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Home My WebLink About5698-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at l~'t. 1~.~. (..0l'l~]a~;&l. AV.$ ~re~ee~ Map No.P.'.I. ~.ES..~.tO.S Block No... ~[ .~ ..... Lot No.19 ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J.al~l'~ .¶]19~... pursuant to which Building Permit No.~S~... dated ......... Jq~.l~..~ $ ......, 19 .~.., 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~,va.~.e. one..f.~;l.J,~..dY~ll~4~g ........................................ The certificate is issued to 14a~.'cha. ~.o .$~a:l~g~;~n ..... 0w~er ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~.,~, .............................. UND£RWRITERS CERTIFICATE No .... ~..~.~.*. ......................................... HOUSE NUMBER..~. ...... Street ................................................. Building Inspector FORM NO. ~B TOWN O~ SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: at premises located at ..~.~o~.k...~,K.....~O~,..~9 ................................................................................. ................................ · lI'l~bi~"2'~'~:'z~r~'~ ............ ~"lml"/~'~ ................................. pursuar~ to application doted .................. ~1~ ....... .q-~ ...................... , 19...e~, and approved by the Building Inspector. 1POB, M ' NO. I TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No..~.....~.....~... ........ Disapproved a/c .................................................................. _ ........................ ........................... APPLICATION FOR'BUILDING PERMrI' Date ....~1'.~.~...&.3. ................................ , 19..?.~.. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premi'sas or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shell 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 Occupancy shell hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, far the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations. (Signature cf applicant, or name,' if e corporation) {^ddres$ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~..~&~Ir~...~ll~'m¢l~ ........................................................................................ If ap~lica/~t ~ a corporate, signgture of duly authorized officer. .... ~ (Name and title'~corporate off,car) 1. L~ation of land on which proposed work w~ll be done. ~ap No.: ....... ~.~...~ .............. Lot No.: ...~ ................ Stre~ and Number .............. ~..~ ................................................................................................................. Munici~ll~ 2. State existing u~ and ~cu~ncy of premises and intended use and occupancy of propos~ construction: a. ~isting use and ~cupancy b. Intended use and ~cupanc,' 3. Nature of wo~k (check which aDplicable) New Building .................. Addition ....X ........... Alteration .................. Repair .................. Remora! .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..... ~St.S~,.OJJ ................................ Fee ....... ~J-,~,.(J~ ..................................................................... (to be paid on fi!ing this application) 5. If dwelling, number of dwelling umts ........................... 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 use ............................ 7. Dimensions of existing structures, if any: Front ......J, JSt ............. Rear ...... J.~l.*. ................. Depth ....,~..~ .......... Height ..... 35.? ............. Number of Stories D~'rnensions of same structure with alterations or additions: Front .... .~,~. ...................... Rear ...J,¢~..~ ................ Depth ....~.? ...................... Height ...... ~$~ ................ Number of Stories ..... 2 ........................ Dimensions of entire new construction: Front ......... ,J~.~. .................... Rear .....G! ................... Depth ..~! .................. Height ..,iS! ........... Number of Stories ....... 2 ................. .... Size of lot: Front ............................ Rear ................................... Depth ...llK~lL.~.t~tCJIl~.~... J[~,l~, 10. Date af Purchase ..... J,~./.;J0~'7.J~ ................................ Name of Former Owner ...~ll:lll~..JJ,..,i~l~.ellll ................. 11. Zone or use district in which premises are situated ...... J~llJ,tJlll:~J, .................................................................... 12. Does proposed construct;on ~iolate any zoning law, ordinance or regulation? ...... ~J~ ......................... 13. Name of Owner of premises .l~.e~..e...~l~l,~l~.....Address t4jt,~e&~,JbJ.~_et..,jjl~,. ..... Phone No. Name of Architect ..A~..~.~....~ ............... Address Jlll,Jt,4JJ~:lJ~...J~l~,. .......... Phone No..~.~J'.w~O,J Name of Contractor ..~,..e...C..~.~..~l. ql~ll ...................... Address Jlf-J~JJ~l...ZJ~ll~ll'".lt'.Phone No. 0. nibhu8 PLOT DIAGRAM ~'-~ ~te clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from p~'~ci/k]ines. Give street and block number or description according to deed, and show street names and indicate ~vhether interior or corner Jot. tim~q d: *2. fi.it 1S', ~ 6', i~tg~t 35', ~toZ:Lel 2 · 8. 9. STATE OF NEW YORK, COUNTY OF ................................ ,f ""~' ........ ~.,..,folJ G~, ................................................................................................ being duly sworn, deposes and says that he is the appJicant (Name of individual signing application) al~;~"nc~ni;,'a'.-He is the (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 gpplication; 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. ......... , ........... ....... ............................... Notor/ L-ounh .~/ (Signature of appJ~ant) 6emmission f-xp]res March 30, I~ ~ ~ 'l'-,c::,