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Home My WebLink About4705-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. ~ ..... Date .......... De~.. ~.~. ......... , 19.~0. THIS CERTIFIES that the building located at l~d- l~&l~. ~ ............ Street Map No.. ~ ........ Block No..~ ...... Lot No. ~ .... Bo~thold . .]~.Y.. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... &FSI .... ~ 19. ~0 pursuant to which Building Permit No..~0~. dated ............ &pl~tl...~, 19. ~), was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . l~l~a~ 'O1~ .£a~t~ly. d~ll~ ...................................... The certificate is issued to .. Ml~m .g .l~&b~th. 14~y9 ....... ~91~ ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Building Inspe~or FOBM 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? ~705 Z Permission is hereby granted to: ~,l~4b~r.e...~.....~m~...~.....~....~s~.....~. t~ P...~ ~.~.. ma r~m ...k~_d ~C42.vu* leek). .......... ot premises [ocoted ot ......................................... ; ............................................................. i .... 8eUt~o .~... I1,I, . pursuan¢ to application dated ................................ .A..J~.I'..~........~........, 19...~...., and approved bi the Building Inspector. TOWN OF $oUTHOLD ~''/ BUILDING DEPARTMENT TOWNsouTHOLD,CLERK'SN.OFFICE¥. / Examined .......~ .................... , 19 ........ Approved ........................................ , 19..~.... Permit No ......................... Disapproved a/c ' ......................................................... ~ O,'f< o (Building Inspector) APPLICATION FOR BUILDING PERMrI' ~ ot. ............ ............... , 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 o detailed description of layout of property 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 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 in 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 ar Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apl~licant agrees to comply with all applicable laws, ordinances, building code, housing code, end regulations. (Signature of applicant, or name, if a corpo~3tion) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................................... ........................................................... Name of of premises ............. ~ I~.~.. ~.... ~ J~l. ~l~e .~..~.... P..*........~.. _~.y.~J~. ............................................. owner If app~ant is a coro0rate signature of duly authorized officer. (Name 6nd title of cor~?ate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number .~t~l...~..~[~l~4~....~lJ~l~....~.~J~.le~.l~$...N~.~.~;t ~1~.~..~.~.~.~..~ '~::~1 __ ~7.~ ~ ~ Mun,cipality ............... 2. State existing use and occupancy of pre~m)ses and intend?L~se and occupancy of proposed construction a. Ex,st,ng use and occupancy ........... .Y~I~.~[t~I~..~ ....... ~,~q~..~. .......................................................................... b. Intended use and occupancy ......... .~ .& .~ .(~ .{,~ ..... ~..t~). ~ [ L .~. (....~.~.l.J~.~.l~.~,.~ .............................. whetherPr°perty~lines' GiVeor cornerStreetlo...t.and block number or description~ according to deed, and shoo street named 3. Nature of work (check which applicable): New .Building ..~. ........ Addition .................. Alteration .................. Repair .................. I~m~oval .................. Demolition .................. Other Work (Describe) ........................................ 4. Est mated Cost ~..~lI ..~...~...~.. !.....'~.. .................. Fee .......................................................................................... (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,entiere new construction: Front ......~.~...'...~ ............... Rear .....~.~...-..I~. ......... Depth ...~.~L~..I~I ....... Height ...][{~.~...~... Numbe~; of Stories ...... .~....~.~. ................................. JJJ ............................................................... 9. Size of lot: Front ....~.~. ........... Rear ........ ~...~1 .................. Depth ...J,..~. .................. 10. Date of Purchase ................ ........................... Name of Former Owner ....~.~.~l~...J.~,.J.~ ................... 11. 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 premise~ ..~. ~.,..~:.!.g...:.~Q...Address .~.~I~IIL~L,%..y..~.,.~., ..... Phone No .......~ Name of Architect ...................................................... ~ Address ............................................ Phone No ..................... Name of Contractor J.'~..,.~.*...~l~'-~'.~t~'..~,~ll~l~J~..~..~..~ddress J~.(~ll&..~.~,.lJ~..l.~.~t~Phone No~9.~.~..~.~..J.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from indicate STATE OF NEW,YORK, ,. ~ee COUN. OF ........, .......... ~,J~k~'J~....~'~.~...~lJ~.~.~...~.: .................. being duly sworn, deposes and soys that he is the applicant (Nome of individual.~ning application) above named. He is the ....... ~....: .............. .~l~,~L~.l~,.Im.....~.~'l,~l~..l~.l~ ................................................. ~.~} ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to mo~,e and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicatign filed therewith. Sworn to before me this~/~ . ~ ,-/// ..... Z. ......................... r, lotary t'ub,,c, ./.Z~/JK~AR~..C~?ULsK~, ~,~-~ -- ....... County (Signature/of NOTAR'," PUBLIC:, S~'ete of Now York RESIDING IN SUFFOLK COUNTY No. E2-SB95900 Oemmlssleel Expires Merch 3~, tg....~. HAROED R, REEVE-AND BON~ BUILDING CONSTRUCTION ,IV~t'E-LIIUCK~ ~IEW, ~Y. QRK , HAROED R. REEVE AND SONS tN'C, , , BUILDING COI~STRUCTION '