The URL can be used to link to this page

Home My WebLink About5459-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. ~9 ...... Date ............ D.~.e. .....1 ....... , 19. ?.~. THIS CERTIFIES that the building located at . W.~. L~,hthouse. I~ ...... Street Map No..~ ......... Block No.. ~ ...... Lot No... ~-~ .... 80II,hold .... N,~.. ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... A~,~t~..¶~ 19. '7~ pursuant to which Building Permit No. ~.. dated ......... &~....l~ .... , 19.71., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..-P~te..o~e. *am~..ly .dW$tl~ ..................................... The certificate is issued to l~lat~.. I~e~k~ &.~&fe ....... Ovllel~s ...... . ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... N. 1~, ........................... i~us® ~ 2~ L~ht House Rd ~ Building Inspector ~ TOWN OF SOUTHOLD 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? 5~59 Z Permission is hereby granted to: ~..Ihnt~...&.J~n~..~...~..~.. aox, t::Lu to l~a.t~ · 4nl~..Idk~&~IL4~, · & · Ilmtl~ ..a.~.t;e~-~.el~- · ~1~ · 41B~t~lt~g.. ~¥e~.~ ................ c~f premises located at ......~J~el~.e.....W~.....~l~b~t~llJLIB~..~ .................................................. ...................................................... .tltntho;Lql .............. lt,~,..: ........................................................... pursucu~t to applicatior~ dated .............................. ~13~ .............. .~.., 19.....~ and approved by the Building Inspector. ~ee S...f.'.~ ........... ~ hcat,on No .~-- .................. ~proved 19 ........ Pemit No..~.~...~..~ ........................................ , Disapproved a/c ................................... ; ........................................................ ~'~9/~ " . ........................................................ ~'~ . ....... ~.'~ ...................... INSTRU~IONS a. This a~lication must be completely fill~ Ins~ctor. b. PIo~ plan s~owing I~afion of lot and of buildings areas, and giving a d~tail~ d~riptim of layout o~ mu~t c. ~ w~rk ~owr~ ~y t~is a~licafion may ~ d. Up~app~wl of t~is ~plication, ~ Bu~ I~tor ~ill i~u~ ~ Building P~rmit ~o ~ applicant. ~c~ p~iJ shall be k~t ~ the premis~ available for in~ti~ th~hout the pr~re~ of ~e work. e. No building ~all be ~cupied or u~d in ~ole or in pa~ for any pu~ose wh~er until shall have been granted by the Building Insp~tor. APPLICATION IS HEREBY MADE to the Building Deportment 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................... ..C.~n~.ac.to~. ..................................................................................................................... Name of owner of premises ....~..e.~.JJ,~l,:~lJ...~.Jj~lr:Lll...~..~:L~8 ....................................................................................... ;.....k~ If applicant is a corporate, signature of duty authorized officer, k~,~. .................. iF~'~'"~';,'~'"~i'~'~'~'";,i"~;~,~'~'~¥~i~;;~ ......... '7'5'- ~L~ ~. 1. Location of land on which proposed work will be done. Map No.: ........... ,T,3E ....................... Lot No ......... 31~ ........... Street and Number .... ~.O. AT~.~.....~J'q..l":~.~.II~I, Se...P,~ ............ .~..~...~..t...~..O.~..~......~ .............................................. ~Z~ .~ ~ Municipality' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... I~I,~I~L]..~L~ ......................................................................................... ~ ............. b. Intended use and occupancy ........... lJ.l~JL~...J/'~J3...a, lJJcl~t;[~l:l..&..&'i.~,~ ........................... '. ............................. ' 3. Nature of work (check which applicable): New Building .................. Addition ......~ .......Alteration ....~1~ ......... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........ .1.i.~.~).QQ...._.+ .............................. Fee ~. ....... ~.(:~ .................................... i ................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....o...~..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 structures, Jf 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 ............... .~f~ ................ Rear ...... .~f~ ................. Depth ..... 26 .............. Height Number of Stories t,9/e 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..~..t.I. c}.:Lst . 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... .~O ............................... 13. Name of Owner of premises ..:~...~.1'~! ~ ..................Address ....S~t,~qL~¢~ ..................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...A..~...~;~,]~...~..~.QT~ ........... Address ......~L~:L~;~Le.~ ...............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 according to deed, and show street names and indicate whether interior or corner lot. I I STATE OF NEW YORK, ~,~ ~ COUNTY Of .~.~;~ ............. ~'~ ................................ ~..,~1~,]..~ ........................................... being duly sw0m, dePoses ~,nd says that he is the applicant (Name of individual signing application) above named. He is the .............. -Oe~-~l,e.~,o:~ .................................................................................................................. (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 tha~ the work will be performed in the manner set forth in the application, filed therewith. Sworn to before me this ................. · ...... ........ ....... ............. NOTARY pUBLIC. State ~f ~tew Yor~ No. 52-8t258~0, Suffolk Term Expires M~rch 30*