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Home My WebLink About4846-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ....... ~0~..~.e..ItG..~,,..(~l.&.~k...~0, ............... Street Map No...~ ............... Block No ......... ;X~ ......... Lot No .......~ .......~O.~tCho~L~t...J~,r.,.~(., ................ conforms substantially to the Application for Building Permit heretofore filed in this office doted ..................................... ~T.Zl.~: ....... J~ .......... 19!1;¢O.. pursuant to which Building Permit No.....l+.J~.l+.~. dated .............................. L[*~[~. ......... C)....., 19.....~.0 was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ...... P. r.i.w, .t~.. ac ca $.so~:~c...btaLld.ing...(.t aol.. ator. age) ......................................................... The certificate is issued to .......~,~.&~..~fi~llO ................. O~/~ieZt. ...................................................... (owner, Jessee or tenont) of the aforesaid building. 35 Clark Building lnSl~ctor FORM NO. ~ TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOI..D, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4846 Z Permission is hereby granted to: ............. J~tc~.~.~L.~:~..~4. ........................ to ........... .~;}.~L~...t, QD3...$~...~., nrlc] ~-~,~.O~...~.O..~.~ .................................... at premises located at ............. ~1.. I~t .&..~s~L~,~L~.e...~L.~I~j .............................................. ............................................................. ~eu~m~-& ....... l/~i~ .............................................................. pursuant to application dated .............................. I~1~ ........~ .......... , 19...~G, and approved by the Building Inspector. Fee $...~..~ ........... TOWN OF SOUTHOLD · BUILDING DEPARTMEHT TOWN CLERK'S OFFICE ..~. SOUTHOLD, No ¥o Examined. ..;.~.. ............ , 19.?...~... Approved ~ .......... : .......... :.'. ........... , 19...~..... Permit No......~....O~.......~....~...., Application No ..... ..,~. ,t~...~'...~.. ........ Disapproved a/~ ............................................................. APPLICATION FOR BUILDING PERMIT Date .............. ~T.u, 1 y. ............ ~., .................... , 19.2.0......k~. INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Buildin~e~J 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 of property must be drawn on the diagram which is part of this 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 sh~ll 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 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 demoliti°n, 'os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature cf applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................................. agorot ...................................................................................................................................... Name of owner of premises ....... ~'aca=k..Macjnc~ .................................................................................................................. If applicant is a corporate, signature of duly authorized officer. aa (Name and title 'of corporate officer) location of land on which proposed work wil~ be done. Mop No.: .......... ~ ....................... 10t No.: ...~ ............. Street and Number ..J~/...g.~3~D,~J~'...O.,~..l~.],i~l:~J~...,~.~,,,c],...~.....~.:J....C]..~ ..R.g..a...~.~ .S...o..u....t~....o..1...d. L x'/- .... ................. State existing use o?d occupancy of Premises and intended use and occupancy o7 proposed constructiOn: Existing use and occupancy ........ 1..f, aJlli[~..~c.e.s.~l;1.et~Lc~ ............. Intended use and occupancy ......=~me...~;kl~k..1;.o. Q1..~f~...£a.q.~..e..s..~.o...=.y...~..d.g:.}. .............................. 3. Nature of work (check which applicable): New Building ~.~,~ ........... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..~,oQ1...~'hecl ................ 4. Estimated Cost ...$1~O...0D. ........................................ Fee ~5. O0 (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units .......... 1 ............... 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 .......... 6~ ............. Rear .................................... Depth ......... .?.3.*. ................ 10. Date of Purchase ........................................................ Nome of Former Owner ...~s,...~.e~e~. ....................... 11. Zone or use district in which premises are situated 12. Does proposed con, struct~on violate any zoning law, ordinance or regulation? ....... ~cx .......................... 13. Name of Owner of premises .-~a~lc..~c~nD ........... Address~gS..-~-~cD.c~.~.l.~l...~v.~.... Phone No ..................... ~oo]c.1.~, ~. ¥. Name of Architect ...................................................... Adc~ress ............................................ Phone No ..................... Name of Contractor .................................................... A~dress ............................................ Phone No ..................... PLOT DIAGRAM locate clearly and distinctly all buildings, whether ex sting or proposed, ami indicate all ~et-back dimensions from property, lines. Give street and block number or description according to deed, and show street names omi indica~'e whether interior or corner lot. STATE OF NEW YORK, ! S~. COUNTY OF .... .................... ~ .......... ~, ......... ,~.i.~-.....~..' .......................... being duly sworn, deposes and says t~ he is the applicant (Name of indlvldu~'slg~inga~ cat on)~ above named. He is the ............................... a~ ....... ; .... ~ ~ ................................ (Contractor, ag~t, co~rate officer, ~c.) of said ~ner or owners, and Is duly authorized to perform or have perfo~ed the said work and to ~ke ~d file this application; that all statements contained In this application am tree ~ the ~st of his knowl~ge and ~lief; and that the work will be performed in the manner ~t fo~h in the appllcatl~ fll~ ~e~lth. Swam to ~fore me thll. : ~ ~ ) :, ........... ~ ..... day of ......... ~. ........................ , 19...2~.., ~o a y rua~c, . ........................................................... C~n~ ~u~zo~ (Slgna~re of applicant)