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Home My WebLink About5142-zFOltM I~'0. 4 TOWN OF SOUTHOT.B BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~..~i. 5.8. ..... Date .......... ~OY. t6...., 19. THIS CERTIFIES that the building located at .. Oak/~; .... Street Map No..XXXXX . Block No. .XX~.. Lot No. XXX . l~at.titllCk, .~,X, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 14~X'~ % 19 .7.1 pursuant to which Building Permit No. .51..i+..2~. dated ........... l~a:~h 1., 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 isshed is .. P~ivate olde..$amt, ly. dw~t t in[;. .................................. THe certificate is issued to . %;~t~,A;:mb~st~ ....... 0wnel' ............... (owner, lessee or tenant) of ,the aforesaid building. Suffolk County Department of Health Approval I/,P,,~ .................. ttouse t,,O0 Oak St Building Insplctor TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK-AUTHORIZED) ~ N? 5142 Z Permission is hereby granted to: ~ ............ .~..~.~Je.~ ....................................... 'J'O at premises located at ........... .~J~l~,..~..~ .................................................................................................. .............................................................. ~,~.s.~ ....... ~.:.~.:. ........................................................... pursua~t to application dated ........................ ..~.?...~....~. .......... ?. ............ , 19.~......, and approved by the Building Inspector. ~:~ ~...~,111} ........... IUILDIN~ DEFAIK'rMINT TOWN CLIRK'S oFIqCI SOUTNOLD, N. Y. A~rovod ....................................... ~, 19 ........ Permit No ............................ ~,d a/a ....... ..~.....~....~...~ APPLICATION FOR BUILDING PIRMI~ c~, ~eh ~ ~9..~.? ...... IN~M~I~S a. ~11 ~llc~l~ m~ ~ c~plm~ flll~ In ~ ~ewrl~r or In Ink end lubmlt~ I~. b. ~ p~n ~1~ ~l~ ~ I~ a~ ~ ~lldi~ ~ p~mlm, mlatl~lo ~ ~l~fll~ o~ ~g~ a ~fl~ ~rl~l~ ~ I~ ~ p~ must ~ d~ ~ ~dl~m_, c. ~ cM~ ~ ~ls ~l~ti~ ~ ~t h ~ ~m I~ of Bulldl~ ~lt. d. U~ ~1 of ~ls ~li~i~, ~ Bulldl~ I~c~r will I~ a Bul~l~ h~lt ~ h ~l~t. ~ ~it ~11 ~ ~t m h p~im ~ll~le ~r I~1~ ~gh~ the p~ of h ~. ~(.. ~ ~lldl~ ~1~ ~ ~cu~l~ or ~ In ~le or in pa~ ~r any pu~ ~a~r u~ o: ~ mn gmn~ ~ the uuildl~ :~r. RB APPLI_CATION IS HEREBY MADE to the Bu Id ng Delmrtment for. the Issuance of a Building Permit pumuant to the U,,udl~-~.~,na~..of ~, T? .o.,..b~o.~, Sueo,k C~n~, ,.w Y.o,k, ~, ~.he, ~,~.b,. ~0~ ~d,~,.. ~ m ,.~m, .mr me c.~ructl.On o.T..ou!t, aing8/, a~..Itl.om or a .teratlon8, or Tar removal or demolition, m herein dsecrlbed. app::cam agrees To comply wis ale ppp::came laws, om nonces, building code, housing code, end regulatlonl, (Address of applicant) State whether applicant Is owner, Isesee, agent, architect, engineer, general contractor, electrician, plumber of builder. .................................. ~Gt.~ ........................................................ ........................................................................................... · W.s~ iArmbrust' Name of owner o( premlmse ............................................................................................................................................... ~ If appllcont Is a coflx)rQte, signature of duly authorized officer, ~ (f~e and title 'of corporate officer) ~ I, Location of land on Which propased wod~ will be done, Map No,: ....... ~ ............................ Lot No,: ..... ,,,z~,,, ............. s~, and ,umbr .......... ~.~.~. ...... ~.,..~....S..~,.,..t ....h..~.~.~.~ ~.:.!..'. ........ i ....... i .................... Municipality 2. State existing use and occupancy of premises and Intended use and _-;_;upancy of propmed comtructlon: a. Existing de and mcupancy ..d...v..e...l, 1Lnf: ~ same w:Lth an additiom b, Intended de and occupan~ ................................................................................................ ~. Nature of work (check which applicable): New Building ~ ................. Addition ....~ ........ Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............... ~..t.OO.Q...~. ........................... Fee ...~a~0 .............................................................................. (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ......... .q.~.~ ........... ~Number of dwelling units on each floor ............................ If garage, number of c~rs ....................................................................... ~ ..................................................................... 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 ..... 12..,~ ............. , ..... Rear ........ .1.~.-..0. .......... Depth ..... .1..~.. .............. Height .................... Number of Stories ...........~ ..................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 ]. Zone or use district in which premises are situated ....... ~A~..4~lii:J;. ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... M ................................................ 13. Name of Owner of premises . .~.?..~......~....~....b....Z~:..~. ......... Address 0B~[ St ~at't Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~aJae .................................................... Address ............................................ Phone No ..................... 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 indicm'e whether interior or comer lot. STATE OF NEW, YQIJK. ! ce COUNTY Of .,.~....l~....z~.e.~ ............. j',.,.-,. .................. · ~.~,,...~'.,..~.,,~,~'11~'.~i.~.1~ ..................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ........................ ~W'AI, IIZ'. ........................................................... .j~ .................................... i .................. (Contractor, agent, coq>orate 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 that the work will be performed in the manner set forth.in the application filed therewith. Swam to before me this Notary [UZABETH ANN NEVILLE NOTARY PUBLK:, State of New York No. 52-8]25850, Suffolk Cou~y. Term Expires March 30,