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Home My WebLink About5192-zFOIgM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at E/S. Oakla~cn .AVe ......... Street Map No.. xx ........ Block No...XX ..... Lot No .... ~ .... 8O~h0.1d,..I~:~.~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~ 14al-. 30, 19.71. pursuant to which Building Permit No.. ~192~. dated ........... ~la.l~el~ .... 3~ 19 7.$ , 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. rSy.a.~e...a.c.e.e..s .sg.x~l' .~.u.~.~..d...~g. ....................................... The certificate is issued to . Chas o..Va~Duzer. & .~i£a .... .~wner$ .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval House ~ 1035 Building Inspfetor TOWN OF SOUTHOLD BUILDING DE?ARTMENT 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? 519~ Z Permission is hereby granted to: - .......... ............. ............. ~.~.,A...~.,~. ........................................................................................................................... at promises located at /~ 3_._~ 0.~.; K LA ~ Ik/ .,t~ U* b- pursua~ to application dated ......................... ~ ........... .~.~....~..~, 19~.., and oppmv~ by the Building Inspector. Fee $ ........ ~.. ............. Building Inspector NO. ! 'I~)WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~.~..~.~....~. ....... ,1 Approved/// ~ 19" Permit No. ,.~/~'3,,~ ~.._ Disapproved a/¢ · (Building Inspector)/ APPLICATION FOR BUILDING PERMn' Date .... ,~,..~...., .~.....~ ....................................... 19..,?.~,. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildir Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio c. The work covered by this application may ncr be commenced bafore issuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such perrr shall be kept on the premises available for inspection throughout the progress of the work. e No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupa'n, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a .Building Permit pursuant to t} Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and othe, applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolihon, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, ' · p' , ne, it~'corporatlon) ./, ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build: 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.: ........................................ Lot No.: ..> .................. Street and Number ..../....~,....~.....~...........~.., .~-..../.~...~..'~. ....... ~.,.~rff......~.. ............ .,..~..,.~,...,~...~,../~Z......'~,..,/.,.~,.. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................................................................................................... b. Intended use and occupanc, .....~...'~¢~...~...,~.....~..~.....z~....~..:..~. .................................................................... 3 Nature of walk (check whicl~ applicable,); New Building .................. Add~tion ....~....... ..... Alterahon ............... Repair .................. Removal .................. Demolition .................. Otb, er Work (Describe) ................................. 4. Eshmat~d Cost .... /..~.~. ............................................. Fee ........................................................................................ (to be paid on fi'ing this application) 5. If dwelling, number of dwelhng un,ts ............................ Number of dwelling umts on each floor ........................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature a,nd extent of each type of use ........................... 7. Dimensions of/e>,istJng structures, if any: F,ont ,..,~...~...~..~..~,.~ ~,ear ................................ Depth .................... Height ,..C~, ................. 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 ...,.c~:......~.,/..~)~. ......... Rear ............................ Depth ...................... Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ ,~ 10. Date of Purch=se ....... o4'..~,....,~.,.~.. ............................. Name of Former Owner ..~....~......~.4~.,.~..../.~..~....~....~;~'.. ...... 11. Zone or use district in ~hich premises are situated .................................................................................................... 12. Does proposed construct;on ~iol~te any zoning law, ordinance or regulation? ........................................................... 13. Nome of Owner of premises ,.~.:..}Z~.~.,.~.~.~..Address ~6.~..~.~:~....~ ..... ~'~ No.~...~.~.~ No~e of Architect ...................................................... A~ress ............................................Phone No .................... Name of Contractor .................................................... A~ress ............................................Phone No .................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set,ok dimensicns fron prope~.]lnes, Give street ~nd block, number or description according to deed, and show street names and indica, whether mterlor o~ corner lot. STATE OF NEW YORK, tS,$ COUNTY OF ................................ $ ' ~H~ ~ LI k" V~r ~w' '3;:) i)7_ E !'~ -. ............................................................................ :...-x ............... oemg duly sworn, deposes and says that he is the apphca, (Name of individual signing application) above named. He is the . B ~t .l~t ~I~ . (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 fi this application; that alt statements contained in this application are true to the best of his k. nowledge and belief; ar thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this / I \ ............... day of ....................... ,,7.../... , '7% .............................................................. .................. ..... Notart Public,~~J,~,.~,/~.~,~...,.~/,c/,~....:.],J,,.' C'our~ty (Signature of applicant) /~' /] ELIZABETH At~ EVILLE NOTARY PUBLIC, St~ of New York No 52-8125850, Suffolk C0upJ/~'~ Term Expires March 30, t9~/_._oI'