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Home My WebLink About4118-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ,Z. 3,~,90 .... Date ...... i ...... ]~1~' .... 20. .... , 19 69. THIS CERTIFIES that the building located at .llew .~ut'~Olk. ~ne ....... Street Map No... ;~. ....... Block No..;~g ....... Lot No..I~...(~t~;~l%0~'~l.~...I.~.~.,. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... lioVe...6 , 19.68. pursuant to which Building Permit No..t~] ] ~ .. dated ......... 1~O~', ....15 .... , 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.~lVa.t~ .~l~e .i~ar~l. ty. d~el~k.ilag ..................................... The certificate is issued to ... l~];l~la. Caae ............ 01¢{a®r ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......]~,l[~ ......................... Building Inspector ] ] ouse 1 t0 FOEM NO. ~ TOWN OF $OUTHOLD BUILDIbiG DEPARTMEbiT TOWN CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~115 Z Permission is hereby granted to: ............ .a.,~.e..~.~i~-~.~ .............................................. at premises located at ....~..~.~f-~,O~,.~,~P,2 ........................................ ~ ........................................ ............................................. ~utch~ue .......... l~...~. .......................................................................... pursuan~ to application doted .......................... ~.0..'~. ......... ~. .............. , 19...~.~., and approved by the Building Inspector. Fee $.~,00 .............. Building Inspector TOWN OF, SOUTHOLD ,BUILDING DEPARTMENT 'I~OWN CLERK'S OFFICE SOUTHOLD, N. Y, Examined ......~..~.. ............... , 19...~.....~ Approved ........................................ , 19 ........ Permit No.' ............ D*sapproved a~ -- (Buildin~ ........................ APPLICATION FOR BUILDING PERMIT liovember 6 68 Date ............................................................. 19 ............ INSTRUCTIONS o. This application must be completely filled in by typewriter or ~n ink and sul~mitted in duplicate to the Building Inspector. b. Plot plan showing location of Jot 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 drawn on th~. diagram which is part of this application. c. Thework covered b,~ 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 t(~ the al~Plicbnt. Such permit shall be kept on the premises available for inspection througl~out the progress of the work. e. No building shall be occupied or used Jn whole or in part for any purpose whatever until a Certificate of Occupancy shell have 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 Laws, Ordinances Or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. Do..~las ~eetm.,& Sons. . (Signature of applicant, or name, if a corporation) .......... C~tcho~u~ ................................................................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, en.cineer, general contractor, electriclan, plumber or builder. ...................................................... ................................................................................................................... Name of owner of premises ....]~&~,~...~.tl~.~ ..................................................................................................... ~ .................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proPosed work will be done. Mop No.: ............................. ......~...i Lot No.: .......... ~...~ ......... Street"and Numbe~ .,,i..~.e~.;;~.~.~ll[.~X~...,;.....O..~...~.~.o.~...e....:: ..... ;;...;....' ......... ;;4 ...................... ~/ _ / cf' / 0 MUnicipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed c~{trbcti0n':' a. Existing use,a~d occupancy .:,.....d¥.e.'l'l:J.l~ .................................... ; .............................................................. ;... b ': ' ' "...i · ........................ · Intended use and occupancy ~ ...... :... e...~.~Lt~3,:.a~,.&~l,~l,~,~;:[,~ ................... , ........ 3. Nature of work (check which applicable): New Building .................. Addition ..~31~ ....... Alteration .................. Rel:x3ir .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .....1..~.~.l~....._.+ .................................... Fee ........ ~.~).0. ........................................................................ (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 c~rs ............................................................................................................................................. 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 .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...1.;~ ............................. Rear ...... 1~, .................. Depth ....... 8. .............. Height .................... Number of Stories ........ One ....................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ] 1. Zone or use district in which premises are situated ................ d~S~ ........................................................................ ]2. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~1. ........................................... 13. Name of Owner of premises ...Jt, lt].ph..{~,S.e. ............ Address ...~.tt.t(t]~l~l.~l ................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........ ~..~...~.~.~..~..~. .............. Address ........ .~.13,~.¢]zQg33.e .............. Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y, OR~ .. t c ¢ COUNTY OF ...... ?...a~....[..o....J~.. ......... ~,~. ................................ ~..;J,~J.~.,.~-.~..~.~.~ ............ ............. ;,;. ....... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................... Ci313t~.il.~,,tOZ~. ........................ r (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hm;e performed the said work and to make and file this application; 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 manne~ set forth in the application filed therewith. Swam to before me this ................. · ~..... day of ......................... .~..e.lr. ........... , 19..~..8... Notary PublicJ.¥.J~J~,O:t%,..l.~.,,.J[~ ........... County / (Signature of applicant) ~. MARION A~EGENT ~OFANY PUBLIC, Stat~ of New Yorl~ ~o, 52-3233120 Suffolk Count~ ;Term Expires ~[arch 30,