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Home My WebLink About4061-zFOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No..Z. 3458 .... Date .......... Alii1 .... 15, ..... , 1959. THIS CERTIFIES that the building located at Meday. Avenue ............. Street Map No. T~l. lew~d. Block No ........... Lot No46 .&%. of. 45 · Sect::Lon %175 conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Septembe~r. 24, 19.68- pursuant to which Building Permit No...4061 .~- dated ....... Septeml~r. 24,, 19~ 68, 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. ona. famtly, d~e lling ..................................... The certificate is issued to ... W-t. lllam .P,. S.~a~.~ ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Inspec~ FO~M NO. ~ TOWN OF $OUTHOLD 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? 4061 Z Permission is hereby grante~_to:. -.~_.~s. ...................................... o,~.,,,,,k..~ .~ ...~..!..~...~ at premises located at ....~l~t~..~J..Jl~.~c..~f.~....~l~J~Jl~l~ ........................................................... ............... ~ ...................... Ile~...~ ........... II~.t~l~lt .................................................................. pursuc~c to application doted ........................ JJ.Jl~J.t~ ......... J~'. ........... , 19...~.a, and approved by the Building Inspector. Fee $....~e~- .......... TOWN OF SOUTHOLD BUILDING DF. PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............ Approved t~. 19 ........ Permit No. Application No ............................. Disapproved a/c ....................... APPLICATION FOR BUILDING PERMIT <,, ........ INSTRUCTiONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this applica- tion. 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 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Departrrmnt for the issuance of. a Build,!ng..Pe.rmit p~su..ant to the Build ng Zone Ordinance of the Town Of Southold, Suffolk County, New York, and other appncame Laws, ~ramances or Regu ations for the construction of buildings, additions, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances a~d regulations. f ......... '" ............................. (Signature of applicant, or name, if a corporation) ............ ./.,: ........................ · (Ao~lress of applicant/- PV T ~ ~C~. ~ .~, ',t t n near enera contractor electrician,-lumber or builder State whether applicant is owner, lessee, agent, arch' ec, e g , g , p - Nome of owner of premises ..... ~....~' ' ....... ~...'"e .~ ........................................................... If applicant is o corporate, signature of duly authorized officer. .: .................. J~--~'"~ Lot 1. Location of land on which proposed work will be done. Map No ~ [ 7 ~ · - -- ./ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction. Intended use and occupancy ... . .................. 3. Nature of work (check which applicable): New Budding .................... Addition ..~... ........Alteration .............. Repair .................. R~i~ova! .................. Demolition ........ j ......... Other Work (Describe) .................. 4. Estimated Cost ........... ..~ ~ Fee · (to be paid on filing this application) 5. If,dwelling, number of dwelling units -~ ....... 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 .................................... ~2, 7. Dimensions of existing structures, if any: Front ....... ~.~.. ............. Rear .:....~...~.. .............. Depth .......... ~ ................ He ght .-/../'-.-/- ....... Number of Stories ................~::?~.....--. ................. . Dimensions of same structure with alterations or additions: Front ........ ~......o~.. ............ Rear ~ Depth ......... ~..~. ............... He ght /. ~ ( Number of Stories 8. Dimensions of entire new construction: Front ............................... Rear .............................. Depth .............................. Height .............................. Number of Stories .............................. 9. S ze of at' Front -'~ -('~ /' Rear '7 .r,'- ~ ,, ,-~ ~ ¢_ / ...... ;;"'~'"~:-~ ...................... ~...~ ................. uepth ... ,e.{....~......~.. ........ , 10. Date of Purchase .../~...~ ..... ~...~.._~..¢ ...................... Name of Former Owner ..~...~... 1 1. Zone or use district in which premises are situated ..... ~.~.. 12. · ........ Does proposed constru~ction violate any zoning ]aw, ordinance or regulation.;) ...... ~. · 13. Name of Owner of premises ...[~...'..~ ...... Address ..~~ ~.~'~';~;~;"~'~ ...................... ............. ~- rNo ................... Name of Architect .................................................... Address Nome of Contractor ~ ~~' --- ;;~~i;~;.~;;;;i Phone No ................... ....... · ~.~.'-',~...' .............. /~aaress Phone No.~.~.~.('..(. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or ..~ription according to deed, and show street names and indicate whether interior or corner lot, ! STATE OF NEVV YORKi ) S S __ ..................................... ~ ' · .............. being duly sworn de os~s an '~;~;Fi~i;J'~;a] signing ap;i;;;~'i';~ '~ , p d says that he is the applicant above named. He is the ......................................................... ~....~ ............ (Contractor, agent, co~orate 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 ~plication; that all st~ements contained in this application are true to the best of his knowl~ge and belief; and that the work will be performed in the manner set fo~h Jn the application filed therewith. Sworn to~ore me this ~ . , ~ ~ ~ ~o. 52-3233]20 Suffolk Coun~ !erin ~pires ~rch 30.