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Home My WebLink About4764-zNO. 4 TOWN OF $OUTHOLD BUIT.rlING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.Z.~28 ....... Date ............. .0.ct .... 12 ..... , 19. THIS CERTIFIES that the building located at . P. vt-Road. (~$.S.. I~ .0rien~eet Map No..~ ,L,Eat. · · Block No ........... Lot No ........... Fishers..I. sland .. Ii...Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .l,~ay. · .21.., 19.?0. pursuant to which Building Permit No. ~+?$1+Z.. dated ............ l~ay ....22.., 19.70., 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 .Priv. ate. one. £emity..dwe.~.ting ....................................... The certificate is issued to . .~ .H....Re.~d. · · · 0~ner .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · .t~ oR.. ............................. ..... .............. Building Inspector I~OB~ NO. I TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............... ~ (Building I mpecto~/V APPLICATION FOR BUILDING PERMII' INSTRUCTIONS a-. This application mu~t I~e comPletel/~iied In by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premiees or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which ~s part of thio 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLIC. A. TION IS HEREBY/Vua, DE to the Building Deportment for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apallcable Laws, Ordinances or Regulations, for the construction of buildings additions or alterations or for removal or .demolition, os herein described. The applicant agrees to comply with all applicable lows, ordinan~s,z~uJ}ding code, housing code, and regulations, , ~.., ~l~..~..~e~l...cT~.~,g~,,~.~. .............. (Signature of applicant, at nome, If a capetian) FiM~zo..Iel~,..lle~..~oxk ...... Il113 gO ............................. (Address of al~pllcant) State whether applicant Is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... !;~t~.~.e;~ .................................................................................................................................................... Name of owner of premises la. He Reid If applicant Is a corporate, signature of duly authorized officer. ........................................................... )L'"",Y~' ....... ~iilSi';'"3'~ Vice ~eside~t (Name and title'of corporafe officer) of o. .............................. : ......... ............ Strata and Number ....... ~&~k.~e~ ......................................................................, : ~.~ ..~c~ll~ ................................................ 2. State existing use apd occupancy of promises and Intended use and occupancy of propos~ construction: a. ~istlng use and ~cupancy ........ ~.1~$.~ ..................................................................................... b. Intended u~ ~nd oc~up~nc,' ......~~1. . ~ ............. ~.~..~ ........................... ;,,..~ ........... 3. Nature of work (check whici~ applicable): New Building .................. Addition .................. Alteration .................. Repair ................... Remova~ .................. Demolition .................. Other Work (Describe) ..~ll...~itJ...~le~,lr, ....... 4. Estimated Cost ...~.~...O~.. ......................................... Fee ............ 5..,.~ ........................................... (to be paid on firina this"~'l~plica~i~) ................ 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 entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed constructlon ?olate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ....l¢~lfu,..J~elJ~l, ................ Addressl~J'silL~l~i..]:~l~llll..,l~'n.... Phone No ..................... Name of Architect ...................................................... Address ............................................. Phone No ..................... Name of Contractor &,..,/oll~..~,~l~ ......................... Addressl~.si~e~j..~:~i.~l. Jl,1,%.... Phone No ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property Pines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot. STATE OF NEV~YC~, ^!_ ~SS -'~z ~ 'z ~ ' r'' ' ' COUN~ ...... $ ' ' ............... I~rT,"'~~..~l~... .................................... being duly sworn, deposes and says that he is the appdcant ~lame of individual sFgning.gl?j~g~ion} ~ .~ above named. He is the ..... ~ ........ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or bqve~ per~fp?med the said work and to make and file this application; that all statements contained in this applicatlon~are trae to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to bejore me this ~ ~ ~ ....... .......................... , . Notor/ Public ............................... - ......................... '~"~ ....~ "~"~ .... ~.ount~ D(Signature of applicant) C/ .... i/ ~,. ~OHN GADA ~' ~o[ary Public, State of I~ew Yor~ Residing in Suffolk Co. Off. No. 52-6439000 ~Commissjon J~.xpires March 30~ ~ ~ ~