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Home My WebLink About5594-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate Of Occupancy THIS CERTIFIES that the building located at I~ .C~'eseex~t .~,vl ........ Street Map No..~ ......... Block No. l ....... Lot No. :g~... F.~$h.~.r.~...I.~.],..a~....l~..,.~.:. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~let.. 2~[ .... , 19.?]. pursuant to which Building pemit No..~. dated ......... .0.c.t....2.9. ..... , 19. ?.~., was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. l~r$¥ate .o~e..f. am~.l.y · ~lw~ll.~g ...................................... The certificate is issued to . .J,..L®stel,. ~'a,l~sen~, .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~. ~. ............................ Building Inspeeto 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? 5594 Z Permission is hereby granted to: at premises located at ...........~./,.~..~.~..e...~.~...e~...~....~..~..~. ............................................................................ .................................................. ~.~lmZ&. ~z~l.e~ t...li.~.,. ............................................................. pursuar~ to application dated ............................. ~ ....... ~.~' ............ , 19.~.~J..., and approved by the Building Inspector. /'4)BM NO. I TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥o Approved '~ 19..:..~... Permit' No.....~....~.......~.....~.......~. Disappraved a/c ..........~...~ *~ APPLICATION FOR BUILDING PERMIT Date ...... O.C:*~.~.. 2,2 ..~ ........................... , 1921 ........ INSTRUCTIONS o. -This application must,be completely filled in by typewriter-or in ink und 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 thio application. c, The work covered by this application may not be commenced before issuance of Butldlr~ Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ~all be kept on the premises available for inspection throughout the progress of the work. e. No building sF~:ll be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit punsuont to the Building Zone Ordinance of the Town of Southold Suffolk County, New York, ond 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, ord nonces, bu Iding code, housing code, and regulations. (Signature of applicant, or name, If a corl~oratlon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................. .gen r. ak..cont .a ;or. ................................................................................................... Name of owner of premises ........ ~,..~e~e,,,e~..~..~l~'~tO~GIl,..~l'~..~ ....................................................................................... t.~te, signature of duly authorized officer. ..-~....=.~ ................ A,..~T=l~..13.a,c~..m..L)J:e~L~l~nt, ~nct 'L~euurer (Name and title 'of corporate officer) I. Location of land on which proposed work will be done. Map No.:. ....................................... Lot No.: ........................ Street and Number .~..~l.g~X1.~...&~.~q~.lA# ...................... ~.~L.~?/].~.~.ql...~.~.~...~.~..e....~....e~......~..o..r.~ ........... : .................... Municipality 2. Store existing use and occupancy of premises and intended use and occupancy of prapesed construction: a. Existing use and occupancy .... ..~.~.B...J:..~...q~...C:...e. .................................. - b. Intended use and occupan? . ...... ~e~.c~tl~ffi. e ..................................................................... ~ .............................. 3. Nature of work (check which applicable): New Building .................. Addition ....~ ........... Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ....~,~.(~,.¢~0.0.,~).Q ................................ Fee .......... ~5.~0.0 .................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........................... ~Number of dwe{ling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancyi specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..],~I.Q?..0..". ............ Rear ...,1,0D...~). ................ Depth .~.07..0.". ....... Height ~,~...¢~ .............. Number of Stories ........ ~.~ ........................... ~ ...... : ................................................................. Dimensions of same structure with alterations or additions: Front ..~,D.0...0 ...................... Rear .10.Q.".D..". ............. Depth ....~.~..".Q..". ................ Height ....~..3..e..~..". ............. Number Of Stories ...~lt ........................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth .~.57..0.". ........... Height .................... Number of Stories ...............~. ..................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. 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 ~aLm...~.i~..&OJ~. .......... Address ~'~,ll]~Ul~a..I~l~,~H~..phone No. 'Z.~.~.-..7.23.~. Name of Architect ............ D.~¢I ................................ Address ............................................ Phone No ..................... Name of Contractor A,,..~Ti3~ll..Gac~..G~n,~..Con. Address ~J,~era..~elm~e..~,.~P. hone No. 288-.7.2,~1. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. ~ee Att&che~ STATE OF NEW YORK, COUNTY OF ............................... ,}' ~'~' ................. ......................................................... oemg duly sworn, deposes and says that he is the applicant (Name of individual ' ~ ' ' s gn ng apphcahon) above named. He is the Contractor · - (Contractor, agent, corporate officer, etc.) of said owner or owriers, and is duly authorized to perform -~P~hav&performed the said work and to make a~d 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 in thq~application filed therewith. · Swam to bef~e me this ...... .... .......................................... Notary Public, ~11~. ~.~'~...~ Cou~' (,,/' (Signature of applicant) Notify Public, State of New York . No. 52-9509185 Qualitled in Suffolk County ~*e*m E,~k'e~ Marc~ 30, 19.-.~. ~ENTf~frl. ?ER 17E~70~ /=1 C ENT~I~L /-~VEi~rU~> ?ER I?Eb'-JD~'