The URL can be used to link to this page

Home My WebLink About4144-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. 2~.3.4~3 ... Date ......... ~y ...... ~., ......., 1969.. THIS CERTIFIES that the building located_ at . .i~I~.a~;h~ .P~.tJ~ ........ Street Map No ............. Block No ........... Lot No....SOUt:ho~L~ .~/~¢~..Yo~rk ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... D~cemb.e~:...4.~ .... , 19 fi8 ~ pursuant to which Building Permit No...4.~44. ~ dated .... D.e.¢er~.~...4., ..... , 19 .~8., was issued, and congorms to all of the require- ments o£ the applicable provisions of the law. The occupancy for which this certificate is issued ~s ...px±v.a~:e..o~e. ~at~.J.X¥..c~.~.ng ..................................... The certificate is issued to ...~o~e.ph. I~1¢ ........................................ (owner, lessee or tenant) o~ the a£oresaid building. Suffolk County Department o~ Health Approval ..................................... ;Building Ins~;(~4~r .... TOWN Of SOUTHOLD BUILDING DEPARTMENT TOWN CLARK'S OFFICE SOUTHOLD, N. Y. lUlLDING I~lU~rr (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4144 Z Permission is hereby gronted to: ....... .~., .. 4r~el~.. {tee~ ................................... at premises located at ......... I~(~.....{i~lMlt~...~l,t, lk .................................................................. 8o~tho{.d 'IL'Z, pursuant to opplicotion dated ............................... .D..?..O, .......... .~.. ......... , 19....(.'..8., ond opprovad by the Building Inspector. F~ $.{.Oli ............. Budding Inspector ~F'ORM ,NO. 1 TOWN OF $OUTHOLD BUILDING DEi~A RTMF-N T TOWN CI~ERK'S OFFICE SOUTHOLD, N. ApproYed ., 19 .... Permit No... Disapproved a/e ...::.:: .:'.: .%.: .'.'::., ............ .~.~.,_~z.,:..,-~, ,~* .~,,. ~.~:.: .... Application No.. INSTRUCTION. S a. This application must be completely filled in by typewriter or in ink and .submitted in duplicate to the Building Inspector. b. P~ot .plan showing location of ~o't and o{ buildings o n premises, relati~anship ~o adj,oining premises or public streets ~' areas, and giving a de{aile,d description of layout of property must be drawn .on the diagram which is part of this application. c. The work covered by ~is applicati, on may not be commenced before issuance of Building Permit. d. Upo.n approval ,of this applicatf.~n, the Building Inspecbo~ will .issue a Building Permit ~o the applicant. Such permit shall be kept ~n the premises available for inspection $hrougho~t ihe progress of the w~ork. e. N.o building shall be occupied or used in whole o~ in p~ ~ ~any purpose whateve~ until a CertificCte ~f Occupancy shall have been granted by the Building Inspect. APPLICATION IS H~BY MADE to the Building Department fo~ the issuance of a Building Permit pursuant ~o the Building Zone Ordinance oI the ~wn of S,~athold, Suffolk ~nty, New ~k, and o~er applicable La~s, Ordinances ,or Regulations, for the conslruction .~f buildings, additi~s or alterations, ,or ~or removal or demo- lition, as herein described. The applicant agrees ~o corn ply with ail applicable laws, ordi~nces, building code, h.3usingcode, a~dregutations. ;~;~ ~:~ ~X~ ~4 /. .......... '.. .......... .... :... ' ',}f~i~i~;;:o~plicant,.or. name if a corporation, (Address of applicant) State whe[her applicant is owner, lessee, agent, areh[~ec[, engineer, generM eontraet~, electrician, plumber or budder ........................ ~ ..... :. ~. · .. ...........-2~ .................................................. Name ~of ~owner of premises ..~?~.~/.~.~:~.~ ................................................. If applicant is a eorp.orate, s~gnature of duly auth,orized ~fficer. (Name and title of corp,,rate officer) 1. I~ocati. on ,of land ~).n which prexposed work w~ll) be .done. Map No ...... .X ....... Lot No .... ~ ..... Street and Number ... ! .zh..;, ................. ~ ......... ~ ..................................... Municipality 2..State existing use and .~ccupancy ,o, prem~i~s~aCn..d~tended use and .occupancy of proposed oonstruction. a lExisting use and occupancy . ./. · · ~2~. · ."¢A~. · ~..~ ............................. b. Intended u,se anal ~occupancy ....... ~ ....... ~ ........................................... 3. Natnre of work (check which applicable): New Building ........ Additi~on......../ Alteration ........ Repair ......... hRemoval ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Costal .',~..5~?.. ~..? .................... Fee ............................................. (to be paid ,~m filing this application) 5. If ,dwelling, number .of dwelling units .. [. ...... Number ~of dwelling units on each fl,eot .............. If garage, number ~of cars ....... ./ .................................................................. 6. If business, commercial ~r mixed occupancy, specify nature and extent ,of each type of use .............. 7. Dimensi~ons of existing structures, if any: Feint ~q .r .......... Rear ...~.~.~. ~ ...... Depth ~..~. I ........ :Height ................ Number of Stories ........................................................ 'Dimensions ,of same structure with alterations .or additions: Front .............. Rear ............... 'Depth ................ Height ................ Number of Sl~ies ..................... 8. Dimensions ,of entire new construction: F~nt ................. Rear .............. Depth ............ Height ............ Number ~uf S~ories ............................................................. Size of l~ot: Front . . ./..o.?. ~ .......Rear ./..t?.~.~.' .........Depth . ./.~.~..' ..... ~,~ , ~ ,___~ 9. Date of Purch, ase .~.../. ?.~...o~. ............... Name ~f Former Owner ~. ~...." .~ ./~......~tfe~ 10. 11. Zone ,or use ,district in which premises are situated .................................................... 12. Does proposed construction/v~ola~e ~a,r)~ z,?~ing ~_w, ,ordinance or regulati,om? . ~.~..~ ...................... 13. Name ,of Owner,of premises~ .E.]./.~.;:2 ..~.: .--~ddress ...................... Phone No. 7.e...~:,..:¢..~.7 Name of Architect ............................. A'ddress ...................... Ph~ne No ............ Name ,of Contractor ............................ Address ...................... Phqne No ............ PLOT DIAGRAM Locate clearly and diatinctly all buildings, whether existing or proposed, and indicate all set-back dimensi,ons from property lines. Give stirrer and bl.ock number ,ar de scripti, on ac¢ording to deed, and sh.ow street names and indicate wheiher interior .or corner ].et. STAa~ OF ~E~_~_ )S.S. COUNTY~ ~L~...) /(N~e ,of ~dividu.al signing application) cant ~e named. He is the .... ~.~ .............. ~ ; ....................................... (Oantraetor, a~nt, o~.o~ate officer, etc.) of said owner ,o~ ,owners, and is duly authorized 6o pe.~,~rm or have per, armed the said w,~k and 6o, make and file th~s application; that all statements contained in th is application ave true to the best of his kno.wledge and be]ief; and that the w~rk will be pe~m~me.d in the mann er set forth~ in the application filed therewith. Sworn to before me this ............ N,~aey Public~.~.~nty ...... ~ ......... ~ (Si~'of~plieant) MARION ~. REGENT Il NOTARY PUBLIG, State of Ne~ york~ No. 52-3233120 Suilolk Term E~pims ~mh 3~,