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Home My WebLink About4842-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..J~&~r~ho~.e..~O~,~ .................................... Street Mop NaP~lll.~...~.a~'JJJ~lock No ....................... Lot No .... ,,~.~. ........... I~Flellpo~.t,.....lit~.t ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................................... ~,i~ ....... ~i/. ....... , 19.~... pursuant to which Building Permit No...~8~1~. doted ........................ ~1~'~' ....... '? ............ , 19.?.~..., 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 ........ .......... ~ute..~ne..£a~l~..~we~l~ ...................................................................................... Yhe certificate is issued to .A~,,~l~.t~ .......... O~lr~l~ .............................................................. (owner, lessee or ter~nt) of the aforesaid building. l~ouae f 20~ FOEM NO. ~ TOWN OF $OUTHOLD 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? 4842 Z Permission is hereby granted to: ..... ................. ~.~n~'~. z".J. ......................................... at premises located at ................... ].~ ....... ~ ................... IIq~.~r..~.~lt~.t~l--~l~..A .... ........................................... I~'"'i~y~l'.~re"Roml .......... (i?ee~.t ........................................ pursuant to application dated .......................... ~. ......... ~. ............ , 19,.~!~, and approved by the Building Inspector. Fee $....~.QO ........... Budding Inspector ~'~ FORM NO, I '~VN OF soUTHOLD BUll. DING DEPARTMENT TOWN CLERK'S OFFICE Examine~l i , . Approved 19 ........ Permit No ............................. Disapproved a/c ..........--..............,. ............. ...... ............................. ( B [l'ii(~'i'~'g'~ ...................... APPLICATION FOR BUILDING PERMII' Cb Date ........................... .~T1,1].~'. ......... ~ .......... , 19.....~.0...U'( INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted irt duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildlnfls on premises, relationship to adjoining premises or public street~ or areas, and giving o detailed description of layout of property must be drawn orr the diagram which is port of this application. c. The work covered by this application may nct be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the epplicont. Such permit;,,,~ shall be kept on the premises available for inspection throughout the progress of the ~ork. e. No building shall be occupied or used in whole or in part fcr 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 pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~nd other applicable Lows, 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. .......... ................... (Signature cf applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generaJ contractor, electrician, plumber or builder. ................................................. .¢'1;o ...................................................................................................................... Name of owner of premises .A..~.~.~.....];JIJ.G.1L~.~J~'I ~1~. ........................................................................................................... If applicant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done Map No.: ..P..e..?....~...a.~....S..t...s..t,.~.e..s..... Lot No.: ...... Street and Number ................. ~.0~.~. ....... ~&~r~b.~l~.g...~(1. ............ G~eel~l~l~~ ....... . ........................................... ~unicipa~ity 2. State existing use and occupancy of prernises and intended use and occupancy of proposed construction: o. Existing use and occupancy ...... (1.1i[.e31:Ll:t~ .......................................................................................................... b. Intended use and occu[;an:.~ . ........ same...w~Lth...a~,,..a6d.t.¢..%.ola ..................................................................... 3. Nature of work (check which applicable): New Building ~ ................. Addition ....... Z3CZ... Alteration .3EII~ ......... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................... .6..0...0.....+ .......................... Fee ...~.~..0...0. ............................................................................. (to be paid on filing this application) .5. If dwelHng, number of dwelling units ....... .o.b.e. .............. 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 st'ructures, 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 ....... .~.,~1, ..................... Rear ........ ~.,.)+ ............. Depth ..... .0. ................ Height .................... Number of Stories ............................ se ................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date uf Purchase ........................................................ Nome of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ............ ~.~]rl~.El; ........................................................................ 12. Does propos,ed construction violate any zoning law, ordinance br regulation? ................... 33.0. ....... i ........................... ]3. Name of Owner of premises ..~e.~.e...~T~..~..l~.~,],~'.....Address ........ .~z'.ee33])~3:~.t, ............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...... ~,¢,~.~3.t~'...~,~.;[.e.(~g. ........... Address .......~Z'.~f~]30~.~. ............... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or descripti.~ig;n according to deed, and show street names and indicate whether interior or corner lot. ~.~/:~ y COUNTY .OF .... .q1~.£~]~ .......... ................................ JLl:t~;~uz'...]~L~.t;~..z~ .............................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................ ~g~.~Zta,ef~,~, .............................. '. ......................... '~ ....................................................... (Contractor, agent, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and thaz the work will be performed in the manner set fo~h in the application filed ther~lth. Swam to before me this ELIZARETH ANN ~EVILLE COUn~~ NOTARY PUBLIC, State of New York No. 52-8125850, SuffolkCo Term Expires March 30, I