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Home My WebLink About5158-zFO]tM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z.~39.6. ...... Date ............ Sgp.~..' .~r...., 19. THIS CERTIFIES that the building located at .E ~..G.:L%l.eJ;t;e. p.~. ...... Street Map No'.er. lo.n. .Pr.... Block No .......... Lot No..~.? ..... E..a.s.t. F~..ri.o.~.t ~:.Yo ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... .l~arch· · .1.1. , 19 74. pursuant to which Building Permit No .... dated .......... ..}~..e.h... 1.1. , 19 .7.1., 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 ...Pri~ate one. £&mii.y..dwelling .................................... The certificate is issued to . . .R0b.e~t~. ~.enig~r..~. ~.if.e . . ~P::D.e.~.s ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ ~.~.. ! .~..7. [... t..~... I?, .~ ~-~f. House ~ 2020 E, Gillette Building Inspector lvOF,,~[ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUIL~DING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5158 Z Permissio~ is hereby granted to: ..... ~,,..w~u~J,~.....~t.. r,a=.~. ......... to ...~Le...a~.....~......t~,l,z...~.~3,~l. ................................................................................ at premises located at ........... J[,ett..-11~ ....... ~:L~l~..]l~al41~ .............................................................. ............................................... ]t~...tlille.ttl.aClaa~ea..P.t..aA ......... ga~t..lla:e~e~a, ........... pursucm¢ to_application dated .......................... ~....].~ ............ , ]9...~.~., and approved by the Building I~spector. ,Fee $.~L{~e ~.~'~ ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg, Permit No. TO WHOM IT MAY CONCERN: The sewage di~sposal facilities for a structure located have been inspected by this department and found to be satisfactory. - AUG '3 5 197! Chief of Oe~er&l EngineerLugSer~lcea 'tOWN CLERK'S OFFICE ,'"~'~ ~ ~'~- ~''' /~' _ ............... ' ......... , A~li~tion ....................... A~ ............ , ~-:.:.....:~ ......... , 19...~... Pe~it No. ~.~.~.~... ~ ~ ~ D~,/~ ..................................................... ~/~/~, ~ ~'"~' ................ ~...~...~.. ~ .... ~,,~ ~ ~, ...... .~.~ ............. L( ....................... . ~.~L ....... INSTRU~IONS a. This applicati~ mu~ be complexly fill~ in ~y ~ewriter or in ink und submitted in ~plJcate to the BulldOg In~r. b. PI~ plan ~i~ I~ation of I~ a~ of buildings m premiss, mlation~ p to adjo n ~ pmmi~ or public st~e~ ar~s, a~ givi~ a ~ailed ~ri~i~ of I~ of pm~ must ~ drawn on the di~ram which is ~ of ~i~ applica~i~. c. ~ work c~e~ by this a~licati~ my not be commenc~ before issua~e of Buildir~ Permit. d. Up~ ~al of this a~lic~Jon, the BuildJng Ins~ctor w~ll i~ue a Buildi~ Pe~it to the applicant. Such ~t ~all ~ k~t ~ the pmmi~s ~Jlable for in~ection throughout the p~r~s of ~e wo~. e. No buildi~ s~ll ~ ~cupi~ or u~d in whole or in pa~ for any pu~e whatever until a Ce~ificate of ~c~ancy~ shall h~e been gmn~ by the Building Ink,tar. / APPLI~TION IS ~REB~ ~DE to the Build ~ De~ment for the ssuance of a ~uilding Permit pu~uant ~ the Building Zone O~inan~ of the To~ of ~uthold, Suffolk C~n~, N~ Vork, and other applicable La~, Ordimnces o~ R~ulations, for the constructi~ of buildings, additions or a terat OhS or for rem~a or demolition, as herein de~rJbed. ~e applicant ~r~s to comply with ~11 appl cable laws, ordinance, building c~e, housing c~e, and regulations. ........ ............ (Signature cf applicant, or name, if a co ration) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... ......... .......................................................................................... Nome of owner of premises ............................................................... ~ ............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........ ..~...O....~.....~. .............. Lot No.: ...~.. .............. ' - Street and Number ........................ ~r .................................. 4~.... ../.~'/./~.~..(..6...~/.. 2. State existing use and occupancy of Premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ~,/'-C- b. Intended use and occupancy ..................................................................................... 3. Nature of work (check which applicable): New Building ?...,~......"'..~ Addition .................. Alteration .................. Repair .................. Removal,. ................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... .~.....~....~J.(~.~...~..e'....~ .............. Fee .......................................................................................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units ........... ~. ............... 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 ~ ............................ 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 ............................ ,I/ Number of Stories ........... ~z' .................... ,-)~-~ 8. Dimensions of entire new construction: Front .....'Z~ .......................... Rear ....-?..?.. .................. Depth ....c~..../.. ............. Hm ht .~ '~ " 'g ................... Number of Stories ....... Z..e~, ...................................................................................................... 9. Size of lot: Front ..... ~..~.~/-/. .......... Rear ...../...~...O...,...o...( .............. Depth ....... ..~....~..*..~..~. ...... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated .................................................................................................... any zoning law, ordinance or regulation? ....... ~'.?.. ............................................. 12. Does proposed construction violate premises .~..r...~.~..N....'~.-- .................. Address ...~.~..~.....?..~.A....J~.~)..~....y.:' ' '- ..... Phone No..?..~..~....-..~'..~....~O 13. Name of Owner of Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~.~:....~.'..//./..~..~...~.. ...................... Address .,~.~..?~g./.J Phone No..~.~...~..~:~ O 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. STATE OF NEW' YORK, COUNTY OF ......... + ..................... ~ '~'~' ........................... ~.(~[~......~/.///.~/~. ........................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) ~/,-,..Z. ,-~ above named. He is the ........................................ ~,.,~42.~.~.-,r~.(..%. .......................... ':: ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rn~ke 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. Sworn to before me this ,A _ // ,~ / ~ ~ , ....... ............ ......... ........... ,'"?/".,.. ...... Notary Pub~.~,~':z-,~w'~,.......uC.:L.../.~nty (Signature of applicant) MARION A. REGENT ' ' NOTARY pUBLIC, State ot New York L/ , No. 52-3233120 Suflotk County Term Expires I~arch 30, lg'"'~