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Home My WebLink About4055-zIroRM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of OCcupancy No. '.,i.~.3.1..~ ...... Date July 26 1973 THIS CERTIFIES that the building located at...1.2.~...Al...d~..i.e.~....I~..e. ...... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore fried in this office dated .3..e.p.t..em..b.e.r..1..~ ....... , 19.6.8., pursuant to which Building Permit No. ~.0.~.?.Z.. dated .~.e..p.t;.e.?.b.e.l,..%.9 ........ , 19.6..8., 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 ......... ~.i.::.~:..o..,:..~.~.,?..~...D,.....n~... ............................... The certificate is issued to Paul J. & Margaret (owner, lessee or tenant ) of the aforesaid building. Suffolk County Depar~nent of Health Approval UNDERWRITERS CERTIFICATE No ............................................. lZ~ AXd~.ic~ Laae~ La~el, N.~. HOUSE NUMBER .............. Street .......................................... FORM NO. 2 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) 4055 Vo~e ...................... ZeSt ......... ~19 ......... ,1~.68. Permission is hereby granted to: ............ .~.~....~..~..~...~ ................... ................. ~.....~...e......~l~.e.~....~ .............. at premises located at ....l~..~lle,~..&..~d~.;l,~h../~ ................................................................... ............................................... .~.e..~ ............ ~.:~.,. ............................................................................. pursuam to application dated .......................... .~..t~.~ .......... .~.~ .......... , 19..~., and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DE ,A. RTMENT TOWN CLERK S OFFICE/,~/.).,.~6 ~U?HOLD, N. ¥. Ex~min~ .... ~ 19 .............. , ....... Approved ~ 19...~.. Permit No...~..~..~ ........................................ , ......... Di~ppmved a/c ~ .............................. ~. ............................. APPLICATION FOR BUILDING Date INSTRUCTIONS ' a. TH~ application must be completely filled in by typewriter or in ink ~nd submitted in duplicate to the Buildir~l Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjo n na premises or pulilic streetS~ areas, and g,wng a detaded description of layout of property must be drawn on the diagram which is part of this apphcation. 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 ~all 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 shall have been granted by the Building Inspector. APPLICATION IS I'IEREBY MADE to the Building Department for the issuance 01~ a Building Permit pureuant to _Build!ng Zone. Or.clinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant ngrees to comply with all applicable laws, ordinanc~ buildir icode,ond~regu[atians )f applicant, or name, if a corporation) ~ . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder': ....................... &~x~4~ ,~<f,r ~T.... ............................................... ~.;. .................. ~ .................................................................... Name of owner of premises. .~. ....................................... If applicant is a corporate, signature of duly authorized officer· ~' (Name and title of corporate officer) 1. Location of land on which~ (~_, ~ /~'// · /'~ .~ (~ ,, . ~_ , ~rpr°p°sed work wilJnbe done.~ap No.: ........................................ ~,~. o..'.~.~-~._/ ....... Street and Number ...~~~~~.~,.a~ ..~.~ ....... 2. State existing use and occupancy of premises and intended use and occupanc.'~ --~, ~f'proposed construction: o. Fxi~lng u~ and occupancy ................................. b ntend use an cu an ~ ....... ~ ..... ed doc:up cy ................................................................................................ - ' . 3. Nature of work (check which applicable): New Building .................. Addition .. . Alteration .................. Repair .............. ._... Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Est mated 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 ............................ 7. Dimensions of existing structures, if any: Front ...... ~..~..:.:.~..~..~.~. Rear .... ~.~..,..~.~......~...:~ Depth ..c~/.,..~'.~:... Height .....~..~ ............. Number of Stories ..... ~. ............................................... ; ......................................................... Dimensions of same structure with alterations or additions: Front ..... ...,~......~. .................... Rear ~'~ ../..~'.. ]~..~...~...'.. N u m be r Depth ..... ................. Height .... of Stories ....... ,~i~.~.. ~. ........ 8. Dimensions of entire new construction: Front .~.,~ .......................... Rear .....~ ................. D~th ....~..'. ......... ~i~ht ~.~..~.~.. ~umb~r of Stori~* ............................................................................ ~ ......................... ¢. Si~ o* lot: Front ...~7~&..~.~.~ ..... R~r ........ ~..~..~ ........ Depth ..~.~..~..~q....~ oto ....................................... o* 1 ]. Zon* or use district in which pr~mise~ *r* situoted ..... ~.g~ ................................................................. ~.. 12. D~s proposed construction violote ~ny ~onin0 Iowj ordinonce or regulation? ..... ~ ................................................ l~. Nam~ or uwner ot pr. raises ....~..~~.....Address Phone Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Cont~ctor ...~.~..~.~.~.....Address .......... ~4 ............ '.f ................. P~ne No...~ ......... Z .... PLOT DIAGRAM Locat~ clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-b~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior er corner lot. STATE OF NEW YORK, ice COUNTY OF ................................ $';"~' · .................... , ........................... being¢ duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ........... ~. ................................... ~...~ ..................................................... i ........................... (Contractor, agent, corporate ot~ficer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; fhat all statements contoined in this application are. true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the opp i~ti6h fi~ed therew~Lh. Swam to before me this /~ ~ ,____ ~ ~oc~ // ~ ~, I '~ / ............. · ........, ................... Notary Public /.~, .~4~:f,~,~.._~Coun~ (Signature of applicant) NOTARY PU~C, State of New ¥~ ~' / /~ 52-0~18100 ~ No. Suflc~tk Couqtj~.~, ~mmis$io: ET- Mnr:h 30, l_~d~r % ~'~""~. N.55c'25' E. 50.16' O~ 2.1.5 5" J J