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Home My WebLink About4697-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.~38.7.7 ................. Date ... Ju.].~r 21 19. 70 THIS CERTIFIES that the building located et ~O.1~,~¥/...~.~.~1 .......................... Street Mop No....~z ..............Block No..~r, ............... Lot No ........~"~ ...... ~o~;~.cl~J[....~.., ............... conforms substantially to the Application for Building Permit heretofore filed in this office doted .......................................... · A~¥~.."I......~.I.., 19....~/~) pursuant to which Building Permit No..,.~.~.~..~..... doted ....................... &~.~.l. ....... 2a ........ , 19...~[~, was issued, and conforms to oll of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ .............. ~:[~ra~e..~r~..~'.aln:~.~y..dtm.~.~.~, .................................................................................. The certificate is issued to ..... ~..Z'~l.~.....~e~.rL .............. ~* ............................................... (owner, lessee or terz~t) of the aforesaid building. House ~ 20~8F Building Inspector FOF,~ NO. · TOWN OF SOUTHOLD 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) N? ~i697Z ~, ........................................................ , ...... Permission is hereby granted to: ~ ~)&e~ .'c)a .JO~,'~...A,f.~..~rlc...~ z. eea ............... to ........... .~. )A..~...~..~.. ~..t, ~.O.~ ....... ~.....~...~ ~.~.~Q~a...~U...e,~ I.t4~.. M2 3J~ ....... at premises located at ............... ~.,~.....~gaZl~..~Lei~..a~.~l ............................................................... ......................................... .~,,~....~...~ .......... ~.:T.. ................................................................................ pursuar~ to application dated ........................... &~l~;J,~, ....... 9.~ ........ , 19....~...., and approved by the Building Inspector. Fee $.....~,~ .......... Building Inspect? ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No. Disapproved a/c ............................................... (Building APPLICATION FOR BUILDING PERMIT Dote .............. ............................. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. 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 Jn 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 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances and regulations. (Signature ef applicant, or name, if a corporation) (Address of'applic~l'nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~ ....................................... If applicant is a corporate, signature of duly authorized officer. ............. ~"(1~1~ and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ................... .;/ ...................... Lot No: Street,~ Number ,~t~...-,,~ ........ ~.~.*...(~,~.*-..~....~/.. *~.*.~..,. ............ ~ o~ O V ~'--~ ~ Mun,cil~ality / 2. State existing use and occupancy of p~r~r~,~:~~de~ .~se and occupancy of proposed ~onltruction: a. Existing use and occupancy ........... /7:~....~,--------------~...~ ............................................................................... b. Intended use and occupancy ............ ~,~19~.~. ................................. ,~? ......................................................... 3. Nature of work (check which applicable): New Building .................... Addition ......... Alteration .................... Repair .................... Removal .................... Demolition,i: ................ Other Work (Describe) .................... 4. EStimated Cost..~.....,~.C~¢~., .................................. Fee'...r.~.. ............................................................................... ~ (to be paid on filing this qpplication) §. 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 ahd extent of each type of use~ ................... : ....... j. 7. Dimensions of existing structures, if any: Front ...... ~.~....~. ........... Rear ...... ;g,.G.. ............... Depth. ~ ¢~ · Height .......,~'~-..~...~'.:........Number of Stories ......... ~,~,,, .................... ~ .................................................................. Dimensions of same structure with alterations or additions: Front ..... ,~...~.. .................. Rear ....,~...~....j.~ ......... Depth ......~....~.~..~..: ........ Height ......... .~....~.......~...'......'Number of Stories ..... /...~.. .................. 8. Dimensions of entire new construction: Front ............................Rear ....... : .................... Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ........ ./../...O~_.~.~..... Rear ..... ~//..,,~....'...~.. ........ Depth .....~.~r.~.,:...~..~' ~ 10. Date of Purch. ase ..................... */~.~¢~'.~.~.~l~'.,)...Name of Former Owner /?~z~......~..~.~.~'...~... ............... 11. Zone or use district in which premises are situated...,~<,~'~.~,-~'~,,?~J~.~.. ...................................................... 12. Does proposed construe;cio'r{ violate any zoning law, ordinance o~/regulation? ..... ~ .................................. 13. Nome of Owner of prem~s ......... Address ................................. Phone NO ..................... Name of Architect ........................................ ~ ............... Address ............................................ ~hone NO .................. :;. Name of Contractor~,a,,~L,~d~.~.~. ....... ~...~..¢~...Address ~/~/~..~:~....~.~"..,~..f.....Phone NO. ~.~....'..~...~'.~. PLOT DIAGRAM Locate clearly and distinctly c~ll buildings, whether ex isling or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. 1 STATE OF NEW YORK, ) S S. COUNTY OF ............................ ) ...... ~, .~.4~T~.....~..~...;~ ,~:.,.~_..~.....:~,b?ing duly sworn~ deposes and'says that he is the applicant '(Name of indJvidUa~ signing app~icatiom ....... above named'. He is the...~t~..,...J~..~./..1~...~ ............................... :. ....... ' ............................................................... (Contractor, qgent, corporate 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 true to th.e. b~st of his knowledge and belief; and that the work will be performed in the manner set forth i,n the appl~icatlon flies1, therewj~h... · .~-~ Sworn to before me this /',,)~, ..... ~ .............. cJQy of .....~--.~ .....~ ......... 19.:~. ....... MA~I0~I ~ ~1~ (Signature of applicant) Notary Pubhc,: ..~.z. ~--.~,w~n......~..,....~.~,~,~-...~.o n~. 52-3233120 Suffolk Coup. \ . , ; ~I Term Ex~ires Mar~h ~ . ~.. '