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Home My WebLink About4151-z FO~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .~30.. ~ay. ~ ........... Street Map No.G.,l,TtTthillBlock No... $~ ..... Lot No. '1~I~ .... L~I~LT'.e~.. I~I,Yo ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Dee...~.0.., 1968. pursuant to which Building Permit No.. dated ........ Dec...lO ....... , 19.68., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...]P~l~ato..~l~e. ff. amil~..d~$Zl~ ..................................... The certificate is issued to ...~.OZe.l~h .Gi~net ........ .~ .0~-s~. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... !q.~1T, .......................... Building ,inspector F~R~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~151 Z Permission is hereby granted to: ................ .,.~...,t......~n.....~ .......................................... ............. .:.. ............. /.',~.~,t....:,....d..,,A,.-..c ............ .......................................... ....... et premises located of ................................. ~..:: ...... .-~..~.:......~,~. ...... rr..¥.r..:,,~-, ......................................... .................................................................................. ._~,.: ~,~.-c-d',, .-~. _~ .................................................. / '/ ~ 19 approved pursuon¢ to application dated ...................................................... ~ ........... nd by the Building Inspector. Fee $ ........ ~. .............. Building Inspector Examined /~) '( f/'£, ~ '~ Approved ........... ./..~...~..".~, 19 ~..~Permit No.,...~..{...?~../.., .~... Application No. Z/{./. 5-/ Disapproved a/c .......... ~'-~ '~k:" __.._.___. (Building Inspecix~r) APPLICATIO~.~' FOR BUILDING I:VE,RMIT Date ................. ./...~.....~....~.... 19~''/.... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink .and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings o n premises, relatkg~ship to adjoining premises or public streets ~r areas, and giving a detailed description of lay out of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. fl. Upon approval of this applicati, m% the Building Inspector will issue a Building Permit t~ the applicant. Such permit shall be kept on the premises available for inspectima throughout the pregrt~.s of the work. e. No building shall be occupied or used in whole c~ in part f~r any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS I-n~-~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~ath01d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as harein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, ami regulations. ..... .... .............. (Signature of applicant, or, rmme ff a corporation) ............ ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .................. ~ .... ................................. ~ ............................... If applicant is a corporate, signature of duly authorize d officer. .................................................... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ................. Lot No. /7 Street and Number . .~:~/....ZI:...ff.~. 0.....~...~'~.. ~ . .~...~ ............. ............ '~ .... ~{lnicipality 2. State existing use and occupancy of premisea an d intended use and occupancy of proposed construction. a. Existing use and occupancy .............. .-]........:.~ ........... ..... .~. .................... b. Intended use and ocCUpancy ............. -----.~.~ ....... ~ .... .~...~.~ ........... 3. Nature of work (check which applicable): New Building ........ Addition ....... Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ~. ~p t~ :~- F~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~r of dwelling units on each floor .............. If garage, number ~f 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 .~..~...~.../..~.. Rear ..... ff.. ~ Depth ...-~..~-. ...... Height ..... /.~..~-~. .....Number of Stories Dimensions of same structure with alterations or additions: Front ..... ~..~.... Rear .... ..~'....2~7..... Depth ...... ~.~.~..... Height .... ,~.~e~.... Number of S~ries .~ ......... 8. Dimensions of entire new construction: Front ................. Rear .............. Depth ............ Height ............ Number of Stories ............................................................. 9. Size of lot: Front ....... /.~. ?. ....Rear . ,..../.~. ~ ..... Depth .... ./..~. ?. .... 10. Date of Purchase ~'/~....../~..~.~....~..Name of Former Owner .~.~-~. 11. Zone or use d~strict m which 4~remmes are situated .......... ~ ~7. ................ 12. Does proposed construction violate any z~ning law, ordinance or regulation? ...... ~ - 13. 'Name of Owner.of premises .~..~'..~.~..~...~../.~..~..~,ddress .~./r..~... Name of Architect ............................. .~ddress ...................... Phone No ............ Name of Contractor . ./~..~./..~'.....~'..~..~...O. ....... Address ....'~./..P'.~. ~..~.~..~. Phone No ............ PLO'i' DIAGRAM Locate clearly and distinctly all buildings, whether existin~ 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. / 00 ¥6 ,AD~ ~-r3 0~ STA'~ OF NEW YORK, )S.S. / COUNTY OF .............. ) (Name of individual signing application) cant above named. He is the ............. (Oontraeter, a~t, ~-~ate ~i~e~, etc.) of ~id own~ ~ ewne~, and is duly auth~d ~ p~om or have pe~ ~e ~d ~k ~d ~ m~e ~d file ~ applicat~n; ~at ~1 stateme~s ~ntaln~ in ~is applicon ~ ~e to ~e be~ of his knowl~ge ~d belief; and that ~e ~k will be p~ in ~e manner set fo~ ~ the application filed ~e~. Sworn to befo~ me ~is ......... ..... ..... ...... MAR]ON A. RE~ERT ~~ ~ ............... NOTARY p~BLIC, State 0f New Y0~ No. 52.~233120 Suffolk Tsrm ~ires Marc~ ~, 19~