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Home My WebLink About5022-zNO. 4 TOWN OF SOUTHOLD BUILDI~TG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .M~...t~...R.o..~l. ................. Street Map No .... ~ ...... Block No.~.. ........ Lot No....1~.... ~g.t.oh..o..gV~' ............... _.~-~-~nforms substantially to the Application for Building Permit heretofore fried in this office .~ ,~.~da~d ...... .0~..t0.b.s.?..2.3. t..., 19.7..0. pursuant to which Building Permit No..~.0.2.2~... dated ...... 0.~..t.o.b.01'...2.~! .... , 19.70, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ...I~. ~,h.~...~..d.u..s.t.~.i..~...b..ui..1.5..t~. g' .(...~...l.~..~l~t.. 9..&...1'.~.~..~..l,..s.~..~..o..~..) .... The certificate is issued to . .J..a~..~.~...H...~....(.B.~..~.~....0~.11~97..~..o.~.~. .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ]l.~t~ · ................... :. ....... UNDERWRITERS CERTIFICATE No ..... .~...~..I~..~. ............................... HOUSE NUMBE~..~...... .......... Street ..... .1~..:~....Rg.a.5' .......................... ..................................................... . ................ Building Inspector I FOIL~I NO. 2 TOWN OF $OUTHOLD i 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) Permission is hereby granted to: · ................ ~.~.n-..~o~.~ ........................ i ................. to ........... ~:L~..~n..a~,~.~..~n..~.~.~-n~..~i~...~'~ ............................. Building Inspector. · Fee $...~,~)(~ ........... at premises located at ........ ~//~.,~4~.,~a;.,,~ ......................................................................; ............ .................................................................. Cut~lm~u~ ....... ~? ....................................................... pursuant to application dated ......................... ~1~.~ ....... ~ ..........;,..,., 19.:~/~., and approved by the ..... i' . "":i;i~;~' i~;;t;;;: ~": ................ E~m~ned ~ 9-3 '~9.~.9.. ' ' ~' ~ 19...~..... Permit No. ~'~ Approved ........................................ , ............................ BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Disapproved a/c .................................................... ~. ............ · __ (Building InspeCtor) [ APPLICATION FOR BUILDING PERMIT ~ Dot. ~ -~2, ~9 ?~) ~' INSTRUCTIONS o. This application must be completely filled in by typewriter or Jn ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining pmmlee~ or public streets or e. No building shall be occupied or used in whale 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 t[mBullding Department for the issuance of a Building Permit pureuont to the Building Zone Ordinance of the Town of'Southold, Suffolk C6unty, New,York, and other applicable Lawl, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein delcrlbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ,/~.~,-~. !~. ~...:.. , ~,..~ ~--~ ................... ~..~..~ ............................................. (Signature af applicant, or name, If a coq~ratlon) · ~ . (Address o~ applicant) State whether applicant is oK qer, lessee, agent, architect, engineer, general c6ntrector, electrician, plumber or builder. ....... , ......................... y-~ ............... // --.---'-L- ..~~,q .............................................. Nam, :,f ow,,r of pr.m~,,~..,,&....'S..~..~..~ ......... ,,~.~.~..."...~ .............. .~:......~ If apl: cant is_aa corporo~'J~atur, of duly aut~'lzed officer. ~, (Nome and title 'of carparate officer) ,. of,andon wh,c,p posedwork w,, ane. apNa.: .............. : ......... ...... ,at ................ ...} Str,t and Number ....................... ~Z..~../...Z~,. ........ ~..~..~.../2. ......................... ~:~.Z.....A.~,~..~..~....~....'.,~.,. 2. State existing use and occupancy of premises and intended use and occupancy of proposed comtructlon: a. E~s. ng us. a~ occupancy...~...~./.<..~..e..... ... ................................. ........ . ........ ~ ........................................... . . . . .... .. b. 'ntend.d u. and ~c-~,on?. ................. ~.:....~/......~~ ............................................... 3. Nature of wo~k (check which applicable): New Building ~ ................. Addition .... .-~.......... Alteration ............... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Esti.,~.ated Cost ........ ~..¢~..~....:~ ................................... Fee ~' (to be paid on fi~ing this application) §. If dwelling, number of dwelling units ........................... 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 ..... .~.~.~...~.. ........... .3...~... Rear ....~.~ ................... Depth ....~....o. ...................... Height ........................... Number of Stories / · 8. Dimensions of entire new construction: Front ............. ~ ................... Rear ............................ Depth .~. .................... Height .................... Number of Stories ........ /. ..................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................ ./~ ........... lO. ~ Date of Purchase ...,Z/.~. ...................................... Name of Former Owner .~<~....~..~...~. ~ .~.......,~...~....o'....~.. ....... 11. Zone or use district in which premises are situated ............ .~....?....C..=.....~.~..~ ................................ 12. Does proposed construction v'o ~,te any zon rjg aw, ord nonce or regu at 13. Name of Owner of prem ses .~//~t/..c..s. .~..~....~t.~t.~.. Address~..~..~(.~.~.~.,E..~../..~. 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 block number or description according to deed, and show street names and indJca~'e whether interior or comer lot. STATE OF NEWt-~O~'_ ~- tee ............................. /../..~,,~..../~..T..E .z...L..~.....~ ....... being duly sworn, deposes and says that he is the opp cant (Name'of indj~cJe'al signing apphcahon) above named. He is ~ ......... ~_....~ ............ ~ ..................... :. ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform afl,have performed the said work and to make and file this application; that all statements contained in this applicatl/~ are true to the best of his knowledge and bel el; and that the work will be performed in the manner set forth in the al~l~licatJon filed therejl~h./ Swam to before me this ~ 11 ~/~ / · .. aay or ........................... , .. -. P.-, ............................... ~o ? o c,~.~..~.~?~.V../,a~'~. Cou~ ~igna~re of applicant) ~ OTA REyL I p~BBE~Li~, AsNt aNt e NoEfVINLeLw~ York No. $2-8~2§850, Suffolk Cou~ Tel:re. Expires' March 30, id'