The URL can be used to link to this page

Home My WebLink About4776-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 7-5.697 ...... Date ........../{0¥,..231 ......... , 19. THIS CERTIFIES that the building located at .. l/ak. Boad ............... Street Map No...XX ........ Block No.. XX ...... Lot No .... XX .... /~OU.~.0~.4 .............. conforms substantially to the Application for Building Permit heretofore filed in this office ~,~,,~dated ........ 1/ay..28~ ...... , 19.7.0. pursuant to which Building Permit No.. ~"~ted ........ l/ay .28s ....... , 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 .... P~.iva.t.e .one .family. dwelling ................................... The certificate is issued to ...8verA .Jo. J. ohl~on ................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N.:R. ? ............................... U DERWRIT .RS C .RT ICATE .................................. HOUSE NUMBER 4980~ Street ~ Road ~outhold TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4776 Z Permission is hereby granted to: ...................... ~vea..&..~a~....J~ ....... ............................. .So~.tt...o3~ .............. ~ ................ to ............. ~,~L. <~.. e~,. ~ ~,.~e~.. e~.. ~.~ ~t$~.. ~t 3~_~_ ~; .................................................. at premises located at ................. W/-~..,..~[I~"~ ................ ': ......................................................... ................................................................. ~a~tt~ol~, .......... l~+¥~ ....... : ................................................. pursuan¢ to application dated .................................. ]~ .......... ~...., ]9......~'~}and approved by the Building Inspector. INSTRUCTIONS o. 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 fo adjo n ng Prem ses or pabl c streets or areas, and giVing, a detailed descriphon 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 issuonC~e of Building Permit. d. Upon approval of this application, the Building InspectOr Will issue a Bud dg Permit to the applicant. Such permit shall be kept on the premises available for ir~pection 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 CerHficate of Occupancy shall have been granted by the Building Inspector. APPLIC,~TION IS HEREBY MADE to the Building Departmel~t for the 'issuc~ce of a' Bud ng 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 ~grees to comply with all applicable laws, ordinances, building ~ations. (Signature of applicant, or name, if acorporation) ..... Ja lzt ..lt.oad ,...S ,', u ~h G,l,d .............................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................ OinlL~ ..................................................................................................................................................... Name of owner of premises $.~aJn.. ;1.,,...e.r,l.d..Jl.8,t. ll..B,Buj~..~ol'z~8.arl .......................................................................... If applicant is a corporate, signature of duly authorized officer. 1.Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: .. ................... Street and Number ....... I~J.n .[a&d (n~...D.~JIIdlll~.). : ~..9. g~hold 2. State existing use anti occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy .................... ~.llll~,Y..,J'.llJJ..J,.cl.~r)J~.lt ...................... ... .................. Intended use and occupan .... ~...~*. 10. 11. 12. 13. Nature of work (check which applicable): New Building .................. Addition ...... x .......... Alteration ..... x ........... Repair .................. Removal .......x ......... Demolition .................. Other Work (Describe) ........................................ Estimated Cost ..........$.6gg0 ...................................... Fee (to be paid on filing this application) If dwelling, number of dwelling units ........... ~ ............... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: Front .........~.~])..I. .......... Rear ...... .~.12..r. ................ Depth .....~...~....~. ..... Height ..~.,.~.. Number of Stories ....... ~ ..................................................................................................... Dimensions of same structure with alterations or additions: Front ........... .~.~'.~..../ .............. Rear ......... .'~..~.d~...../. ...... Dimensions of entire new construction: Front ................................... Rear ............................ Depth ........................ Height ....... ~../...'. .... Number of Stories ............. /. ...................................................................................................... Dote of Purchase ...........-..-...-. ....................................... Name of Former Owner ..~az'.y...~,J[I.a~az' ......................... Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning Iow, ordinance or regulation? ....................... ,ua ................................ Name of Architect ...................... .-...-. ........................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... 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. STATE OF NEW_~R~i~'c ~-- , COUNW OF ....... .......................... ..~-~...~..~....~...~..t~....~...~ ....... bain~ duly sworn, deposes and soys that he is the applicant '" (Nome of indivJ'dual signing opl~i~ation) ' " ~ above named. He is the ................... .O.~ll~' .......................................................................................................................... (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 conta:ined 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 ........................ to before,~/"~me this "'; ~"~ ~'""1 , 9Z 0 ~ t , ~1 -- ~ day of .................... :~. ................ 1 Notary Publ~....~...t...~..~..~--. County' ......... . ~'"~'""~"~(Signature of applicant) ...................... MARJOf~ A. ~EG~IqT HOTARY PUBLIC, State ~1~ New York Ho. 52-3233120 Suffolk Coun~ Term Expires 14a~ch 30,~[~'~ .. i