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Home My WebLink About5241-zFORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z..~.20.~ ..... Date J~® 1~ 1973 THIS CERTIFIES that the building located at l~on~; & ?~;u 8ts Street Map No...~ ........ Block No. ~ ....... Lot No. ~ .... ~P0~.. ~.'~ ~ ........ confoms substantially to the Application for B~lding Pemit heretofore file~ ~ th~ 9ffice a~e~ ............ 16.., 19.71. p~suant to which Building Pe~it~o.~6~ 18 dated ....... ~...: :1.6 ..... , 19. ]., was issued, ~d conforms to all of the r~uire ments of ;he applicable provisions of the law. The occupancy for which this certificate is The cer ificate is issued to ~ & A ~=h~e; ~e~s , (owner, lessee or tenant) of the/afores~d building. / Surfak Cowry Department of He&~ Approval uNDERwRITERS CERTIFICATE No. ~ous~ NU~ER..7~8~...Street. Front ~t ([~in Rd) Building Inspector · '~0~ NO. ~- ?OWN O~ $O~?~OLD BUILDING DEPARTMENT TGWH GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER/rUT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5~Z]1 Z D.c~'e ...................... .~.'J*.."~ .......... .~..~1,. ...... , Permission is hereby granted to: .......... &..&.~.~t~ ...................................... at premises located at ............ ~JJl~..G~..~..~::Jlt~..~ ....................................................................... ....................................................... .......... :'7 .................................................................. pursuan¢ to application dated ............................. ~]pZ',~,~ ......... .~.~...., 19...2.~, and approved by the Building Inspector. Fee $..~]~J ............. ~ ! - Building Inspe~5{or , J TO~N O~ SOfT,OLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Approved " " " ~ ~ i ~ ..................................... ~ 19 ........ Pem~t No ................................... D~sapproved a/c ................................................................... ........................... ......... ( 'dmo Impair) ~ .................... Application No. '~- LI ( APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th~s application must be completely f~lled in by typewriter or m ~nk and submitted ~n duplicate to the BuiJdin, Inspector. b Plot plan showing iocotton of lot and of buddings on premises, relationship to adlommg premises or public streets o areas, and gwmg a detailed description of layout ofproperty must be drawn on the d~agram which is part of th~s application c The work covered by th~s apphcohon may not be commenced before issuance of Building Permit. d Upon approval of th~s application, the Building Inspector wRI ~ssue a Building Permit to the applicant. Such permi shall be kept on the premises available for mspecbon throughout the progress of the work e. No building shall be occupied or used ~n whole or in part for any purpose whatever until a Certificate of Occupanc; shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for ~he ~ssuance of a Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances o Regulations, for the construct.on of buildings, additions or aJterat~ons, or for removal or demohtion, as herein described The apphcant agrees to comply w~th all opphcable laws, ordinances, building code, housing code, and regulations. E & A Richter (Signature of apphcant, or name, if a corporation) (Address of applicant) State whether opphcont ,s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Owner - builder Name of owner of prem,ses ..... .~.....~....&...~..~.o..~..~.e...~. ............................................................................................................. If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work w~ll be done Map No: ............. ~ .................. Lot No ....... ~ ......... Street and Number ............ l~.~:l.J&..&.....~.t]:;I,....~t ............. G~.~e~]::)G.~, ........................................................... ~'~ ~ 0 ~ ~ ~ __ ~ Mun.cipality 2. State existing use and occupancy of premises and in~ended use and occupancy of proposed construcbon: a Exisiting use and occupancy ......... ~.~.~.~.~ ................................................................................................. b Intended use and occupancy ................... ~.~...~.~...~.~.~$.~...~...~$&~.~$.~ .................................. 3 Nature of work (check whic¼ appHcabl~)' New Building .................. Addition ......~ .......Alteration ............. Repmr ................ Removal .................. Demolit~or~ .................. Other Work (Describe) .................................... 4 Estimated Cost ................... .8...0..0. ............................. Fee .... .~. ?..0..0.. ........................................................................... (to be pa~d on fihng th~s apphcation) 5 If dwelhng, number of dwelhng umts ...... .o..~...e. ............... Number of dwelling umts on each floor .......................... If garage, number of cars ................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........................... 7 D~mensions of ex~stmg structures, if any Front ...................... Rear ................................ Depth ................... Hmght ........................ Number of Stories .. D~mensions of same structure with alterations or additions. Front .................................. Rear ....................... Depth ............................... Height ......................... Number of Stories ............................. 8. D~mens~ons of entire new construction Front ......... 6 ..................... Rear ............. .6 ............ Depth ...... 6 ......... Height .................... Number of Storms .......... 0,,-'1~ ......................................................................................... 9. S~ze of lot: Front .......................... Rear .......................... Depth ............................... 10 Date of Purchase ................................................ Name of Former Owner ...................................................... 11 Zone or use d~stnct in which premises are s~tuoted ................ ,~ ........................................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulation~ ........... ~ ........................................ 13 Name of Owner of prem,ses ..~...&.. A.....~...~..q.b,..t..e.~ ...... Address ....... .G.?..~.e...~.!g..9..~..~.. ............... Phone No ................... Name of Architect ................................................. Address ........................................... Phone No ................. Name of Contractor .......... S&l:~te .............................. Address ............................................ Phone No .................. PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex~sting or proposed, and indicate all set-back d~mens~ons fro[ property lines. Give street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot STATE OF NEV(_ YORK. t ¢ COUNTY OF ...~.t~.~.¢~ ............. ¢~ S ........................................... &.~t,~t~'...i~.:L.e~e~ ................. being duly sworn, deposes and says that he is the apphca (Name of indwMual signing application) above named He ~s the ......................... ~At[~.~ ......ll;)l~l,~l~e.:~ .................................................................................... (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 f thru apphcation; that all statements contained in this application are true to the best of hm knowledge and behef; a tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me th~s ~ ..................... .................. ....... , ,..?.:.. // Notary Co ty~¢~ (Signature of applicant) ........... ELIZABETH ANN flEVl~L~yerk NOTARY PUBLIC, $~ate of New' Yorl~ No 52-81258§0, Suffolk CouJ~.I Term Expires March 30, 19~..~