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Home My WebLink About4731-z FORM NO. 4 TOWN OF $OUTHOLD~ BUILDING DEPARTMENt' Town Clerk's Ot~ice Southold, N. Y. Certificnte Of Occupnncy No...Z6.615 .... Date ...... ~ ........ A~... THIS CERTIFIES that the building located at .l)~Od. L. an$ ............. Street Map No.. ~ ........ Block No... ~X ..... Lot No, .XX. .... $~]~1.~....N.,.Y. ~ .... ·.. conforms substantially to the Application for Building Peri'nit heretofore filed in this office dated ............ 14a~ ..... b~, 19...~.0pursuant to whic~ Building Pemit dated ........... Pay. .... .if..., 19..~.0, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P2.iva.t$. O~a~ .family. 4well~a'lf~ ,With a,"~. &ddt~:l, Ola .................. The certificate is issued to ...W.~.i..1.~a.m.. ~)~R~,$~,~...~.I~. e.~. .................... (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Healih Approval .. ~.*.It.~ ............................. UNDERWRITERS CERTIFICATE No... P.~.~.~..g .... ~'. ........................... HOUSE NUMBER ... ~.0. ....... Street ..... .D.O.~..Op~.../~..~.~. ..................... Building Inspector/ TOWN OF SOUTHOLD BUILDING DEPARTMEN? TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 4731 Z Permission is hereby granted to: .................. ~.~,~.~.....~.~;~..~ ....................... .................... ~o~o~...~ ................ .i .................. ....................... $ou~h~ ................... r ................. ,a ......... ~.z.~..~.....~...~.t.~....°.~,..~.~...~?~.Z..t.i~g. ..................................................... at premises located at ...................... ~.O~O.¢~...~...f~'"..~J~ ........ J~ ..................................... .................................................................... .S..9.~Lt:~.o. ~ ............ ~'.,.~.... ................................................... pursuan,t to application dated ................................ ]:~,:~' ......... .~...:~....., 19..~..0..,, and approved by the Building Inspector. ~OUTHOLD, N.Y. ~ Exam ned ................... ~ ....... L....., 19 ........ ,, . Application No...L; ....................... Approved .................. .....~.....(...~ ......... , 19.1..~.... Permit No.....~...~....?../...~. ~Z,~ c~~' ',':~'~'~ ~ "' ............................. ................. i ........ APPLICATION FOR BUILDING PERMIT Date ...~.~.. .......... ~ ...................... , 19...~.(~.... 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 application. c. The work covered by this application may not be commenced before issuonce 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 sholl have been granted by the Building Inspector. rtme~~f~or the" APPLICATION IS HEREBY MADE to the Building Depa 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ~/~ / ( *g o app 'cant, or name, if a ~:orporotion) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ~..~.....~....~..~..~ ............ .L . .~...~. ...................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1.Location of Iond on which praposed work will be done. Mop No.: ................ ~; ............. lot No.: ................. St~ and Number ~..~ ........ ~ ~ ~.~.~.~ ~ ~~ ........................................................ ................................... 2. State exi~ing u~ and ~cu~ncy of premiss and intended use and ~cu~ncy of p~ con.motif: a. ~,~ ~ aha ~cu~n~ ....................................................................... ~ .............................. ~.. b. .se and cape w ....................................................................... ./...;. ....... .................. ....... Repair .................. Removal .................. Demolition .................. Other ~Work ~(Desc ribe) ........................... _. 4. Est mated Cost .....~....~-.g~.....~..~. ..................... Fee ........... ,.~ .................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ..~...~...L'.~ ............. Number of dwelling units on each floor ................... ].~ ...... If garage, number of cars ....................................................................... : ..................................................................... 6. rf 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 ....................................... z ............................................................. .~.., ...... . Dimensions of same, structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number_ o~c Stb~'ie~ ................................ 8. Dimensions of entire new construction: Front .............. ~..(e. ................ Rear .......... ,~..~. ............ Depth ....~...~./..?'~'" 9. Size of lot: Front ............ ~ ......... Rear ......... ~.~. .................... Depth ................ /...~.....0.... 10. ,Date of Purchase ......................... Z?......ff..,ff... .............. Name of Former Owner .......... .?....~././....?_..~...~.. ...................... 1 t. Zone or use district in which premises are situated ........................... ~..~.~...~..../...D..~..../l/....r../..~....~:.. ............................. or regular on? ......... 12. Does proposed construction Rate any zoning law, ordinance 13. Name of Owner o{ premises /~..,Z..~./,~'~. .............. Address~ ...'~./. ...... r/.~.4/~f.. Phone Nl~'.,,{..~, .~.....~ Name of Architect :..~..'. ............................................. Address ................................... : ........ Phone No ................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, ~vhether existing or proposea, and indicate o.ll set.back' dimensions from property lines. Give street and block number or description according to deed, and r~ames and indicate whether interior or corner lot. STATE OF NEW YORK, IS.s COUNTY OF .............. ~ ................ I ' ............ : . (Name ~qd!w.d~al signing application) ................. being duly sworn, deposes and says that he is the applicant above named. H~J~is the~ ....... .....~ ........ ..................................................... .~' "~x:_ (Contractor, agent, corporate officer, etc.) of said ownel~or owners, and is duly a?thorized '~o' 'perform or have performed the sa d work and to make and file this applic~.,~on; that ~dl-statement's' cohtained.in this applicatio~ are true to the best of his knowledge and belief; and thor the w~l~will be Peffbrmed in ;the manner set forth in the application filed therewith. Swam tobef~re me;thi~ ......... ¢::.'.'..Y.... .................... ,7...E. ×, _,,, ., ,,o. . . c ' .............. Not~ Publi~.l}7..~':~,}?.,;..;,~,.-.~0!,~:........;;...~;~.~., C6,',nty I[LIZABETH Ar~, ,EV {~gnature of applicant) ": ............. . ~ /~,~,~,~/r/,.~.,d/,) ~r//~',~l,~ NOTARY PUBLIO, ~ate of New York :~ ~~,,~m~'~.~, /~r~'o"~.,~,,~.,~. NO. 52-8125850, Suffork CoulltY,, .~*;- i~.,;?~r ~' .Term Expires March 30, 19~