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Home My WebLink About5141-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 . Ig~..l~t~ .~IA~ ........... Street Map No....~.. ....... Block No.. ~ ..... Lot No ~...]~..~;~;~...~1~..~....1{,~. ? ....... conforms substanti~ to the Application for Building Permit heretofore filed in this office dated ......... ~, 19.~'. pursuant to which Building Permit No. ~.. dated ......... ~~.. ].~ 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 . .~0~.~ .~d~. The certificate is issued to . .~~k $*8O.¢tag~.8 .~ ....... ~0~ ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval &}~ ~,. ~...~.~,..~ .... UNDERWRITERS CERTIFICATE No. Building lnsl)Cctor~ FO~ ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 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? 51 1 Z Permission is hereby granted to: Fa:emin&~XXXe Aamoo:tatofl by Rudolph Holk at premises located at .]JJ~.........~. ~l~....~.~t~....~..~..~.). ................................................................. ................................................... ll~.t,.t,~,.t~l~ ...... !!..,.~;, ..................... pursua:n¢ to application dated ........................... ~.~b.~Z'lll.~'~.....~..~...., 19.~J.., and approved by the Building lnspector. BO~I P~{"~lt muMl:)~o~t ~e t~to plfdlLaS ap~:FOvod bT Pl M S~te ap~v~ of access to highwa7 " " " all app~eable ~es, laws etc. Fee $..~W~ .......... 3 Nature of wo~k (check which aDplicable): New Building .... ~... Addition .................. Alteration .................. Repair ................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .........'~'¢:~7.C~ ........................... Fee ......................................................................................... (to be paid on fi!ing this application) 5. If dwelling, number of dwelling umts ............................ Number of dwelling units on each flor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use~G~..~ 7. Dimensions of existing structures, [f any: Front ........................... Rear ......... ~ ..................... Depth .................... Height ...... ~ ............... Number of Stories .............................................................................................................. D~mensions of same structure with alterations or additions: Front ...... ~ .......................... Rear ~ ......................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... ~.~:] ......... Rear..~.~].~ ........ D~th ..I.~.~:~.'.'. .... Height ...~.1]~.~.'. .... Number of Stories ......... I ............................................................................................................ 9. Size of lot: Front ..... ~.~.L~ ~ear .... ~,.~.~ .......... Depth ...~.[.~..~.~.~.~ 10. Date of Purchase ........................................................ Name of Former ~ner ........................................................ 11. Zone or use district in ~hich premises are situated ........ ~....~.~ ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~ ............................................ ~ ~ ~ ~ Addres ~'- / .... ~ 13. Name of Owner of premises ....... ~4..~ ........ s · .~.3~.w~t~[.~.~ ....... Phone No.%.~.~r.7.~.[I .... Name of Architect~e~....~...~ ........ A~ress2~l~.~.~7~f.~E ............ Phone No. ~[~.:.~1~. Name of Contractor ~.~....A.Sg~.C. IAff:E.~..A~ress ...... ~u. gfA~.~ ............. Phone No.~.;.]~ PLOT DIAG~M L~ate clearly and distinctly all buildings, whether existing or proposed, and indicate all set,ok dimensions from prope~ Hnes. Give street and block, number or description according to deed, and show street nam~ and indicate whether interior or corner Jot. STATE OF NEWF~OR~,,/J, )'SS COUNTY Of ..~ .......... J' ' · ............... ~-~,-~ ....... ~,:..~l~-~.J-I.~- ............................ being duly sworn, deposes and says that he is the appJicant (Name of individual signing application) above named. He is the .............. ~f'Z.~-~.~..T.~'..G..l. ............................. .......................................... (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 applicatiop~re-f'F'~to the best of his knowledge and belief; and that the work will be performed in the rnanner set forth in the ad'Dlication~led there~ ~ Swor~to before me this '-~-- ."' ' / ~. / ~ / /~ ...... day o, ............... . fr ........... ......... -- ELIZABETH ANN NEVILLE / ~/"~ '/'~-'~" ' NOTARY PUBLIC. State of New York -~ ' '- , No. 52-8125850, Suffolk Coup.ti, Term Expires March 30, 19~