, ~ffolk C~.~ ~e~ ~ires March ~.