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Home My WebLink About4126-z FoRr~ NO. 4 TOWN OF $OUTttOLD: BUILDING DEPARTMENT Town Clerk's Office Southola, N. ¥. Certificate Of Occupancy No. 2;. 348J. .... Date .......... l~la~.... 9., ........., 196.9. THIS CERTIFIES that the building located at .I~/S..ami.th .D~lv®. ao. uth. Street Map No ............. Block No ........... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... iqov~raloe~ .... 14~., 19.68. pursuant to whidh Building Permit No..4126. ~;. dated .... iqov~ra~ea: .... 14,.., 19.6~., 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 .pa:iv. ate..one. £ami~.~ .ak~eJ. ling ....................................... The certificate is issued to ...I~,..~t~omaen ......................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... : ............................. Building Inspector~ ~ouse ~ 730 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? ~1~6 Z Date ............. ' .............................. : .............. PermiSsion is hereby granted to: j,./~? ~,~/~ ~'/[//;',..~/-( j ,4 D D ~..~../...~ .......... :..:: ........... :.::~- ................................................... ............................................ ~:/~ ~ ~-., ' '~"; /) i~,:t t. /z~ ~U TH at premises located at. ........................................................ '~"""]~.~ ' - /.~,,~c ~,~=c~ ~ ~ ~z--J :~]~,'. ~..~.~..~...r..~ ............................ ............................. k.~:.~:.~..-..'. .......................................... , ..... ............... ./f/ tV'P;P. 19.~:/.~..~.., and approved by the pursuan,t to application dated ................................. ......................... ' Building Inspector, Fee $ ........................ Building Inspector iF,O R M ~NO. ?O~N OF SOU?I~OLD BUILDING D~ART~NT TOWN C~RK'S OFFICE SOUTHOLD~ N, Y. Examined / ~/' /~'/ t~"" ..................... 19 .... Permit No .............. .................... .... (Building Inspects) · - Application l~o ..... ?. .......... APPLICATIO;N FOR BUILDING PERMIT Date ................... INSTRUCTIONS a. This applicati.on must be completely filled in by typewriter or in ink and ,submitted in duplicate to the Building InspecOor. b. Pict plan showing 1.ocation of l~3t and ~of buildings o n premises, relationship ~o adjoining premises or public streets ~0T areas, and giving a detailed descripti, on of layout of property must be drawn ~on the diagram which is part of this application. c. The work covered by this applicat~m may not be commenced before issu.ance of Building Permit. d. Upon approval ,of this .applicati.~n, the Building Inspector will~ issue a Building Permit to the applicant. Such permit shall be kept ~n the premises available fo r inspection throughout tile progress of the work. e. No building shall be occupied or used in whole o~ in part for any purpose ~vhatever until a Certificate ~of Occupancy shall have been gran.ted by the Buiiding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant ~o the Building Zone Ordinance of the Town of Southold, Suffolk O~Unty, New Y..ork, and other applicable Laws, Ordiaances .or Regulations, for the construction ~f build ings, additions or alterations, .0T f. or rer~val or demo- lition, as herein described. The applicant agrees ~o cpm ply with all applicable laws, ~ordinances, building code, h.cmsing code, an, d regulations. name if a c,orpo~ation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................................................................................................... Name .of owner of premises ............................................................................. If applicant is a oa,rporate, signature' of duly ;~e d, ¢ (Name and title of corporate officer) 1. Location ,of land ,on which pr~p,o,sed work will b e done. Map No ................. Lot No ......... .~ .... · Street and Numb~: ..................................................... . ....; ...................... 2. ,State existing use and ~ccupancy of/p~emises and in%ended use and ,occupancy of proposed construction. a. ~xisting use and occupancy / /': !~ ~t l Z.~ " f' ~ t ~/ L:' /. I /ix'gL- b. Intended use and ~ccupancy ............. i~/'~ A¢/~ 3. Nature of work (check which applicable): New Building ........ Addition ..... Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Fstimated Cost ......... ./.:?.'..g{. (). ............. Fee ,..,~. ~ (to be paid ,~m filing this applicati,on) 5. If ,fl~velling, number ,of dwelling units .../?./.~./::".~. Nnmber ,of dwelling units on each floor .............. If garage, number ,of cars .......................................................................... 6. If business, co.mmercial ~,~r mixed occupancy, spec ify nature and extent ,of each type of use .............. 7. Dimens}ons of existing structures, if any: Front .............. Rear ............. Depth Height ................ Number of Stories ........................................................ Dimensions ,of same structure wiih alterations .o.r additions: Front .............. Rear ............... Depth ................ Height ................ Number of S~o~ies ..................... 8. Dimensions ~of ~re new const~ction: Front .......... ~ ..... Rear ...... ~J. .... Depth ...~. ~ ..... Height ........ ~ ....Number ,~f S~ories ......... ~ ~.~5( )f .............................................. 9. Size of ~t: Front ....... ~. ~2... Rear ~ ~ ~ ~ ....... ~ ~/.~.. Depth ...... a~.~.~.7 . k~b~ $ 10. Date of Purch~ase ............................... Name ~f F~mer Owner .... ~ ....~/.kU. ~J=? ........ 11. Zone ,or use district in which premises are situated ........... ~ .... ~ )4 Y~). ). [~. ~. 7 ~/~ L~ ............. 12. ~s proposed con. st~ction vi,o]a~e any z,~ing law, ~ordinanee or regu]ati,~ ......... y~.~ /' '7/~/ eq~e~/5'-'-' . ........ ~J.~ ~ ~ .... ~e No ............ 13. Name ,of Owner.oi premises ...: ........... w.;... ~uuress Name of Architect ............................. ~ddress ..-~ ;(~. ~.[. ?/. ~ ~.. ~ Ph,vne No ............ ....... .... .... .......... - . Name ,of Con~ac~o.r A/ . ~ I,, ~ ,NI. ~l~/Addr,,~ ...... .~.~:('. [(~('~.~.. Ph,~e No. PLOT DIAGRAM L,ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensi,ons from p.r~o.perty line,s. Give s~reet and block number ,~r de script}on acoording to deed, and show street names and indicate whether interior ,or co~ner ~ot. I_ STA~ OF ~EW YORK, COUNTY OF .............. ) ................................ -<~..I ................ being duly swo~n, ,deposes and says that he is the appli- (Name ~of in.dividu.al signing ~pp]icati. on) cant above named. He is the .................. ~ l~ .... ~ .l~:. ~% ......................................... (Oon~a~or, ag.e~t, o~o~ate .officer, etd.) of said owner or ,owners and is duly auth. ovized t,o pe~rm or have pe~ormed the said w~k and to. make and file th~s applicati.on; that ali state.merits oontained in th is application a~e, tree to the bes~ of his knowledge and belief; .and that the w~k will be pe~mme.d in the mann e~ set ~orth~ in the applicatio,n filed therewith. Swo~n ~o before me this (Signture of applicant)