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Home My WebLink About4637-zI~OR~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at . '~OX'~;[3"'[xr~ll~ .......................................... Street Map NoGe~la~S[ ...... Block No...S~3...[[~,.~.... Lot No ...~8 ......... -~a.~S+~..Y'~Z'.i.O~ ..................... conforms substantially to the Apphcahon for Building Permit heretofore filed in this office dated ................................ .1~1~ .......... ~ ..... , 19~} .... pursuant to which Bu,lding Perm,t No...~.~.~.. dated .......................... [~.l'. ...... ..tlr ............ , 19...~Q. was issued, and conforms to all of the requirements of the apphcable prows~ons of the law. The occupancy for which th~s cerhficate ~s ~ssued ~s ........ ..... P~.;[.va~e.. ~ne.. ~m~%l .y .~elll~g ....................................................................................... The certificate ~s issued to ~'.~e..,KoCt~ ......... 0Wlq~=. ................................................................... (owner, lessee or tenant) of the aforesaid bu,ld~ng Bu,lding I nspec~r FORM NO. ~ TOWN C~: SOUTHOLD BU ILDINGD~.PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT fi.HIS PERMIT MUST BE KEI~T ON THE PRF. MISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 4637 Z Permission ls hereby granted to: .............. ~e.~r.~.....z~ ....................................... .............. ~a...~~..~ ........................ ................. ~a~.tb~r ....... ~,X, ........................... ~ an addtt~lLo~ ~ ex~tilag 6~ell~ ct premises located at ................ ~.~-.~."~.~.~....~..~..~..~....~.....~...~...~..~.~.~...~..~.'~.'~-~.~'~..~.~.~. ....... /. ............ ..................................... ll~....]toz~..~e~e ......... ~at.....~r.t.~.....,l[,~.,. ................................... pursucn¢ to application dated .............................. ~.tl~;I ......... ~. ....... , 19~tJD..., and approved by the Building Inspector. Building Inspector BUILDING DEPARTMENT' TOWN CLERK'S OFFICE ,G~.,'-~ / SOUTHOLD, N.Y. ./~-*~-~'~, ...... ....... ,,,..7..0 "S ......... ,,.'1 ^pp,,=,,on No. ........ Permit No ,Z/~ ~ ~ )0 Aaproved ........................ f.! ............. , ................................ ................................................. ........................ (Building Inspector) APPLICATION FOR BUILDING PERMI'I' ~ Dote ....~ ............ ...~.....~... ............. , 19.,?....0..... ~J~ 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 pram sas or pub c streets or areas, and giving a detailed description of layout of pro~erty must be drawn on the diagram which is port of this application. c. The work covered by. this application may not be commenced before issuance of Building Permit. d. Upon approval of th~s 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 MADF to the Building Deportment for the issuance of a Building Perm t pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app cab · Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations or for remova or dem° t on, as herein described. The applicant agrees to comply with all applicable laws, ~7b.~ildi-r~g'~Je, hoj/sing ,e~e, and regulations. ($ignc~rre of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................... .~....'~z..~..~....r~... .......... .. Name of owner of premises ......................................... .~.. ....... .~.......~. .......... ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~_~6rzr~t=~--&,= F-~t:~-~ ~--~T- :~ 1. Location of land on which proposed work will be done. Mop No.: ..~..~..~.!.b..~........~. .......... Lot No.: I (~C,~ '~ an umber .~..~ ..r~...--[.. I,~ L, ~ i,J ~_. ~-~ 17_1G~'-J Street n_~LN ........................................................................ .~../~ ......... . .~....~ ................. ~ 7r" / - .,~. ~ .__.~ Municipality 2. State existi.ng use and occuponcy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. ..~:..~....W~......~.....~....~... ........ .~.~....~.....)....~.....~...~......~...~r.. ......... b. Intended use and occupancy ~'~ \ ~ 3. Nature of work (check which applicable): New Building .................. Addition................../ Alteration .................. Repair .................. Removal .................. Demolition .................. Other'Work (Describe) ........................................ 4. Estimated Cost ...~...~..~?....c~....cj~... .................................... Fee ........... i;;"i;; .................. 5. If dwelling, number of dwelling units .............. ..-T; .......... 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 j~xisting structures, if any:.Front ....,...~_..~ ........... Rear '.Z....~ ................. Depth Height ....... .~......~. ....... Number of Stories ...... .~....7- ................................................................................ 'V~ ............. . Dimensions of same structure w th oterat o~s or add t OhS: Front .... ..~...~ Rear 4."~. Depth ...:2.,.(~ ..................... He,ght ........ ..~...:....~.. ....... Number of Star es ....... !...!....-C ............... 8. DimensionsI°f entire new construction: Front ....... L.~. ....................... Rear ...)....4:. .................. Depth ..... ) .................. Height ...~.~ .............. Number of Stories 9. Size of lot: Front .......)...~....c?.~. ......... Rear ...... L.~...~ ................... Depth ..... J...(~...~. ................ 10. Date of Purchase .~[ .~. -?.. ...... L.~.....(4'...~ ..... Nome of Former Owner ~_~.~...~..~...~....c~..,~...~...~..~.....~...~.-~.~....~ ..... 1 l. Zone or use district in which premises are situated .....................~....~...~..: .... 12. Does proposed construction violate any zoning law, ordinance or regulation 13. Name of Owner of Drem ses ~'-c:>d-,t[ ~--~e.~='~c~.~ Address~%'w3b,~l~-%-T ~.-~. - · ..................................................................... ~..,¢. ..... Phone ........................ Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor hone No.4. PLOT DIAGEAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block number or description to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWV,_ORK,,,~ __ tS.S COUNTY OF ~t~.../:~....~Y~.~{?~...,.$ · ................................................................................... Demg duly sworn, d~oses and says t~t he is t~ applicant (Name of individual signing application) above named. He is the ....................... (Contractor, ag~t, co~orate officer, etc.) of said owner ~, and is duly authorized to perform or have performed the said work and to ~ke ~d file this application; that all statements contain~ in this application are tree to the best of his knowledge and belief; and that the work will be perfo~ed in the manner ~t foffh in the applicatio~ filed ther~ith. Swam to before me this ....... ....... Nota~ Public,.~~~.~~ Coun~ ..... ~u;;'~~"'-~g pp cant) ................... .~ o/ NO, I REVISIONS VAN SUMM'~..I:tl~T & WEI~-OLD PLANNING ASSOCIATES, INC. JOB NO. 0 0 9..4' sUMMEI~ & WEIGOLD