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Home My WebLink About4871-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Occupnncy Sotmd ~v® THIS CERTIFIES that the building located at .I~..R~d..~..~ ~1..l~. ....... Street Map No.. ~ ....... Block No... ~ ..... Lot No .... ~... ~tt~tuek. ~.Y, ...... conforms substantially to the Application for B~lding Permit heretofore f~ in this office dated ......... July -.2~- .-, 19.70 p~su~t to which B~ld~g Pe~it No.. dated ............ j~y .... 2~ 19 70', was issued, ~d conforms to ~1 of the req~ ments of ~e applicable provisions of the law. The occup~cy for w~ch ~is certificate is issued is ...~v~te. ~eoseo~..(.stooge). b~lding .......................... The ce~fficate is issued to . P....E~trsJ~.a~ ...... ~n~ ........................... (owner, lessee or ten,t) of the ~ores~d buil~ng. Sm~olk Co~ty Department of Health Approv& ..... N~, .......................... .......... ~i~;ng I~pecto; '~' ........ FOF,.M NO. ~ TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4871 Z Permission is hereby granted to: ................ I~,,..~,,:l,.'J~Jeml. ................................ at premises located at ............. Jl~tr.~ll~..tjll ....... Jl~"811~lJl~.~ ................................................. ................................................... il~t,.t$~ln,mlE ......... IICi., .................................................................... pursu~ntc to application dated ................................ e~h~l~ ....... ~ ...... , 19....~ and approved by the Building Inspector. ' 7 ~) TOWN OF SOUTHoLD BUILDING. DEPARTMENT ' TOWN CLERK'S OFFICE xam .ed.. ................... N. Z./. ............. . _F/ ........ ' ..... .......... Di~pp~ a/c ................................................. ......................................................... ........... ....... ................ APPLICATION FOR BUILDING PERMIT Date .................. ~..1~.~ .......... .~...~. ......... , 19 ........... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plo. t .plan sho. win~ l .,~,,ati~n ~f. !ot ~ ~bU~!~ings ~n Premises,,.relgtionship to adjoining rJJ~Jmj~$ or J~lblJG streets or~ a r~i~n~,~ng.,,~ ~ de~dpfl0~n Or [~rp!.;p(o~' .~ mu~t bedfawn cn tl~e d lagr6m W~ch i~ part of, thte.app laotian? c.:~' ~h6'wdrk ¢~e'r~ by 'this aPplicafi0h 'ma~ n~t be 'co,men, ed before issuance of Building P, ermlt, d. Upon approval of this application, the Building Inspector will issue a Building Perm t 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 ssuance of a Building Permit purauant to the Building Zone Ordinance of the Town of Southold, Sulfa k County, New York, and other applicable Lawl, Ordinances or. Regulations, for the construction of buildings, additions or a .terations or for removo or demolition, as herein described, q', The applicant agrees to comply with all appl cable laws, ordmances, bul ding code, housing code, and regulations. P. Na~t~e~ean ' (Signature cf applicant, or name, If a corporation) .B..g.z..8...8.8 Pvt; Road i~ Nattituek '- (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~...*....W~....~.?,..z'...e.~ea.n If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) ~ ~ ~.~ 1. Location of land on Wh ch propo~ed work will be done Map No .... ~ . · . ,... Lot No ....... ...Z~.......:...::.:.~~'~'~ 2. State existing use apd occupancy of Premises and Intended use and occupancy of propo~ed construction: i~ o Existing use and occupancy ..... I:I.wILI.~I t.~ .~c.4LCP-~eI~,.R. i3~...~3,R1,G~. . ..... eccu an ~,' . .~.~me v t.b an .~dd~t~oz~ on aecesso b].cl~ b. Intended use and p c ........... ~. .......................................................... ...~'.. .................................... 3. Nature of work (check which applicable): New Building ~ ................. Addition .....~ ..... Alteration .................. Repair .................. RemOVal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ......... ~....,.~ ................................... Fee ....~.(~l ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~g~. ............ ~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 ............. ].Ex .................. Rear ........ .1Ex .............. Depth ..... 2~. ............. Height ....~ ............... Number of Stories .............. QZ~I ................................................................................................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ N~rne of Former Owner .~.-...~.o.~..v..e..~.t..9.P. .......................... ! 1. 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 premises ..~.~..~l~,~,~.~&~ ...... Address .......,v~.~,:l;~l~gJr. ............... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....... ~1~ ................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propc~d, and Ind cate a I set-back dimensions from property lines. Give street and block number orLd, escri~ti.oq.,a~cj~lng to deed, and show street names and Indicate whether interior or comer lot. L, ' - · STATE OF NEW YDRK- ! · · . . (Name of individual Ilgnl~ ~llc~I~) above named. He is the ....................... ~ ............................................................. : ........................................................ (~ntm~r, ~t, co~ officer, ~.) of said ~ner ~r ~ne~ and Is duly a~hor!zed to pe~orm or h~e ~do~ the ~id work a~ ~ ~e ~d file ~ls ~p,co?on~..t~at a~ state~en~ conmln~ In ~hll apP~lcatl~ am tree ~ ~e ~t of his ~l~ge a~ ~lief; and ?m me ~o~ wm ~ ~e~o~ m me manner gt tach In the a~licatl~ fll~ ~1~. ~LIZABETH ANN ~VILLE ~ /' ~ARY PUBLIC, State of N~w y~ No. 52-8125850, Suffolk Cou~ ~rm ~pires March 30. ]~