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Home My WebLink About4138-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 2..~C.CI~ ..... Date ............. .April · .6 , 197~, · THIS CERTIFIES that the building located at . .Diedrick~.s -Ret- Plt~? ..... Street Map No.. ~ ........ Block No...la; .....Lot No.xa~x.. Orient,..~.¥. · ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... l~ov ....25' · ', 19.68' pursuant to which Building Permit No. 1+138Z.. dated .......... Nov .... 25 ...., 196&., 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 t'r&vate..one..i'.an~il.~; .dwe.lling ........................................ The certificate is issued to .James. k~oti, n.. · of the aforesaid building. Suffolk County Department of Health Approval .O~ame.~ ............................ (owner, lessee or tenant) UNDERWRITERS CERTIFICATE No.. lg..R. ........................................... ItOUSE NUMBER..1.785. .Street .... D. iedrick ! s. 5:,d.. ~-..,.'~ J.. ~ .~i. ~ ............. Building Inspector I~0zero NO. :l TOWN OF SOUTHOLD BUlLiNG DEPAKI*MENT TOWN CLE~IC~ OFFICE SOUTHOLD, N. Y. BUILDING PIP. MIT CTHIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL FUI./ COMPI. ETION OF THE WORK AUTHORIZED) N? 4138 z e'er... ~tAYlE$ ~'7~g)EPLIN ~....e.,.~ ............. ?~.~.~ ...... .~./..~..~..0. at premises located at ........................................ ?.,.. ....... .................................................................. ~../.~.~ ...... ~ ................................ i ...... : ............................. '~'~:iii~.;.'.'~;':~Ji~J~ ...... : ............ pursuane to appl{cation c~rea ................................... , ly ...., cma approvea oy mo Building Inspector. Building 'tOWN OF ,~J'i'l, lOt~ ....-- -- . , . TOWN CLEI~K'S OFFICE Examined ................. ~ .................... , 19..)...~ / ,', ~ .--',_ ..-, Appliccrl~on No ......, ...................... Amrc~ ........................................ , 1~ ........ Pe~it No ............................. D ~ ~/~ .............. ~ ~.. .... ~ ~ · ,/? ................................ ~'~'~;l'~/~'~"i~' "~i ................................. o.- ,~/,._ A'FLI~TION FQ~DIHG FERMI? ,.~, ....... o.~ ............ .~;.~ .................. , ~..~.~. INTRUSIONS a. TM~ application must be completely filled in ~y ~*riter or in ink and ~ubmit~ In~r. ~. Plot plan s~o*in~ I~ation of lot and of buildings on Pr~mis~s, ~lationsMp t~ ar~as, and girlng a d~ailed do, tiglon of layout ~ prap~ must ~ dm*a on t~ diagram c. ~ *ork c~r~ by tMs application may not be ~om~n~ed ~for~ is~ of Bull~in~ p~it. d. Upon ~p~al of t~is application, t~ Building Insp~ctor ~ill i~u~ a Building ~r~it to t~ ~pli~nt. Suc~ ~rm~t s~all be k~pt on t~ pmmis~ arailaM~ for ins~ction t~mug~out ~ ~r~ ~f t~ *ork. · ~. No building s~ll ~ occupied or used in t~ol~ or in p~rt for any pu~ ~atev~r u~til s~ll ~ar~ be~n g~nte~ ~y t~ Buildin~ Inm~ctor. AP~LI~TION IS ~REBY MADE to t~e Building D~pa~m~nt for t~ iss~a~c~ Building Zon~ Ordinanc~ of t~ To~n of ~uthold, Suffolk Coun~, N~* York, R~gulations, for t~ construction of ~uildings a~dition~ or alterations, or for m~al ~ applicant ~s to comply ~it~ all applicabl~ I~s, ordinance, building c~, ~sin~ n ......... .................... , .,? ......... (~gnatum of appl cont, ~r ~~) ............ ....... ........ (A~ State thet~r applicant i~ o~r, I~ss~, agent, arcMtect, ~ngin~r, ~n~ral comractor, ~l~ctri~ian, ~lu~r N~e of ~ner of ~remi~ ................................ ~...~ ........................................................................................... 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. Map No.: ........................................ Lot No.: ........................ Street and Number ...~....I.'..~.......~ .................................................... ....~...~..~:.~...~.......~....~ .................. ,....i ........... ~*/- / 7~,'~~ ~.~.,~--.4 '~,~ p,,.~ ~ Mu.~c~,~/ 2. State existing use and occupancy of premises and intended use and o(:cupancy of' proposed construction: a. Existing use and occupancy ........ .~...c?....n~...C'~. ............................................................................................................. b. Intended use and occupancy ......... ..~..~'~IJL~9.DJ~B. .............................................................................................. 3. Nature of work (check which applicable): New'B6i'l~ihg '. ................. Addition : ................. Alterotion ' ~ Repair .................. ~emoval .................. Demolition .............. .... Other Work (Describe) ........................................ 4. Estimated Cost ........... ..~...I...o..9.g ........... ,'.i ....... ....... ~ . Fe~ .?i 'i ,, i ................................................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... i..... ............ 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 ..... ~1..~ ................. Rear i'~.~'. ................... ii... Depth ...~....~..;...i ...... Height .....)...~...! ........... Number of Stories .... /. ............... ~ .................................................... : .............. ~;..i ............. i...., Dimensions of same structure with alterations or additions: Front ....... .~...~. ...................... Rear ....~..~.. .................. Depth ........~'..~.. ................... Weight ...... ~..7,.~. ............... Number of Stories ...... ./. ........................ 8. Dimensions of entire new construction: Front .......... ~..J....'~.. ................. Rear ....... 4..~. ............ Depth .....~.. ............. Height ....~! ............ Number of Stories ....... ~. ............................................................................................................ 9. Size of lot: Front ......... /...O.....~.¢. ....... Rear ....... ]..~....~.,..~ ............. Depth ....~....~'..~.,...~..c/. ..... 10. Date of Purchase ........................................................ Name af Former Owner ........................................................ 11. Zone or use district in which premises are situated .............. ...O.....~./...~...~...~..i ................................................................. 12. Does proposed cons. truction violate any zoning law, ordinance or regulation.;> ...... .~....o. ............................................... 13. Name of Owner of premises .....~.....~...e.~..~.~.~....o~>...!!:..~'...Address ..... ~...~./:..~..~.~ ............... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~..~....u~..~.~.~.......(4~.{.LJ.!:..a...~,,~ ...... Address ...~D..~..~...~-..~..~..~ .................... Phone No.~..~...~.Z..~...~....c~° PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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' YORK, COUNTY OF ................................ ~'~' ................................. ~ ......... Z~ ...% ............................... being duly sworn, d~oses and says t~t he is the applicant (Name of individual signi~ application) . ,h. .......................... ............................................................................................. (Contractor, agent, co~orote officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed the said work and to~ke 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 manner set fo~h in the application filed therewith. Swom to before me this ..... .......... ................................ , ............. ........................ N~ARY PUBLIC, ~¢~; of ~ y~k Coun~UffFOL~ (Signature of applicant)