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Home My WebLink About4965-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~ .~10.~ .... Date ............. ~il .... 2~[..., 19 THIS CERTIFIES that the building located at .. ~f.5. P,.tddle. ]~oad ........ Street Map No..xx ......... Block No .... x~ ..... Lot No.. ~.. ~tti~.. ].,I · ........ confoms substantially to the Application for B~lding Permit heretofore filed in this office dated ........ Sept., 2~ ..... , 19 .~0. p~su~t to which B~lding Pemit No. ~.. dated ....... 8~pt... 21 ..... , 19.70., was issued, and conforms to all of the r~re- merits of the applicable provisions of the law. The occupancy for which ~is certfficate is issued is .Private. ~ags. · (I~110~ .b~) ................................. The certificate is issued to . .~ .~. & Rife..~ers ......................... (owner, lessee or tenant) of the afores~d building. Suffolk Co~ty Department of He~th Approval ..... N,~, .......................... UNDERWRITERS CERTIFICATE No...N.,R, .......................................... HOUSE NUMBER.2~ ....... Street. ~dd~ .~.. (C~7) ......................... Building Inspector FOEI~ NO. :~ TOWN OF $OUTNOLD I BUILDING DEPARTMENT TOWN CLERK'S OFFICE r SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) N? 4965 Z UNTIL FULL Permission is hereby granted to: A~ta~ ~,~, ....... ~ .......... pursuan¢ to application doted ......................... ~;e~ ......... ~J.,~.,-i...-, 19....~ and approved by the Building Inspector. ~ - (Building Inspector/ APPLIGATIoN FOR BUILDING PERMIT Date ............ .............. eZxt ......... £.1 ......... , ..... INSTRUCTIONS ~' a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building''4 Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjalnlng premises or public streets or areas, and giving a detailed description of layout of property must be drawn on 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 pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein clmcrlbed. The applicant agrees to. Cbmply with oil applicable laws, ordinances, building code, housing code, and regulations. (Signature cf applicant, or name, if a corporation) l~dd~e Road. ...:zimal4z e. .......... ...................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar builder. Name of owner of premises .~i~L.~.g~q.g~ ............................. ~ ......................................................................................... 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.: ......... ~ ................ .......... Lot No...~.. ................... ..~ 2.State existing use a.nd occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................................ 3. Nature of wo~k (check which applicable): New Building ~ Addition ................ Alteration · Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ............ .1.t.(~X~.~.~. .............................. Fee ......... ~..t..O0 (to be paid on fi~ing this application) 5. If dwelllng, number o~: dwelling units ........ ~q_~A ...... :...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 ....~..~...~..e...~..s..o....~· .... 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 ..214- ............................. Rear .......... 2,}4. ............. Depth ..... 28 .............. Height .................... Number of Stories .............OM ..................................... .. 9. Size of lot: Front ......... .l~G ........... Rear .................................... Depth ......~.O~)..,~,+ ............. 10. Date of Purchase ........................................................ Nome of Former Owner ............................................... 11. Zone or use district in which premises are situated ...... ....................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;> ......... -~O ............................................. 13./ Name of .Owner of premises .~,:t~,..]~eB~:t ............ Address ...... ~e,t.t,;I.:~l;tOir ................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor ........... ~q.~.~. ............................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly oil b~ ildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, ant show street names and indicate whether interior or coruer lot. STATE OF NEW YORK, ! COUNTY OF .1[113~!~ ............. $~. ............... ~'" '[[~''~ .......................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ~..l~.e.z' .-.. ~..~. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ............... 2:t.... _day of .......... ....... ....... , Natal/ Public~ (~]~ Cou,tv"~[;~Z/";;;..'K__~":',· ............................. ~'t;l'~L-~-'~'.~· . ~ ~ignarure or applicanr~