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Home My WebLink About4978-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z.ItJ..6?... :.. Date ............. l~arch...~12.., 19. ~1 THIS CERTIFIES that the building located at . Alber.ts®n ~4 ............ Street Map No...xX ....... Block No. xx ....... Lot No. xxx.., gtre®~p®l't .... ]l,~ge ...... conforms substantially to the Application for Building Pemit heretofore filed in this office dated ......... Sept .... 29., 19.7~. pursuant to which Building Permit No..~?SZ. dated .......... .S.®pl; .... 30 , 1970.., 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 .... /~r~v&te. ®ne. fa~il~,, dwell~ ................................... The certificate is issued to . .3~tte~X. C.epg~x ~ .~/~.e .... 0~mers .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ]~,lte ........................... ..._........] Building Inspector I POII3I NO. 2 ; TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) N? 4978 Z Date ............ UNTIL FULL Building Inspector. ...... ' ..... Permission is hereby granted to: ....... :...S~.ueI..~:,~..~...... ................. ............... ~e~,m,.~e., ................ ~, ................ .................. ~,~,~,~ ...... ~s'~,......i. ................ to ............. ll~14..~:~e4~.~-~.*~J~ts~.~t~ ................................................ at,premises located at .................. ,.~l~i~.~il~tiffi,..~ ................. .. ...................................................... pursuan¢ to application dated ................................ :,~l~t~.-.'.~l?,,., 19.,..~ and approved by, the I~OK~ NO. I 'FO~4'N OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGB SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. Application No....'~'....~..?..~. ........... Disapproved a/c .............................................................................................. (Building Inspector~/ APPLI~.,ATION FOR BUILDING PERMIT mt. ................................ .... .... -4 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 premisas or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of thle application. 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 o 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 hove 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 applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinanc~ building code, housing code, and regulations. name, If a corporation) .......................................... "......:......,~ .............. LI.~,.,T.I,,,y...~..:.~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. U -L I' N Name of owner of premises .................................................................................................................................................... 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.: ....................... Street and Number ~- I /A L] IDR, T ~0 N kAU~ ~EFN~T 2. State existing use a~d ~c~ncy of promises and intended use and ~cupancy of pmp~ construction: a. ~isting u~ a~ ~cupancy ............ ~.~. ........ .~.~.J~..~.~.~. .......... ~..~..~.~.J.~...~ ................................... b. Intend~ use and ~cupancy ~A ~ ~ ~ ~ H A ~ ~' ~' o~ 3. Nature of work (check which applicable): New Building ................. Addition..................~ Alteration .................. Repair .................. Removal .................. Demolition .................. ~Other Work (Describe) ........................................ 4. Estimated Cost . ~:~ ..~...~..~. 1:,, . ~- o~.~, (to be paid on fi!ing this application) 5. If dweUing, number of dwelling units ....~../~.. .................. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancyi specify nature and.extent of each type of use ............................ o 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 ................................... Rear ...................... Depth ........................ Height ....... I..~.. ........ Number of Stories .................. ~. ................. 9. Size of lot: Front .......... ..~.....~....,0...... Rear ........ ..~...~,..~ .............. Depth ......... !..~ .............. 10. Date of Purchase .................. :~..~....~. ............Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated 12. Does proposed construction violate anv zoninn aw ordnance or r~ulation~ 13. ~ame or uwner or premises ........................ Addre~ ...... ..); .......... Phone No .. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~ 6 L ~ ~<A~ t~ -~ ~A*t E-- .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex st ng 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. ................................................................................................. being duly sworn, deposes 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 nerform or have "erformed th- ,,=a .._.u __., ~ ~ - ~ ~- ~ au,u wur~ ~an~ tO rna~e aha file this appUcation; that all statements contained in this app cot on are true to the belt of his knowledge and belief; and that the work will be performed in the manner set forth n the appl cation filed therewith. Swam to before me this ................. day of .................... : ....... ,9...b...?. ,_/) ./p . . . ......... ............................. ~o. 5~-81258§0, Suffolk