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Home My WebLink About4713-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTME~NT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. 4 .q.l+.2. ~ ...... Date .......... .G. ct ..... THIS CERTIFIES that the building located at . .. G.temna.$ne. 6..~on. tat~k. · Street Map No...xx ........ Block No.. ~ ...... Lot No... xr .... F.~-shers .I s.~ end ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ apr. · .1.3., 19..7.0 pursuant to which Building Permit No...~.7.13z. dated ............ .~,.p.r....2.7..., 19..7.0., 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 .. ~uSXue ss..bul~[~.lr, g...(.Gas..3.t, ation. ) .............................. The certificate is issued to . ,~.,~Iohr~ .Gada,..Ger~ tl. Contr. ac t(~r., inc ....... owne~.. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~..2~ ............................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN a. IRK'S OFFICE SOUTHOLD, N. y. Examined ........~....~ ................... , 19.....~....C~ Approved ' \ · ~ ..~.. ........................................ , 19'.' ..... Permit No .... Z../..~......~. Disapproved a/c ........................................... ~ .... ,. APPLICATION FOR BUILDING PERMIT Date.. Apg11 23 ........................................................ ,°. ..... INSTRUCTIONS a. This application must be completely filled in by t~pewriter or in ink and submitted in duplicate to the Building Inspector .... b. PIo, t .pi.an sho,v(in.~ I,oc.ation. of lot ?.nd of buildings on Premises, relationship .to adjoini,r~, premises or public streets or areas, ana gwmg o ae~a.ea aescnption of layout of property must be drawn on the diagram which is ~ of this application. c. The work covered by this application may not be commenced before isstmnce of Building Permit. d., U.pon. appr. oval of .this app. ic.a, ti ,o~, .the Building Inspector will issue a Building Permit to the applicant. Such permit shall oe Kept on the premises ava aom Tar mspechon 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 Occapanc¥ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bud ng Permit pursuant to the ~Buildln.g' Zone. Or?l. inance of ~e Town .o,f..Southo.l~., Suffolk Count, New York, omi other applicable Laws, Ordinances 'or ~.~geu arLo. ns, tar the construch.on of bu,amgs, additions or alterations, or for removal or demolition, as herein described. · applicant agrees to comply with all applicable laws, ordinances, building code, housing code, arid regulations. ..A,...J. olm..Giidi..Gea~.~l,..Cd~JIl.t~itg..~.l...qg~ 'mc. (Signature of applicant, or name, if a corporation) ..3;.a..$..~...~ uev Zock (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................... Om3ez:...-....Gestate.3,.. ~a~Gtd~.~g.t~;¢. ................................................................................ Name of owner of premises ..... 2ke...~Ta}lrJ~..~.~,..g.~lllLqll;~...~D.~r~'.~..~..~..~..cJ[a....~..~.~.e. ................................................... If applicon is~a~orporate, signature of duly authorized officer. 'X; .............. · ...... a~:' ............ 1. Location o~ land on which prapmed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number .G3.e~dl~LGe..~v~nlZe .................................... ff~,~l~:;:ll...~;~l~p,~a...~.l[~. ~.O.,~k Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed 'constnu~lon: o. Existing use and occupancy ..... GalJI..a~:~;~,.J~L~G .............................................................................................. b. ,n nded use and occ .w ............. ............................. : ........................ 3. Nature of work (check which applicable): New Building,; ................. Addition .....~. .......... Alteration .................. Repair .................. Removal .................. Dem~li~io~.....Z~ .......... Other Work (Describe) ........................................ 4. Estimated Cost .~.~.,..8..0.Qa.0.~. ................. ~.~..~.i.i..i.., ee ...,, ......................................................................... (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~ql,~,~...~.C~...~l.~ff~lo 7. Dimensions of existing structures, if any: Front ...~.4.". ................... Rear ......... 4.~..e ................. Depth ....... ;~.~,e,..... Height ...~.&.*. .............. Number of Stories ..............1. ................................................................................................. Dimensions of same structure with alterations or additions: Front ...~.~.! ........................... Rear ...... .~.~ ............... Depth 62* . . Height ......... ~.~ ............... Number of Stories ..........~. ................... 8. Dimensions of entire new construction: Front' .....~2! ' Rear ........ 3~.? .............. Depth .....3.,5.e. ............. Height ...,t.&.". .......... Number of Stories ........ z ............................................................................................................ 9. Size of lot: Front ............................ Rear .................................. Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which prem see are s tuated ..................................................................................................... 12. Does proposed construction vialat~ anv ~4~ law, ordinance or regulation.;> ............................................................ 13. Name of Owner of premises .G~l).,...~,ol~t.~'&¢3JF.~l. llcJAddress ~;J~tl~at..Z~lZ~,'l~...~.Phone No..'/..81:1w.~.31 Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor~T.~...~l,¢~'il,..G$111~...(~DJl3.t,l~..-Address .~;LIIl~el~iE..]'-~l~,.ellt~l,~I~.~%°hone No..7.~1.1~..-..~.;~;}.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setd3ack dimenSions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y~)RK/~ ,9Z ( ¢ c COUNTY OF ~...$~'~' ..~ ~..;....~...~.-....~-..;..: .................... .: ........... being duly swam, deposes and says that he is the applicant '"// (Name of individual . _ _. ~_ . ,~_ --.,.~sig~lngapplicati°n) ~ . . above named. Pie is the ....~...T.~. .................. ii .......... '..' ...................................................... ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly aUt.horizecl to, perform or have performed the said work and t0. make end file this application; that all Statements cantoned iH 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 application filed therewith. Sw°m t° =bel~ me this "~. ~ ......... ....... .................. ,....., . J ~.1 .' 0 ~ ~ . ...... (~.~/~/4.m~.....:..~....,~z .......... ~...~.: ...................... Notary Public, .~ ............. : ....... Count~ , ~t,/~N_ O. W~..Ig~a~r.e of ~lSplicant) · I1 /% ~ ,, Notary Pubflc, State at ,~ew ~ I~ ~ I,)~/11/ No.