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Home My WebLink About4132-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z .344~ ..... Date Apr~tl... 1.4, ....... , 19 ~i9. THIS CERTIFIES that the building located at .~:h'~ .Ro~d ............... Street Map No ............. Block No ........... Lot No. Olgi~lt, .Nee~.Yo~k ............ conforms substantially to the Application for Building Pekmit heretofore filed in this office dated ... Noven~er.. 18,..., 19.68. pursuant to which Building Permit No...4132 .Z dated ... NOV~r...19, .... , 1968., 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 .. [zl::tvate. one. :[alalllr. ~el~aq ..................................... The certificate is issued to ........ ~'~-tlaq. 0¢. ~hllal ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Inspector FORM NO, :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE~ SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF: THE WORK AUTHORIZED) 4132 Z Permission is hereby granted to: ............. ........................................... ............... ;¥.~. ~, .¢,,~ ;.¥. .................................................. t o ..... ~.t~,~d,..a~../~,~ctt ~l~n..0~.. a~.. a~L S .~,'bng..a ee t~ ~o~... l/~ ~:,~&lg~-. A. ~pa/v.. ~ho]p ) at premises located at ................... ~/~.....~.;~,~:l..tit:r~ ....................................................................... ............................................................ Ol.l~k~g ...... g,,~ ..................................................................... pursuan,t to application dated ............................... ~.0~ ........ ~.~. ......... , 19~***, and opproYed by the Building Inspector. Fee $.~?,...(~,. .............. ,FORM ,NO. 1 TOWN OF SOUTHOLD BUILDING D~ARTM~NT TOWN CI~I~,RK'S OFFICE SOUTHOLD. N. Y. Examined ........ ' ............. 19 .'. ................ .................. Application No....~.~ .'?. ~.. · APPLICATIO;~ FOR BUILDING 'FERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Pl. ot .plan showing location of Lot and ~of buildings on premises, relati~o:nship t.o adjoining premises .or public streets ~r 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~an may ri,et b e commenced before issuance of Building Permit. d. Upon approval ,of this applicati.c,n, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept ~n the premises available for inspection throughout the progress .of the w. ork. e. No building shall be occupied or used in whole e ~1 in pai't f,m'. any pure. ese whatever until a Certificate ~f Occupancy shall have been gran.ted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant ~o the Building ~aone Ordinance of the Town of S,~athold., Suffolk O~lmty, New Y~ark, and other applicable Law.s, Ordinances .or Regulations, for the construction .cfi build ings, additions or alterations, or f. or rem~)val or demo- lition, as hea'ein described. The applicant agrees to corn ply with all applicable laws, ~ordinances, building code, (~i~nature ,o~61~ant, or n~me if a c,orpo~ation) ........... .............. ( · State whet~pplicant is owner, lessee, agent, architect, engineer', general contractor, electrician, plumber or uilder ..... .................................... Name of.owner of premises...ff.ff~.~z: ..... .~ ..... i-~ ..... ; ........................................ If applicant is a eorporat ,e~sisignature of duly authorize d o/ricer. (Name and title of corp.,rate officer) ~vhich prolpo.sed ~v,ork will be done. M~aNo ...... .. .......... Lot No .............. Locati,on ,of ]an,d o'n ff,~.,~. ~ .~. ~ . .~....~./.~ .~.. ~ · Street and Number .. . .~....~.. .... ,_~ .~. ~,.....,...,:,. ..................... lvlUnlclpaul:y State existing use and ,accupancy ,o~ premises an d intended use and ,occupancy of proposed construction. a. Existing use and occupancy .. £;~/ Y.../'~ ! ~ ? ........... b. Intended use and .eccupancy . : ............ 3. Nature of work (check which applicable): New Building ........ Addition ~ .... Alteration ........ Repair ......... Rerrm~al .. ~.. Demolition ........ Other Work (Describe) ...................... 4. Estimated C.~st ~. .l [fft~.O. Fee (to be paid ,on filing this applicati,on) 5. If dwelling, number of dwelling u~s .......... ~)~mber ,of dwelling ~nits .on each floor .............. If g. arage, number ,e.f cars .... <:2~-....~.~q,~...~.~,~. ~...-.~.., .................. . .......... 6. If business, commercial ~r mixed occupancy, specify natffre and extent of each tyge of use .~¢ ..... 7. Dimensi~ons of existilJ, g,,stl~uctures, if any: Front ..... ~. ~.P/T.~..~. Rear ...~.~..~... Depth .:J.~] .~.; ..... Height ..... ~.~.]~..~... Number of Stories ...] .................................................... Dimensions ,of same structure with alterations .or additions: Front .............. Rear ............... Depth ................ Height ................ Number of Steeples ..................... 8. Dimensions .of entire new construction: Front .... .~ .~.' .~.... Rear...~.~..~.~ .~.. Depth .~..~.. ..... Height.../~.~.. Number ,cfi Slhories ..... .~ ...... ~'. .................. ~'-z'' '/' ....................... 9. Size of ~ot: Front .... ~2.~2 .... Rear 0.2.~.. ....... Depth OD~.l~.f~. ..... 10. Date of Purchase ..... ].~.~'~. ................... Name of ForTer Owner ~.. (.~¥~.. . ..... 11. Zone ,or use .district in which premises are situated ...... ~..~...~ ................................ 12. Does proposed coastruction v~late any Z~ning law, ordinance~g>r re_~rulati~n? .~.~. ..................... ,13. Name,of Owner.of premise~s~.../~.;).C'. ~.....A, ddress. ~1~.~.~...~ ....... Phone No3;~,~'~.~.,~.O Name of Architect ...... ~ ~ .....~ ......~ ....... A'ddress ...~, .. ,~..~. ....... Phone No ...... ~ .... Name .of Contractor . .~. ~.t/~e~ ..... Address . ~ ......... Phone No. ~..~:.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ,or 'proposed, and indicate all set-back dimensions from pm,perty lines. Give street and bI.ock number ,~r descripti, on according to deed, and show street names .and indicate whether interior ,or corner ~ot. STATE OF NEVf/~YOR~, )S.S. COUNTY OF~./~.~ ¢%... ) . .~q(.~.~. ~. ~../(/.,. ~ ~ .................... being du,y sworn, ,aeposes and says that he is the appli- (~e of individual signing applicati, on) cant above named. He is the ...~ ................................................................ (~f~-~~o~at~er,~e.) of said owner ,or ~owners, and is duly authorized ~o peff~r~ ~r have pe~orme.d the ~aid ~k and ~o, make and file this application; that all statements contained in this application are true to the best of his kn,o~ledge and belief; and that the w~avk will be peff,o~med in the mann er set fm~h~ in the applicatie~ filed therewith. Sworn ~o before me this .... /~. ........ day of N taryPublie, ..... Oounty NOTARY pUBLIC, Stere of Now Yor~ ~ Suffolk C,~'u,[y .i ...... '~ ~ / ~/(Signture of applicant)