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Home My WebLink About4950-zFOI~M NO. 4 TOWN OF $OUTHOLD' BUILDING DEPARTMENT TOWN GLERK'S OFFIGE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..E/.S...O~.]~a~/.l~..~,.v~t..~,t~ ..................... Street Map No...;Y,l[ ............... Block No..F-~ ................ Lot No..-~]i~ .......... ~Ol,l~n~o.'l~t. ....... ~,.¥, ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. ~O-p~ ....... .~.1 .......... , 19.~0.. pursuant toiwhich Building Permit No...~.lff.0~... dated .............................. $O~0t~.....1.:J ....... , 19_70., was issued, and conforms to all of the requirements of the cpplicable provisions of the law. The occupancy for which this certificate is issued is ........ ............... .P~$v~e...a~ce.s sor~,. · ~.$ to~e.~...bu, itc~ ~$ ........................................................... The certificate is issued to ..A,~tar~.&..Amel:t,a.P.e.t:t. al~Lel'~ ............ (hc~ez'~ .............................. (owner, lessee or tena,nt) of the aforesaid building. House ~ 1~12~ , Building Inspector' FOEi~[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 950 Z Dc~te ........................... ]., 19..~' . ot premises located at ................... ?~/.S.....~a~..:l.t~:~..~"~..~ iE~CI.~..~ ...................................... ................................................................... ~.~.~.~l/t ......... ~t,~ b, ........... ~,.~ ....................................... pursuen¢ to application dated ............................... .,~.~.~ ......... .~J Building Inspector. :Fee $. ~.*..0...~. ............. .... , ~19,..~, and approved by the .,,/] , .; ............ · ~OB~ NO, 1 T~,VN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...,~,~ A~rowd ........................................ Di~pp~wd APPLICATION FOR BUILDING I~ERMI'I' ~.~ ' 19...?o.... Lh Date ...~. ..................... S~p.~e~he;~......$.%..., INSTrUCTiONS & ~ Thi~ ~pplicotion mu~t be comp~t~l~ filled in b~ t~pewrit~r or in ihk ~nd ~ubmitt~d in ~plic~t~ to th~ Buildin0 In~pOctor. : b. ~lot plan showmfl Iocahon of lot ~nd of buddmo~ on prem~% rslotlon~h~p to ~dlolmn~ ~r~mm~ or ~u~lic ~tr~t* or ~ areas, and giving a data'ed description of layout of prope~ must be drawn~n the diagram which is ~rt of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of thru appt~cahon, the BuHdmg Inspector will msu~a Build:ng Perm:t to the applicant. Such permit ~ shall be kept on the premises available for inspection throughout the pr~r~ss of the work. ~ e. No building shall be occupied or used in whole or in part for any pdrpose whatever until a Ce~ificate of Occupancy shall h~e been granted by the Building inspector. APPLI~TION IS HEREBY MADE to the Building Department for the i~suance of a Building Permit pursuant to the Building Zone Ordinance oJ the Town of Southold Suffolk County, New ~ork, and other applicable Lows, Ordi~nces or Regulations, for the construction of buildings, additions or alterations, or,or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and ragu at OhS Amelia P ~ra~ch (Signat~re cf applicant, o~ name, if a corporation) ...... O~kla~.A~e,.~ ~.o~tkol~ ................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engin~r, genera~l contractor, electrician, plumber or builder. ..................................... Qw~. ..................................................................... ; .......................................................................... Nmne o~ owner o~ ~em~se~ . ~ ~ ~ ~ a ........... P ' · .... ".. ~&~ ..... ~ ~i~ ........ '~ ............................................................. ~:~ tf applicant is a corporate, signature of duly authorized officer. 1. L~otion o~ Iond on which propo~d work will b* done Mop ~o,: .....,~ ............................ kot ~o,: ...~ ................ I Stre~ and Number ..... :...x....~/a..~a~..X~.~o~-- ~ ........ '. ........................................................ 2, State existing use and occu~ncy of prem{ses ~nd intended use an~ occupancy of propos~ construction: a. Existing use and ~cuponcy ..... ~.~ ............................... ~. ......................................................................... b. Intended use and OCCUr:on:', .,. . ~.~.~...~ ,~.C. eS.~OZ~ .~ ~Q~ ~ .......... 3. Nature of wo~k {check wi~icb applicable): New Building ...~.- ........... Addition .................. Alteration ............. Repair ................. Removal ................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ...... ./.....~.......~.Q ..................................... Fee ...~,~0 ........................................................................ (to be paid on fi'.ing this application) 5. tf dwelling, number of dwelling units .......... ,O.]~.~ .......... 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 ....... 6 ........................... Rear ..... ~, .................... Depth ....~) ................. Height .................... Number of Stories ............... O~ ............................................................................................... 9. Size of lot: Front ............................ [),ear .................................. Depth ................................ ]0. Date of Purchase ........................................................Name of Former Owner ....................................................... 1 1. Zone or use district in which premises are situated ......... !!A.!!..~L~'I; ........................................................................ 12. Does proposed construction ~iolate any zoning law, ordinance or regulation? ...... .11¢~ ................................................ ~3. Name of Owner of premises .~o...~.G.l;~l.~:Lg~ .......... Address ........ ~QU..~O'lC], ................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........... ~ ................................ Address ............................................ 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 black number or description according to deed, and show street names and indicate ,vhether interior or corner lot. C) Al( L kuo Av '- STATE OF NEW YORK, ! e e COUNTY OF .....~.~.~..~..~.~. ........... .fo'o' ...................... ~.~.~.....~.~.~. ................................. being duly sworn, d~oses and says that he is the applicant (Name of individual signing application) above named. 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 all statements contained in this application are true to the best of his knowledge and be et' and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before mo this 70 ~[LIZABETH A~ff NEVILLE NOTARY PUBLIC, State of N~w York No. 52-8125850, Suffolk OD t