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Home My WebLink About4825-zFq~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. CERTIFICATE OF' OCCUPANCY THIS CERTIFIES that the building located at .8~..~.~r~.A11~ ........................................ Street Map No. ~,~l:l~r~lo~ No..a~[ ............... Lot No. ~:~ ...... ~ll~t,t,~,~&lL...~l~'~ ................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................... · 1111~ .......... ~ ...... , 19..~O. pursuant to which Building Permit No.....~,~ dated ..................... ~1'~ ......... ~.~. .......... , 19...~O, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ....... l~at~ ....owe .. famLl~...d~e~Ltal ....................................................................................... The certificate is issued to of the aforesaid building. aerie f ~1~o [owner, lessee or temmt) IOTIt ~o eeem~t kXtohen faeL1Ltte~ may be iastalled FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4825 Z Permission Is hereby granted to: ............ .............. ~ ........ .l~A ............................... to .......... lmLl~..a~.a~_t J~,~.~.~x~.~..dam3.1,~ .................................................... at premises located at ................ I~.~1 ..~"~,.J~.~'~ ..................................... ; ......................................... .............................................................. g, ZLt.t ~.u~k ...... 31,.~ ........................................................... pursuanrc to application dated ................................. ,T.~.::~. ....... ~.~....., 19..~., and approved by the Building Inspector. APP.LIGATION FOR BUILDING PERMIT Da,- ;~ne 2~ 19. ?0 INSTRUCTIONS a. This application must be completely filled 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 premises or public streets or areas, and giving a detailed description of layout at property must be drown on the diagram which Is 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pumuont to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lawn, 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. D~ Au.1. Contractin~ Ce (Signature cf applicant, or name, If a carparatlon) 1.~,. Adtronda~k Dr Sel4en (Address of Opl~llc. ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................................... ~ontr&c,to~. .................................................................................................................. Name of owner of premises ..,Ji~,~q~l,~..~i,l~.t:n~ .......................................................................................................... If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on Which proposed work will be done. Map No.: n~.~,.~gP~,P,: ~: r ~. Lot NO.: street and Number .................... ............... ............................................................. 2. Stote existing use and occupancy of premises and Intended use and occupancy of preposed canstmatlon: a. Existing use and occupancy ........... d,lle].:L:L~/~ .................................................................................................... b, Intended use and occupancy .............. SA~I~,.I~+,~,,A~,&dz:],~,t~]~ .............................................. ,, ............... 3. Nature of wo~k (check whicl~ applicable): New Building .................. Addition ........ ~Z.,.. Alteration ....... ~ ..... Repair .................. Removal ..................Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ~i~)t~) .......................................... Fee ~.~(~1 .................................... (to be paid on fi!lng this application) §. 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 ...~1~ .......................................................... 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 t~nA 9. Size of lot: Front ...... ~0 ................. Rear ............ ~.0 ................... Depth ........ v~-q~'6...:t'. ........... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated .............. ~,~..~.:[~.~ .................................................................... 12; ' Does proposed Construction<violate any zoning law, ordinance or regulation? ......... ~ .............................................. 13. Name of Owner of p~rre~.s,...~lLl~..;l,,~:l~ ............... Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .O:l~..~l~a~,~Z~,~.~:Ll~.[ .......... Address ........ ~eleZl. ..................... Phone No ..................... PLOT DIAGRAM Locate clearly end distinctly oil 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 NE~ Y.O,~K I e e ~ o J~ ~, C COUNTY OF ....1~....~..~ ................ ..................................... ~'~1~1~.]11~.~'1 ~ ........................ being duly sworn, deposes and says that he is the applicant (Name of individual signing apl~lication) above named. He is the. ........................ . 04)~,t, Da, et,~'...a..~ela~;I ........................................................................... . (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 tk, at the work will be performed in the manner set forth in the application filed ~jherewith. Swam to before me this ' ............... day of .................. ................. , / NOTARY PUBLIC, State of New York rio. 52-3233120 Suffolk County T~rm Expires M~rch 30,