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Home My WebLink About4641-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sonthold, N. Y. Certificate Of Occupancy No. Z1~26]. .. Date ,]'~Pe 9 ,~1~9 7t. THIS CERTIFIES that the building located at ~t~a¢e Roaa~a~a Street Map No. p~D~aBlock No. Lot No. 39~ Fishers Isl~ conforms substanti~ly to the Application for Building Permit heretofore filed in this office dated ~V 9 , 19 70, pursuant to which Building Pemit No. dated ~ 11 , 19 ~0 , was issued, and conforms to E1 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P~i~ate erie ~il~ dw~tl~ ............. The certificate is issued to ~, Do~$~. Ho~to~ ~e~. · (owner, lessee or ten~t) of the aforesaid b~lding. Suffolk Cowry Dep~tment of Health Approval ~en4~.g ............. Building Inspee~r FOlt~ NO. 2 TO~N 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? 4641 Z Permission is hereby granted to: at premises located at .................. ~]~e~,..~,O~:~....~9~...~O~...t~.lr..~l~l~l~ ............ ~. .... pursuon¢ to application dated .......................... ~i~F~ ............ ~ ....... , 19.....f~ and approved by th~ Building Inspector. l~B[ NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ............................. ~..~ ....... , 19 ........ Permit No ........................... Application No...,.L~...~..,.~...[. ......... Disapproved a/c ...................................................... ..... , ......................... .............................. APPLICATION FOR BUILDING PERMI'I' INSTRUCTIONS a Th~s application must be completely filled in by typewriter or in ink and submitted tn duplicate to the Bu,ldin,_ Inspector. , b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets o areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatior 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 permi shall be ke? 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 Occupanc' 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde ............................................................ G e~.e z;.a::l....C o~ ~,~'.e C,, ~ ................................................................................... Name of owner of premises .... ~T%.~.,,...,~i~.¥n).n_~..~j~...-T-ZQc3.c~e~....(,i~O~Q.~3~'...~.o.. ~-[i3.c3~.) ..................................... If applic, an,l~ is a corporate, signature of duly authorized officer. - ';t .............. t~ame anatme or corporate o~ncer) I. Location of land on which proposed work will be done Map No.: :g~-~.f.~s~l.].~..,[~a~ ........ Lot No.: .;~9.~..~.Q~.~.~,.. Street and Number ......................................................... .~j,~i~t~..~,l,.~.~&..~f~.t~...~.~/;'~ ....................... '. ....... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~sting use and occupancy .......... ~one. ....................................... '.t'"t ............................................................... b. Intended use and occupancy ........ .~..~..~.~..~..e..rt...o..e.. ........ ~ ........ i ................. ~ ............................................................ 3 Nature of work (check which apphcable) New BuHdtng .... :~ ........... Addmon ..................Alteration ........... Repair ................Removal .................. Demolmor .................. Other Work (Describe) 4 Estimated Cost .... .~.~..O.,..0.O. 0.~ .O .O. ........................ Fee ..... .~J.D...D.Q ..................................................................... (to be pa~d on filing this apphcat~on) 5. I~ dwelling, number of dwelhng umts ..... .~ .................... Number of dwelhng umts 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 D~mens~ons of ex~sting structures, if any: Front ......................... Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................ D~mensions of same structure with alterabons or addmons Front .................................... Rear ........................... Depth ................................ Height ......................... Number of Stones ................................ 8 Dimensions of enhre new construction. Front .... 32.~. .................... Rear ..... 3.2.~. ................ Depth ..... ~8.! .......... Height ..J,.~½.~. ....... Number of Stories ..... Z .................................................................................................... 9 S~ze of lot Front ........................... Rear .................... Depth ............................... 10 Date of Purchase ................................................ Name of Former Owner ...................................................... 11. Zone or use district ~n which premises are situated ................................................................................................ 12 Does proposed construction wolate any zomng law, ordinance or regulation:) ...~.q ............................................... 13 Name of Owner of premises ...~...~.t...~.-..~..?...~...°..~...c]~ddress ..~..~..~.[....~..~.1~.~...~.~.~., ........ Phone No.2..O.~.-...'/..~..?..-.. Name of Architect ......... i~.Q~.eJ ................................ Address ............................................ Phone No ................... Name of ContractorJ~^.~.,...~i~gl,~..~,...CDJ~.~::,...Address ~],~Tze~',.~..~.~sl~n~l.~t.,¥~hone No.5.3,~..-.2~8.~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and indicate all set-b~ck dimensions fro~ property hnes. G~ve street and block number or description according to deed, and show street names and indicat whether i~terior or corner lot STATE OF 'NEW~OI~,/ ....... ~ ....... .~~....~...~..~....:....~.....:. .......... being duh/ sworn, deposes and soys thor he ,s the apphca (N~ m e o f md ividua I s~,~ n i.~ng, a~ li~c~c~io~n~,.~ above nome~t' He is the ..... ~.t~¢:~.......%....~... ................................................................................................... (Contractor, agent, corporote officer, etc.) of smd owner or owners, and is duly authorized to perform or hove performed the said work and to rnc~ke ond fi th~s apphcotion; that all statements contained in this apphcation are true to the best of his knowledge and behef, that the work will be performed ~n the manner set forth m the application filed therewith. Sworn to el~re me this '~ ......................... ................ ....... ...... Notary Public,. ..... ~ ......... County: ; ~/'"' '(Signature of appli~a~'i .................... %9' i~p~'~ ' \ / \ / ~,0 ~ /& ~ - ~ ~0 //~'~ //~-b' . ~ ~, ,~ I I , ~Lo~ ' ' ~ 70. o' ~.oo I I I ~ " , I i I I ~x ~, '~l.~,""~] i i~~..~~p.~~o,o, I I ~ ~ ~1 ~1 ~7 I ~ I ' ~ I I PEN/IV ,.t UL A C/Tar;d/er ~C /~/~Ter