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Home My WebLink About4768-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~lO16. .. Date ........... 0~1; ...... 13 ..... , 19. ?0 THIS CERTIFIES that the building located at Gl~ee~vay. ¥~lt ............ Street Map NOG~eeil .Aer... ~B]~l~t ......... Lot No.. '~9 ...... 0l'.ient ..... N,~. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... May .... 2~, 19.. ~0 pursuant to which Building Permit No. ~+?$~Z · dated ......... Ml3r .....2~[ '" 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 ... l~iva'~e' O~'e' f~/~J.y' ~lW~llll~'g .................................... The certificate is issued to 'Anf. ho~y. ~l~.tt~ll~o' ' o~wnler, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval '0et '13 ~' '$9~0' · 'by' R,~ · Vi'l;.la ..... 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? 4768 Z Permission is hereby granted to: .... 11~.~...~6.~.~..~...~/..~.....~ .o...~...~t~o ...... .~.....W.o..~..at~ .................................. to ...... ~a~:X~t "amr ..mxe'-~'a~ii~T'~bm~ ............................................................................. at premises located at ........~llt~....,~ .......... 0~Z~Ii..~C~.e. II...~...~.R,,I,~D,g ......................................... .............................................. ~;J~.....~-ze~nwn¥.. We~t ............ t~ia~1~ ........................................... pursuar, t to application dated .............................. ~¥ .......... ~.~ ........ , 19.....~.(~ and approved by the Building Inspector. F~ $......1.9.,.~ ....... TOWN OF sOuTHOLD ¢"~- BUILDING'DEPARTMENT TOW. c.m's ~,OUTHOLD, N. Y..~ /. Examined ........................ t ................. , 19 ....... Approved ~4. 19..!.!... Permit No. q '7 ~ ~r~.~-- D~sapproved a/c ...................................................................... ~' ~ 1~ )y~ 6u~' ............................ [......I....*...J,_.~.~.........' (Buddy, ,~ ,, ,~,~,,..,.~..~.'~Z.{ ](,( ....... ~ ,~':~ ~ ,~/o ~u'~'~-'' APPLICATION FOR BUILDING ,E~IT ~ ~- . / .~Z,_ ~te .............................. TI ............................ , ~. Thi~ pppli~otion must be completely {ill~ in b~ ~writ~r or in ink ond ~ubmi~ in ~plic~t* to th~ 8uildin~ In--for. b. ~1~ plan ~howin~ I~ion o{ lot ~nd of ~ildin~ on pr~mise*, r~lation~ip to ~dloininfl pmm~* or public str~t~ ar~, ond Oivl~ o ~il~d ~rlP~ion o{ I~t o{p~ mu*t be drown on th~ diagram which i~ ~ o{ thi~ applic~ti~. c. ~e wo~ c~er~ by this application may not be commenced before i~uonce of Building Pe~it. I d. U~n ~r~al of this ap~licati~, t~' Building Ins~ctor will issue a Building Permit to the applicant. ~h ~all ~ k~t ~ the pmmi~ ~dable for ie~ction throughout the pr~ress of the Work. e. No building s~ll ~ ~cupi~ or u~d in Whole or in pa~ for any pu~e whatever until a Ce~ificate of ~c~y shall h~e b~n gmnt~ by the Building Insp~tor. APPLI~TION IS ~REBY ~DE to the 8uildi~ De~ment for the issuance of a Building Permit pu~uant to the Building Z~e O~inance of ~e To~ of ~d, Suffolk Co~n~, N~ York, and other applicable ~, Ordi~nces or ~ulations, for the c~ruction of buildings, ad~s or alterations, or for removal or demoliti~, as heroin describ~ ~ applicant ~mes to c~ply with all applicable laws, ordinance, building c~e, housing c~e, and regulations. ........ ...... ........................ ~ *. ~ ~ ._ (~gnature of applicant,--~or name, if a co~omti~) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ......................................................................... ............................................................... ......... Nome of owner of premises ..~..(~.../.-~.~...~..,~'...~.. ....... ~...~..././..*~.../.--~..~,.~...~... ...................................................................... If ~t~C~, iS o~.~o~.e,.~gn_aT~re~uly authorized officer. ............................... (Name and title of corpc~e officer) 1. Location of.land on which proposed work will be done. Map No.: ..~....~....,~....~. ..................... Lot No.: ..~...~.. .............. o.d N.mber T'F} - I)~O ..~ Municipalit~ ' ...................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ............................................................................. Intended use and occupancy ..~./.~.~.~.~.......~..~..../~..Z.'./xk/.........z~...~...~¢.~../.././...,~.' 4~..; ........................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... /..~..~..~.~.__ .......................... , ........ Fee ........... i~'~"~;"~;i~"~'~"¥iii~g"¥1~'i'~"~'l~'l~'li'~;~i;r~i .................. 5. If dwelling, number of dwelling units ....... ~.~ ................. Number of dwelling units on each floor ............................ If garage, number of cots ....................... ~. .................................................................................................................... 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 ............................ Num6er of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~...~.:..~'.:: ........... Rear ...~'....~...:...~..'.: ...... Depth ....~...~.] ............ Height .....(..~..'. ...... Number of Stories ........... /. ......................................................................................................... 9. Size of lot: Front ......... [..~,~. ......... Rear ......... L..~..~.. ............... Depth ........ /..~...O.. .............. 10. Date of Purchase ........ /./~./~./..&..2 ......................... Nome of Former Owner .,'~..:....~'..~....~../(/.~.~.~. ................. 1 I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... .~....Q. ........................................... 13. Name of Owner of premises B..;..~....0..I~...~..~/...~.'...~.....Address ...-~..:......~../~..~...~.../..~....~. ........ Phone No.~...~..;'.'...~....'~'../.-3 Name of Architect .../~......~.../~..J...~.Z~..~' ..................... Address ../~../.i~...~..~..6...~.:..~...,~.. ........ Phone No.~..~..Z.C .~...~/.~. ~ Name of Contractor ./~.~../.YL~..~.~.......~...../..~.~.,)'....Address .~..'~..~..~..~J..(...'~...~... .......... Phone No.~,.~...-.../...~..~..6 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. L- ! STATE OF NEWYORK, COUNTY/'~OF .... .S..R..~...~9....k.!.(: ......... ~"'m' ,- , ~...~j.~z.....'x).J~.g~.~..~.Z2..~q~ ...... .¥.?...~...~.~...~..?4...~.x~../..../../(.~.~.being duly sworn, deposes and says tha¢ he is the applicant (Name of individual signing application) above named. He is the ....... ~'-'-~.~.~L~.f-~. ................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the' said work and to make 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 application filed therewith. Sworn ~ before rne this .... ........... ......... ...................................... Notary Public, ....~/~(....~.~-...~'Y~. -~ ............. Count~ 7' 4? ,,y/ (Signature of a[61zl_icant) Romart BubO'der ~lu~ ~. s~ ~ Riverbed, N. Y. 1190~. RECEIVED SB~¥OLK COU~ DEPARTMENT OF HEALTH Date Bldg. Permit No. ~7 ~ f 2.- TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Giv~ deed location) have been inspected by this department and found to be satisfactory. District Engineer ,~E'A ~')/21VE' .'" o¢: 4-0 A/v z-/4,9/v ~-' z'~oz L_ I¥~