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Home My WebLink About4856-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No.Z~I~22.1 ....... Date ............ A])rll.. · · 27- · -., 19.71 THIS CERTIFIES that the building located at .. ']1/8' .Hi6~.'l;e. Held. (CRF~)~treet Map No. -X- ......... Block No..XX ....... Lot No. lal~....Cutehogue .... I{,2[, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... April-..6 ..... , 19.70 pursuant to which Building Permit No. -~8-~. dated ........... Apr. tl .... 13, 19.70, was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P~iva. te. erie. la. Sly. dwell, i~g ..... (.app~eved..by. ]~ .Appeall.) .... The certificate is issued to . Jelm. I~.t~iek ....... Owner ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approvai House ~ 1910~ Building Inspector ' FORM NO. ~ : TOWN OF SOUTHOLD ~ BUILDING DEPARTMEN? TOWN CLERK'S OFFIGE' SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? /]856 Z Dote .................... ~.1~ ....... .~,~ .............. , 19....~0 Permission is hereby granted to: ............... #eb~..~.~ .................. .................. ................... ~,,~lle..,B~,~l ................ .................. ...................... ~.~a$~ .................................... to .......... /~.l~..e~ ..~i.t~n.. ,,...~ .e/lll-...~.ql ~.~.e.~.., g.~r~.. ~ .. ~..~ .. ~.... ............................... ~o~ .. oE.. Al~t~e.;l.ae ..~.....$t~ ..~ e)~/t).I .......................................................... at premises located at ................ ~/~'""~I~L~L'~' '~ ........... .......................................................... ................................................................... C.~.¢ho~u~ ........... ]~.:~. .................................................. pursuan¢ to application dated ............................... A~'~]..-...~-...."", 19...~.~., and approved by the I~uilding Inspector. ~ ~O~:~t ;~t;~ ~ ~]~VOC~ ~ ~'~ O~ &})~0e~.]L~l Fee $...~.D.t~ ........... lOBlf NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam:ned ..~ ..................... , 19 ........ ~te ............................................................ , I NSTRU~IONS a. 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 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 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 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 agrees to comply with all applicable laws, ordinances~.~build~g cad__regulations. ........ ;¥ 'ji j' ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ......................... .~....._t.:~r_.~._~.._. .................................................................... 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.: ............ ~ ................. Lot No.: ...... Street and Number ......... ,~/~.....]~[0.~L].e..,~::~a, cl.....(.(~,~.). ....... D.~t~c:b~g~e ........................ /~'/- /~ / ~' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~.~e'13,~n.g. ........... .............................................................................................. b. Intended use and occupancy ................ [~,RI.~....~.~.t-~'L.~rJ,..a~;L~;LQzl. .......................... Repair .................. ~Removal .................. Demolition .................. Other Work (C~escr be) 4. Estimated Cost ........... I' ~......~... ...........i".~ .......... ;Fee ...i..~.e..0..~. .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ QlqE~;i.~ ......... Number of dwelling units on each floor ............................ If garage, number of oars ............................................................................................................................................. 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 a.lterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... .1..~ ..................... Rear ....... 1..6. ................. Depth ...... .~..0.. ............. Height .................... Number of Stories ......... :.x~'l~ ................................................................................. 9. Size of lot: Front .......... J..O..0.. .......... Rear 1 O0 Depth 1 70 10. Date of Purchase ........... .1.:c)..~.~ ................................... Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated .................~,.....~L,~.S.(;. ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~'e.~ ............................................... 13. Name of Owner of premises ..~.O....b~.......~....~..~..~..e..~.. ........ Address ....... C.~l.~,]~e§l~e ............... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........ .s..a.~.e. ................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description a, :ording to deed, and show street names and indicate whether interior, r corner lot. STATE OF NEW ~ , t,~ COUNTY OF ...... .o..u:..z...z.'..o...J~... ........ .), ~.~. ......................................... ~-ob_.'rt..~[a,t~.:;L~l~. .......................... being duly sworn, deposes and soys that he is the opplicont (Name of individual signing application) obove named. He is tee ............................. ~M~e~. ............................................................................................................... (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 thaz the work will be performed in the manner set forth Jn the application filed therewith. Swam to before me this ................... ~..,4~,. , .., /~)'- 'l~day of .......... ~ ~Zt.:L], ..................... , 19.~.0... .....~C~ ~..../../..~.'""~" .'~e~ ' // ..... ELIZABETH A~IN NEVILLE NOTARy PUBLIC, State o~ New York No. 52-8~2~850, Suffolk lmmtu~ Term Expires March 30, C unty