The URL can be used to link to this page

Home My WebLink About4153-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. 32.00 ..... Date .......... D.e¢~. l~ .......... , 19.69. THIS CERTIFIES that the building located at .... E/~, South 14arbor .Roa~;treet Map No.. ~; ........ Block No..;~kl~ ...... Lot No...x~ ..... ~oUtho.].d .tl,~. ........ conforms substantially to the Application for Building Per'mit heretofore filed in this office dated ........ Dec...12 .... , 1968.. pursuant to which Building Permit No... ~+J.~3. Z dated ........... D~ ... ]~.., 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~iw~.~.e. o~e .far~ly. d.~lli~g ......... ~ ............................ The certificate is issued to lYly~on. ~. l~eab¢~¢l~. .... .0~ll®~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~/llJ,~. r..I.~... ].~9...by. ii.,..Villa.. Building Inspector # FO~I ~0. ~ TOWN OF SOUTHOLD BUILDING DEPART/v~ENT TOWN CLERK'S OFFICE SOUTHOLD, 14. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 153 Z D~e ........................ ~,e~ ....... ~12 ............ , Permission is hereby granted to: .................... ~.~l~t~a. ,~ ......................... to ...... ~1~ ..~v.. ~..~y..4~e~.~ .............................................................................. ot p~m~s~s ~ted ~t ............ ~/~....,a~b~-.~"~"~**~'~ .......................... ............................................ ~1~,...~.~ .................................................................................. pursuon~ to application doted ............................. ~ .......... ~* ........, 19.~., and approved by the ~uildin~ Inspector, S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: at T~e sewage disposal facilities for a structure lo~c.~ted (Give deed 1, have been inspected by this department and found to be satisfactory. Distriot Engineer District Engineer '- ' T,, -~,.. J*.~ O.'~<, ~,,-.1~, r,,~. TO~ ~ SO--OLD . / ~ BUILDING ~AR~T ~ ... ................. ............. ......................... Date J ~ 19~ ~S~UCrlONS a. This applicat~n must be ~mpletely filled in by t~pe~ter or in ink and submi~ in d~plicate to the Building ~s~. b, PI~ pl~ showing ~cation of ~t a~ ~ buildings o n premix, ~lat~ip ~ a~oin~g p~mi~ ~ public s~ ~ ~, .~d giving a d~ailed description of lay out of p~p~Y must be d~wn on ~e di~am whi~ is pa~ ~ ~ ~pplie~ti~n. c. ~ work ~ve~ by ~is applicat[~ may ~ be cummenced bef~e i~uance of ~flding Pemit. d. U~ ap~v~ ~f ~is applicuti~, the B~ld~g I~ spear will ~sue a Buil~g P~it ~ the applicant. Su~ ~it sh~ ~ kept ~ ~e p~mi~s available for ins~ti~ ~ughout ~e pm~ ~ the ~rk. e~ No building sh~l ~ ~pied or u~ in whole e~ ~ p~ ~ .~Y pu~e wh~v~ ~til ~ Ce~tca~ ~ Oc~p~cy ~1 ~ve ~n granl~ by the Buil~ng ~sp~. ~CA~ON IS ~Y M~E ~ ~e Building D epa~ment f~ the issuan~ of ~ ~il~ing P~it pu~uant to the Bufld~g ~ O~in~ af the..~wn of ~athold, S~lk ~ty, New Y~k, ~d o~er a~ble Laws, Or~nees or ~la~ns, f~the ~n ~ buildings, additi~s ~ al~ations, ~ f~ ~v~ or dem~ lition, as h~in des~i~d. The applicant agr~s ~ eom ply with all .applicable la~, o~i~nces, building ~e, h~sing ~e, ~ re~l~tions. ~~~~.~.~~ ........... .... .... ~' (Si~ture ~ ~pplicant, o~ ~e ~ · ~rat ) (Ad ~ ~'~,' ~,. , . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................ ~: ....................................................................... i .................................... (Name .and title of corporate c~ficer)rk dl b done Ma NO ~ Lot No ~ 1. ~ion .of land on which propo~ed/~vork ~vill~b~O ~! p ....... .~ .... .~ __ ............ Street~and Numbe.~...~..~...~....~..~ · .~ ..,.. · .~ ................ State existing use and occupancy of prem~ and intended use and occupancy of proposed construction. a. Existing use and occupancy . :~. ;. ·; .................................................. b. Intended use end occupancy .~~.~~" .................. ~ .............. ' / 3. Nature of work (check which applicable): New Building'~ ........ Addition ........ Alteration ........ ~ 4. EstimatedRepair ...... ,Cost,'" Removal.~ ~..~.... .... .. Demolition. ..... ~.Other Work (Describe) ...................... ................. : ..... Fee .~Z.~. ............................................ (to'be paid on filing this application) 5. If dwelling, number of dweni_ng units ..../. ..... Number of dwelling nits on each floor ../ ............ If garage, number of cars .~. ................ .u. 6. If business, commercial or mixed occupancy, specify nature and extent of each tFpe of use....---~. ......... 7. Dimensions of existing structures, if any: Front ...'~m-T.. .......... Rear ............. Depth ............. Height . -- Number of Stories --~ Dimensions of same structure with alterat~0ns, or additions: Front .............. Rear ............... Depth ..... , ........... Height ................ Number of Stories ...................... 8. Dimensions o.f entire new construction: F,~t, ... ~"~.. ......... Rear .~.~. .......... Depth .~. ......... Height ~..x. ...... Number of Stories . .~.~'~ ........................................................ 9. Size of lot: Front ./Jg.. Rear ./.~..~" ... Depth ./~. O . D ! .............. 10. ate of Purchase ............................... Name of Former Owner . ~, ~..~.~, 11. Zone ~r use district in which premises are situated .................................................... 12. Does proposed con~tructio~u violate any ~ning law ordinance or regulation? ........................ 13. Name of Owner,of premises~%..~.-~. A(tdre~~ Name of Architect ............................. Address ...................... Phone No ............ Name of Contractor ............................ Address ...................... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly an 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. STA'i~ OF ~ YORK, )S.S. COUi~TY OF .............. 1 " ' ap~ii'c'a't~i'''''' '°'being duly sworn, depose~ and says that he is the appli- cant above named. He is the ... (~'~.: ............................................................ (Oontractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application axe true to the best of his knowledge and belief; .and that the work win be p~ed in the mann er set fortN in the application filed therewith. Sworn ~o before me this ~'~ ~__'~' .~.~. 19~.~/'/' '//x~"~' '~ A .......... day of ........ · . ....................... Notary Publi~c, ........ (~ounty (Signlt~i~e 9t~ applicant) 0. 52-050S300, Ierm [~q~ire~ March 30, 1~.~_~