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Home My WebLink About4159-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Jb'~Sbr ..... Date .......... A.ugll~.t..2! ....... , 10.7.3. THIS CERTIFIES that the building located at .6185.0 .~/~..l~tn .P~O~ .... Street Map No... ?.~.' ....... Block No...~.. ...... Lot No...X~.....~..u.t.h.o.1..d.~. ~: .Z.o ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .D?.c.t..27. t, 19..5.8. pursuant to which Building Permit No.. dated ............ Pac,. 2~t ., 1968., was issued, and conforms to all of the require- ments o£ the applicable provisions of the law. The occupancy for which this certificate is issued is .. ~u$1r~s$. t~utldtn~:Fl~h~ng. ~tai;:k~n. & ~;o1'.~ .................... The certificate is issued to . 141.ehae:[ .J ,. l~Orl'll .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No....P.~n~l:131g ................................. HOUSE NUMBER . .6~.8.~Q ...... Street . .l~a~, ~O~d.t ............................ .................................................... ~o~.t~ol~.~..1~, ~*... ........... Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4159 Z Permission is hereby granted to: },9// ]/J9 - ' ///~'~/ ... Z,(.../..~:~.:~. to ...... ~ ................................... ~ ........................................................ ;x.. ........................... .................................................. 7"," .................... T ........... ~'Z' ....... %'; ....... :'"'~"~'"~ ............. at premises located at ................. ; ................ ./~'.... ...... ~/.~/../..~....................~. ............... pursuant to application dated ,a~ ~ "~'~' ~ 19....~?.,~and approved by the Building Inspector. Building Inspector Approved ...................... 19 .... Permit No,.. ,~_,~:....,~ ~ · ._.~. · · Disapproved a/¢ ............................................... /. .... APPLICATIOn'S' FOR BUILDING P~RMIT INSTRUCTIONS Application No ................. Date .................................. a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building lnspectm'. b. Plot plan showing location of k~t and of buildings o n premises, relationship to adjoining premises or public streets or areas, .and giving a detailed description of layout of property must be drawn on the diagram which part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building In specter will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspectio~ throughout the progress of the work. e. No building shall be occupied or used in whole o~ in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building InspeciX~. APPLICATION IS I-ij~el~y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building ~one Ordinance of the Town of S~uthold, Suffolk Oounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable la' housing code, and regulations. ' State whether applicant is owner, lessee, agent, }~rChit ect, engineer, general contractor, electrician, plumber or If applicant is a corporate, signature of duly authorize d officer. ., ordinances, building code, , .name if a corporation) 4_1 of applicant) (Name and title of corporate officer) 1. Location of land on which proposed work will b e done. Nap No ................. Lot No .............. ............................................... ' " 2. State exis~g use and ~cup~cy ~ premiss ~d intended use ~d occu~cy of p~ ~ction. a. ~isting ~e and occupancy ................................................................... b. Int~ded ~ ~d ~cup~cy ................................................................... 3. Nature of work (check which applicable): New Building ........ ddition ........ A1 ........ Repair ......... Removal ........ Demoliti,on ........ Other W.o..vk (Describe) ...................... 4. ~stimated Cost ........ t. ~. ~ .................. tee ..... 1. .......................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... 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 .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of Stm'ies ..................... 8. Dimensions ,of entire new construction: Front ........ ~..~. .... Rear ..... ff...~..... Depth ,....~'....O... Height .... ~..O.... Number of Stories ....... .~..Al..~.~. .............................................. 9. Size of )or: Front .... /..~. ~ Rear / ~ ~ . Depth ... ~....~. ?. 10. Date of Purchase .......................... .~.~.'-~'.~. .... i i::iI~ of Former Owner'"~'..~,e~.~~ ......... 11. Zone or use district in which premises are situated .......... .*:~..: :.....~...~..~. (.~.~..--.~ .............. 12. Does proposed conatruction violate any ~ming law, ordinance or regulatkm? ....... . .~'~'~'~'~'~'~'~'~...'-? ............. 13. Name of Owner.of premises .~..~..~'. .F(~..~.?.l.~'ddress ..~.~..~.~/...~..]~. ....... Phone No.?.~.~.~:..~..gl..OO Name of Architect . ..~..I.D....~..~. ................ A'ddress ...................... Phone No ............ Name of Contractor ....... ..~...~...~.0.../~. !..~-~..... Address ...................... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether e xlsting or proposed, and indicate all set-back dimensions from pregexty lines. Give s~eet and block number or de scripti, on acoording to deed, and shew street names and indicate whether interior or corner lot. ~ STATE OF N~W YORIf, )S.S. COUNTY OF .............. ) /'/-~ .......-- ~./. ~- l~//~ /~-L.. )~ ~ ~L~ ... being duly sworn, ,deposes and says that he is the appli- (Name of individu.al signing applicati,on) cant above named. He is the ....................... /~..~-..~.~..~..?. ........................................ (Oontraetor, agent, oorporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said v(~rk and to make and file this application; that all statements oontained in this application ave true to the best of his knowledge and belief; and th'at the vc~rk will be p~ed in the mann er set fortl~ in the application filed therewith. Sworn to before me this ................ ILS.z_ .'iJ , :: 1 I-