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Home My WebLink About5238-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Zt~299 Date J .~L~.~' 28 , 19 $'1 THIS CERTIFIES that the building located at OhRmpllI~ P1 & A~ti~treet Map No.. ~ Block No.~ Lot No. ~ G~ee~oyt~ conforms substantially to the Application for Building Permit heretofore filed ~ this office dated .Kp~t~ 6 , 19 7] pursuant to which Building Permit No. dated Ap~t~ ]6 , 197~ , was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private .~r~g~ (~cce~.~y, Bldg) - ....... a~;~roved .~y ...... Bd A,~eals'~ ..... The certificate ~ issu~ to Ethel An,esteaa ...... %ncr ............ (owner, lessee or tenant) of the aforesaid build~g. Suffolk Cowry Dep~tment of Health Approval N ,R~ ...... House, 1050 Cha.pl~ ~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5238 Z Permission is hereby granted to: ......................... ~,,~..~..,M~) ............................................................................. pursuant to application dated ................................ ~1~....~- ....... , 19..~/.e.1,., and approved by the Building Inspector. .... ............... fOII' NO. I TOWN OF SOUTHOt. D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥o Approved ....................................... , 19..Z../. Permit No...~...~.....~......~........~ pp~ea a~¢ · ,.,,~,..~.,~.~.z..,d~,~,...,~ ................................. .................. ,,~ .... ~ f~ ?~ .......... ~ ....~......~. ........ ~. ............................ · . ......................... ........ ..................... APPLICATION FOR BUILDING FIIL~I'/ ~'/~ 97 ~te ............................................................ , I ..... ~. INSTRUCTIONS a. ~is ppplicoti~ must be c~pletely flll~ in by ~writer or in ink und submitt~ In ~plic~e to Inspector. b. Plot plan showing location of lot and of bu.ildings on premi~es, relationship to adjoining preml ~r public streets areas, and giving a detailed description of layout of property must be drown on the diagram whlah is part of thle appllcatl ~o~ ~, c. The work covered by this application may not be commenced before iuuance of Building Permit. d. Upon approval of this application, the Building InIpector will luue a Building Permit to the al~plleant. Such parrot shall be kept on the premises available for inspection throughout the progre~ of the work. · ~ e. No building shall be occupied or used In whole Or In part for any purpoIe whatever until a Cirtlficate of Occupar~/ shall have been grontod by the Building Inspector. .A. PPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other pppll~ble Law~, OMinances or Regulations, for the construction of buildings, additions or al.terations, or for removal ar dem~lltlen, al heelln deIcrlbod. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ..... ........... ...................................... (Signature of applicant, or name, If a emigration) ......... ~..~,.~.,¢..,,.,,~ ......................................................... State whether applicant is owner, lessee, agent, architect, englnIer, general contractor, electrician, plumber or builder. ......... 2~/.L.p. .................................................................................... Name of owner of premlse~ .. ~- ..T~....~-.. E ..~. 0 /%/.~/--- ~' If app~nt~l~ co~r~ slg~m of dul~ aut~rized officer. ..... ~.~.,.~ ....... ~ ....................... (Name a~ title 'of co~omte officer) I. L~otl~ o{ I~nd on ~l~h ~ wo~ ~ill ~ don~. ~p ~o.: ........................................ ~ ~o.: ..................... St~ and Number ............................................................................ ~ ........ ~ ......................................................... ~ ~E E N ~e ~ MunlcI~II~ 2. S~te exi~lng u~ and ~cu~n~ of pmmi~ and intended use and ~¢u~ncy of p~ a. ~isti~ uH a~ ~cupan~ ............................................... ~ .............. .~ .......... ~,~, ........................................... b. ,.t.nd~ ~. ~nd ~.:....: .......... ~.~ ....... ,~.~ ........ ~.~.~.~ ...... ~A~.~.~,~C ..... 3. Nature of wo~k (check which applicable): New Building .................. on .................. Alteration .............. Repair .................. Removal .................. Demolition .................. 9~er Work (Describe) ...................................... 4. Estimated Cost ................~...~.....~....~.. ........................... Fee ....... ...5......'..-~. ...................................................................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units ........................... Number of dwelling units on each flor ......................... If g°rage, number of ca~ ....................... ~..~.~. ...................................................................................................... 6. If business, commercial or mixed ~cupancy, speci~ nature and extent of each ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ ~pth ........... Height ........................ Num~ of StorJ~ ................................................................................................ Dimensions of ~rne structure with alterations or additions: Front .................................... Rear ........................... Depth ................................ Height ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ................. ~.~ ............. Rear .......... ~..~. ........... D~th ....~.~ ........... Height ........ ~.~... Number of S~ries ...................................................................................................................... 9. Size o~ lot: Front ............. ~. ........Rear .................. ~.~ .......... Depth ......... /..~..~. ........... 10. Date of Purchase ........................................................ Nome of Fo~er ~ner ....................................................... 11. Zone or u~ district in which premises are situated .......................... ~ ....... .~.~ ............................................. 12. D~s pr~osed construction violGte eny zoning law, ordinance or r~ulation? ............................................................ 13. Name of ~ner of premises ~...~.~:~:~.~Address ~71~ .. ~Phone No ..................... . · ........ .~.~.~ ~..~.~.. Name of Archit~t ............... ~ ................................. A~ress ............................................ Phone No ..................... Cantra to ........ ............ PLOT DIAGRAM locate clearly and distinctly all buildings, whether existing or Pt~sed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicat'e whether interior or comer lot. STATE OF NEW~OJiI~_,/]/ ! S.S COUNTY OF ~ ............. ~ ' ~, .~.. ICH., T ~ ben ..................... ,~,~.,,H., ,~.,~ ................................. ,L,--..,..~.. ........ ' g duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ..... ~ ................... ...--~..../~..!.../=...~..b:.~.....~. · ..................................... -~ ........................................................ (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 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 man~er set forth in the application filed therewith. Sworn to before me this ................. day of .............. , .......... Natal/Pub H O~g-~.~.~ · .~/I!~.. · ........ :w.. '"' I'IOTkRY PUBLIC, State of No. §~-81~§$50, Surf011 Cou, l~t~ Term Expires March 30,