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Home My WebLink About5128-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~.3.1.6 ...... Date .............. .i.~.... 9 ......., 19..7! THIS CERTIFIES that the building located at .Id./~...B0.e~[~. P~;..R.~.~ ....... Street Map No...~ ....... Block No .... ~ .... Lot No...~ .... ~S~..~r~s. ~. conforms substantially to the Application for B~ld~g Permit heretofore filed in this office dated ........... ~ .... ~?, 19 F.1.. p~su~t to which B~ld~g Permit No. ~2~.. dated ............. 4~ .... 27., 19.7~ .., was issued, and conforms to all of the requ~ ments of the applicable provisions of the law. The occup~cy for which th~ ce~ificate ~ issued is . .~.! .~ .~[. (~P~!) ............................................. The ce~ificate is issued to . G.r~e..g~.~ ..... ~ ............................ (owner, lessee or ten~t) of the Mores~d building. Suffolk Co~ty Department of Health Approval . ~eR~ .............................. Buil~g Inspectort FO~ NO. ~ TOWN OF $OUTHOLD 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) l~l? 51~8 Z Permission is hereby granted to: to .ll~e..~LteratdtolaL~nd..a~d~t. ie~..e~..eziat.~l~..~~ ............................... at premises located at .......... ~l~t~i'...~'~ll.t,..J~hl~ .......................................................................... ................................................... ltaat..aar~ea ...... ~ ................................................................. pursuan¢ to application dated ............................. ~tlll ......... ~¢~. ........ , 19.~.., and approved by the Building Inspector. Fee $..~,.~. ............ 1~O]~,3~ Naa I T~WN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ^pproved ........................................ ~9 ........ Permit No ............................ D~ppr~ed o/c .............................................................................................. ................................. ........... ^pphcot,on No ..~..,/....~...?....~.... APPLICATION FOR BUILDING PERMIT · Tan 27 ]~ 71 Date ............................................................ , ........ INSTRUCTIONS a. This application must be completely filled in by typewriter or ~n ink and submitted irt duplicate to Ihe Bulldu Inspector. b. Plot plan shawing location of lot and of buildings on premises, relottonsh~p to adloining premises or public streets areas, and giving a detailed description of layout of property must be drawn cn the diagram which is part of th,s applicat~o c. The work covered by th~s apphcat,on may not be commenced b~fore ~ssuance of Building Pernut. d Upon approval of this application, the Budding Inspector will issue o Building Permit to the applicant Such pern shall be kept on the premises available for inspection throughout the progress of the work e No budding shall be occupied or used in whole or in part far any purpose whatever untd a Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budd,ng Department for the ~ssuonce of o Building Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New Ye,k, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as hereto describe The applicant agrees to comply w~th all applicable laws, ordinances, build,ng code, hous,ng code, and regulations Richter Home Improwement Co (Signature cf opphcant, or name, ~f a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buddc ............................................. .~ on~r,~t on. ................................................................................................ Nome of owner of premises ......... .~...~..~...q~....~..8...~...Q.~..d... ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) i Location of land on which proposed work wdl be done Map No .~..$.¢~R~.¢1,~0~ ........... Lot No .:~F~ ........ Street and Number ........ ..~...o..~..~.~.....~..O...~..~..~.....~...o..~..~.. ........ ..~.R.$.~..}!~..$DJI.....~]...~ ................................................ /~,.~ .6'~ ~.~ Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ..... .~.~.e.].~.~.~.§. ..................................................................................................... b. Intended use and occupant, . ......... s...a~....e...w.../..t~...~l.tlD~..~...A..1.ter~£o~ ....................................... 3 Nature of woik (check which applicable): New Building .................. Add,tion ....Z~.. ............ Alteration .....Z~... ..... Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ............. ;~.y,~(~O....-._~ ........................... Fee .... .~[,.0.Q ...................................................................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelhng umts ............................ Number of dwelling umts on each floor .......................... If garage, number of cars ........................................................................................................................................... 6. If business, commercial or mixed ~ccupancy, 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 addihons: Front .................................... Rear ......................... Depth ................................ Height ............................ Number of Storms .............................. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ..................... Height .................... Number of Stories ...................................................................................................... 9. Size of lot: Front ....~...¢.?...~..~...[.?. ........ P, ear ................................... Depth ............................ I0. Date of Purchase ........................................................ Name of Former Owner .................................................... 11. Zone or use district in which premises are situated ........ .~i,.?...l~l,i$.ll ...................................................................... 12 Does proposed construct;on violate any zoning law, ordinance or regulation? ............ ,"19. ..................................... 13 Name of Owner of premises G~..~a.~:rtcl~ ............... Address .....$.,.~%:~i,q~, ................... Phone No .................. Name of Architect ...................................................... Address ........................................... Phone No .................. Nome of Contractor ~ic.h.l~er..-F~me ..Trap.Irt ........ Address ....... Gr. eet~pc~. ............. Phone No ................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back d~mensicns fror property lines Give street and block number or description according to deed, and show street names and ind~cal whether interior or ccrner Jot. alteration & addition on dormer &. porches etc STATE OF NEW YORK, 1S $ ,~O ct.. ~ C;~ COUNTY OF ..St~.t~]Jc ............ J' ' ' ....................................... .~?..~.~....t~.,....~..:T[-..9..h..~.e.~. ................... being duly sworn, deposes and says that he is the apphcan (Name of indwidual signing application) above n~med. He is the ................................. g.f~'.~fL~.f}~ ............................................................................................ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and fil this applicahon; that all statements contained in this application are true to the best of his knowledge and belief; an, that the work will be performed ~n the manner set forth ~n the application filed therewith. before this ~2. day of ~n , 19 21 ~ E~ZABETH ANN NEVILLE ~ ~ ~ - - ~OTARY PUBLI~, State of Na~ Yor~ ~o 52-8125850, Suffolk Co~ Term ~ptres March 30, 1