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Home My WebLink About4945-zFOI~M NO. 4 TOWN OF SOUTIt0LH BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...~.~.i.~o.ol...]~ ........... Street Map No..~. .......... Block ~o...~ ...... ~o~ ~o. ~... ~?~? .... ~?~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ ..... 9.., 19~?~. pursuant to which Building Permit No. ~.. dated .......... .~. ..... ~, 19.~0., was issued, an~ conforms to all of the require- ments oE the applicable provisions of the law. The occupancy for which this certificate is ~s~u~d ~s .. ?~?..~*~..~. ~?~ ........ : ............................. The certificate is issued to . .~5~. ~0~ .... ~e~.: ....... : .................... (owner, lessee or tenant) of the aforesaid buiMing. Suffolk County Department of Health Approval .~?~.*.. ............................. ../ : Building Inspe~or / FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTN~EHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 49~5 Z Permission is hereby granted to: .................. ~e~ ....... tt,X,.....i .................. to ............. ~:t4..~..~d.i~,S,m~..ea..,~.~tta~.~t~.~t~.....i[~:~..~,/) ............... Building Inspector. · Fee $-...-,~,0~ .......... ............................................ : ........... ¢~tet~....*~.,.l~-....~ ........... i~:.-'.~ ....... ~ ....... ~: ...................... pursuon~ to opplicotJorl dated ........ : ......................... ,~t~li,.,~l~..:?..., 19.~1~., ~and approved by the t', ' :~'~:~,;~w;;'~';:;;7-/ ................ reNO. I ·OWN OF so rmo o BUILDING DEFARTMEMT 'TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ....................................... , 19 ........ Permit No .... ~..,. Disapproved a/c .............................................................................................. r'~ APPLICATION FOR BUILDING FIRMLY 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 buildings on premMs, relationship to adjoining premiere or public streets or areas, and giving a detailed description of layout of property must be drown an the diagram which 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 appllaable I.awe, Ordinances m Regulations, for the construction of buildings, additions or alterations, or f.or remOVal or demolition, al herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and ragulotlonl. (Signature of applicant, or name, If a coq)oration) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ ~.~e,C .......................................................... : .......................................................................... Name of owner of premises ....lK~l,~,~.~il~..~g. lg)~ .................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and titl~e 'of corporate officer) I. Location of land on which proposed work will be done. Map No.: ...... ~ ......................... Lot No.: ......z~... ............ Street and Number ...~:/.~...:~,l~:J,~Go~l...~l~...-.a~.~..~[~i~.c~..~..~e. ....... ~.'G~g~p~l~ ................................ ~>/' -- ~50 .~ MUnicipality 2.State ex,sting use and occupancy of premises and intended use and occupancy of proposed ¢om~ctlon: a. Existing use and occupancy ....d, wel-'l.:~G~ ........................................................................................................... b. Intended use and occupant', ......S.~..B..e.....v..~..~.~;~;~G...-....~I,..~.~i.q~Lr .................................................... 3. Nature of walk (check which applicable): New Building .................. Addition ....~ .........Alteration ~ ........... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ............... ..~..~1~....~ ........................ Fee ....... ~...e..O...O. ........................................................................ (to be paid on filing this application) 5. If dwelllng, number of dwelling units ....... O]~e~ .............. 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 ........... -3(~ ........... Rear ........... ~0..~ ............. Depth .... 2~ ........ 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 ......... .30- ..................... Rear .......... 3.0 ............. Depth ....... 2.1t:. ............ Height .................... Number of Stories ..... .~t~.~.¢)~...-....P, fl,~l,~.~g~ ....................................................................... 9. Size al: lot: Front ............................ Rear ...................... ; ............. Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ......... J.....~;:~L~'~ ........................................................................... 12. Does proposed construction violate any zoning law, ordinance ar regulation? ......... IlO .............................................. 13. Name of Owner of premises~..~].].::L~lL~O.~ ............ Address .......~.Xl,.~.~,h.~g.~ ................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~A)~'k¥...(~.t~.l,l~. ....................... Address ........ ..C..~...~.~.O.~...e. .............. 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. ~O STATE OF NEW ~OP:J~, . 1. S~ COUNTY OF ..... ~.'.1~.'~ P. ,1~: .......... ~' · .................................... ~.~.l.~l.a~..,~D]l) ................................ being duly sworn, deposes'and says thor he is the applicant (Name of individual signing application) above named. He is the ........................ 03~31e~ ............................................................ 'iL ....................................................... (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 ti,ar the work will be performed in the mannerset forth in the application filed therewith. Sworn to before me this ................... of ........ ......... , I'~l · ~t ~ I I _ · I ' AA ....... ~,.,.............................: ....... ~...X.~..£ ............................. biotin'/ Public,~.~Tm~,,~..k~CFk~./.../~/~ ...... County ~j~'~m~l~6 (Signature of applicant) (7 ELIZABETH ANN N~V~/LLE NOTARY PUBLIC. State of New York No. 52-8]25850, Sufldk Co,Q~'. Term Expi~ ~ ~0,