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Home My WebLink About4964-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .][/8.1~ .Ilo&4 ........... Street Map No..Z~ ......... Block No .... ~l~ .....Lot Nc~ .... h~; .!~1'~,o~. · HeY, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~ept. ~ .¶8.., 19 .~0. pursuant to which Building Permit No.. dated ......... 8~t ..... ¶8.., 19.?0., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .l~rl~r&to. avlnm~ug. Pool. & ,A,o~oosO~8 ............................... The certificate is issued to ...ROtm~t. if., .OJ.~.l~pJ~ ** ~1' .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · I~,R, .............................. UNDERWRITERS CERTIFICATE No...]~,1~. .......................................... HOUSE NUMBER....'1:5~1~5 .... Street ...... ]~. ]~1~4 ................................ Building Inspector FOF.~ NO. 2 TOWN OF ~OOTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4964 Z Permission is hereby granted to: · : ............. ~.t,..~r-~ ...................................... ............................. .~.¥, ........................ : ................. to ........ ;~aa.ta3~ .. ~,~ ..t~o3,..~.~.t]a..$~<~e r ..b~..$~..b~e~ · &..£~l~ l~qp~,~ pursue~ to application dated ............................... ~])~, ......... .~...., 19...~,, and approved by the Building Inspector. ~ee $..:5,~ ........... TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No .............. APPLICATION FOR BUILDING PERMIT ~ Date ............................ .~,e,~.t......1...8. .......... , 19...~7..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 buildings on premises, relationship to adjoining premtee~ ar public streets or areas, and giving a detailed description of layout of property must be drawn an the diagram whlch Is part of ~nle application. c. The work covered by this application may not be commenced before i,uance of Building Permit. d. Upon approval of this application, the Building Inspector will l,ue a Building Permit to the appIIcantt 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 hove 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 Lawi, Ordlnancel or Regulations for the construction of buildings, additions or alterations or for removal or demolition, Ol herein de~¢rlbed. The app leant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. Robert W. Gill&spie Jr (Signature cf applicant, or name, if a corparatlon) ain Road, East Marion N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................ : ................. ........................................................................................................................... Name of owner of premIse~ ...Ro}zer.t..~/....Gt~:~sple..J3: ............................................................................................ If applicant Is a corporate, signature of duly authorized officer. (Name and title'of corporate officer) . 1. Location of land on which proposed work will be done. Map No.: ...~mr ............................... Lot ,No.: ......... ~ ........ .~- Street and Number .... ]j/..~ ~:~. ~l,g~.0, ..{.~.~.~e...~f.q.Z~......~...A.~.t:.....Y~...r.;~ ....... .~..:..~.,*, .......................... _ / Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..TJ¥~,].~J.~ ............................................................................................................. b. Intended use and occupon:', . ....... ........... 3. Nature of wo~k (check which applicable): New Building .................. Addition ..;11~, .......... Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .&..A.¢¢~$~,OZ~. ........... 4. Estimated Cost ......... ; .................................................. Fee ....... .~...~.e.(~). .................................................................. (to be paid on fi[ing this application) 5. If 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 ................... ~ ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear ................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... ~,?....(1..~. ............................................................................ 12. Does proposed c~nstructlon violate any zoning law, ordinance or regulation? ..... ~ .................................................. 13. Name of Owner of premises ..R,l~.~P4~.l],~.~.~:[.e...~T~,ddress ....~.~,~.~...~l~'~ ............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...~a~,e ........................................ 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 block number or description according to deed, and show street names and indicate whether interior or corner Jot. .......................... ~.~o~;~e:~.t~..1~.o-~;L~i)~Le.o~.:~ ............... being duly. sworn, deposes and says that he is the applicant ' (Name of individual signing appfication) above named. He is the 01~ez' - b~$1ctez' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief: and that the work will ~ performed in the manner set fo~h in :~ r~ SwoT~fore me ~i~ ~,, the ~p!ic~ /- the/]th. ~ Notart Public,~.~..~..~.. Cou~ ~ARY PUBLIC, ~ ~ ~ Y0r~ No. 52-8125850, Suffolk ~'~rm ~.xpires March 30,