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Home My WebLink About5049-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No... Z~66 .... Date ........ 0~.t~be~. THIS CERTIFIES that the building located at .. Jake. Dl'~,l~e .............. Street Map No ..... ~ ..... Block No .... ~ .... Lot No..~...80u.t~o~.~ .................. conforms substantially to the Application for Building Permit heretofore fried in this office dated ........ l~velabel,. ~.6t, 19..7.0 pursuant to which Building Pemit No.. ~..0~.9.Z. d~t~d ......... l~b®l~..~.6~ 19..70~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for whieh this certificate is issued is l~.vate .one .fa~ly. d~'ell.lz~ ....................................... The certificate is issued to .... Ge. C,~alLae ......................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...NeR. ............................ UNDERWRITERS CERTIFICATE No...PENDXI~G .................................. HOUSE NUMBER .... ~3.~ ....... Street .... ,T,~ke. 13'1":1.9'~. ......................... ...................................................... .~u.~..o .~. ................ .... ........... Building Inspector/ FORI~I NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMEN1 TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERI'IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5049 Z Permission is hereby granted to: ..... eee--~s-...-~/e..~.--er~e ................ ................. ~ ~ ~l~eX~l ......................... ! ................. to ....... ~ .... ¢~la ...... i ..................................................... at premises located at ................... ~e--~'l~ ........................................................................................ pursuan¢ to application dated .......................... ~O'e' ....... ~J~ ............ ", Building Inspector. Fee $.F,,.Oa ............. 19..~, and approved by the ........... . i .......... ....... IFO~M ' NO. I TOWN OF soUTH°LD BUILDING DBPAITMIN'r TOWN a.nK'S OPFJCi S04JTHOLD, N. Y. Examined /~ .......... ................. , ,j...o. Approved ''~ 19.:.~... Permit No ............ .~.....;...:.. ~ . ........................................ , z Di~ppro~d a/c ....................................................... " "' (Building Inspector) li=.on .......... APPLICATION FOR BUILDING PIRMrr pet, ................................ ~9..~]~.~.~....~.~., ~9....2.9...~ INSTRUCTIONS a. This ppplicotiofl 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 bu.ildings on premises, ralationship to adjaintng premises or public itreets areas, and giving a detailed description of ayaut at proper~ must be drawn an the d agram c. The work covered by this application may not be commenced before issuance of Building Pleenit. d. Upon approval of this application, the Building Inspector will Issue a Building Permit to the apl)licant. Such permltA'-- 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. R~.A, ~P. PLI,CATION ,!S HEREBY MADE to the Building Department for the issuance of Q Building P.~. It punluant to the UiICIiIr~.. /.C~. ~.~3_. mance of ~ Town of Southold, Suffolk Coun.ty., New York, end other .al~lk~)le L41v~_': ulorolTcs, mr tl~e coflstructton of buildings, additions or alterattons, or for removal or demolition, al ~ dmlarlbe~ apl~ cant agrees to comply with all applicable laws, ordinances, building code, housing cac~, and ~lgulatlaM;- (Signature of applicant, or name, If a cOrpOration) Southol~ State whether applicant is owner, lessee, agent, architect, engineer, ~leneral contractor, electrician, plumber or builder. ................................................... ~o~.t~.a~.~z. ................ ~ .................................................................................................... · G. Cruise Name of owner of premises ................., .................................................................................................................................. If applicant Is a corporate, signature of duly authorized officer. (Nama and title 'of corporate officer) 1. Location of land on which propnsed work will be done. Map No.: ........... ~x~ ........................ Lot No.: ....x~... ............... ~ Street and Number ..................... ,T&~e..~)~,.~ ......... .qo3~o~d~ ............................... ~ ........................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propmed comtrm~*jo~: Existing use and occupancy ....... .~I,W.~.~,~,~,~ ............................................................................................. ag Intended use and occupant., . .............. s~m~..Ki.t~.a~i.t~o~ ....... 3. Nature of wmk (check which applicable): New Building .................. Addition ...:1~[~ ........ Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ......... .bt. Q0.....-+- .................. ~ ................. Fee ...,~.~0O. ............................................................................ (to be paid on filing this application) 5. 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 ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... .1.~ ...................... Rear .......... .1.~ ............. Depth .....1.0 ............... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front .~(~ ..................... Rear ........ 1.00 ..................... Depth ...... ~.OO.:.~ .............. ]0. Date of Purchase ,: ...................................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....... .a.~...~l.:J.~.t~ ........................................................................... 12. Does I~roposed construction violate any zoning law, ordinance or regulation? ......... ~.e .............................................. 13. Name of Owner of premises .G.,~..D.~u.;Lse. ................. Address ............ ~'a¢~o.3.~1, ............ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...~.,..,,~a.ttez'. ............................. Address ........ ~.0.13.1;,b,0.1.~ ................. Phone No .................... PLOT DIAGRAM Locate Clearly and distinctly oil buildings, whether existing or proposed, and indicate all set'back dimensions from property lines. Give street and blocl$, num. be_r or. description according to deed, and show street names and indicate whether interior or corner lot. K ~) ~1~ ~ STATE OF NE-'~/'I~(~RI~, ! ee COUNTY OF t~.~,:~; ............... }'~'~' ................................. ~.~.~,..~J~,~.~.. ....................................... being duly sworn, deposes and says tl'~t he is the applicant (Name of individual s~gning application) above named. He is the ................ C.Ol~.t,:~&C~.t~ ...................................................... ; ........................................................ · (Contractor, agent, coq~orate 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 )~rue to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicat)(j~n filed 'therewith. Swam to before me this ~,/ I)_, .............. hlotart Public,~D..~,,~.Aq~?/,~..(-~.. County~ /4Signature of applicant) ~ ELIZABET/I ANN NEVILLE ~/ ~'~' ' NOTARY PUBLIC, State of Naw York No. 52.8125850. Suffolk Term EXpiTaS March 30, 19~