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Home My WebLink About4500-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Of/ice Southold, N. Y. Certificate Of Occupancy No.Z b195 Date April 20 , 19 71 THIS CERTIFIES that the building located at , S~_mmer Lane. Street Map No. Bayside. Te_vB1aebNo. Lot No. 2.5 Southol¢l N.Y, conforms substantially to the Application for Building Permit heretofore filed in this office dated .0et 9 , 19 69. pursuant to which Building Permit No. ~4~00Z dated 0et 9 , 19 69, 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 Private. one £amlly dwelling ...... The certificate is issued to Chas. L Derma. Tltrbush Cwner. s . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval House ~ 200 pending appr~aval, of C.I.s.ewer line .I , ~ ..!. ~2 I 70 Building Inspector / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,r N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4500 Z Building Inspector IPOilM NO,. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN .CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Permit No.....~. ................... Disapproved a/c .....~ ................... ~:~ ......... ..................................... .......................... .............. ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 on premises, relationship to adjoining premises or public streets or areas, and giving a cte~oiled description of layout of property must be drawn on the diagram which is port 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 Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pUrsuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housfng code, and regulations. .... (S'gnature of applicant,~br name, if'g"c;r~'~i;'~')' ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of pram see ................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~ ~:~..t~ .'~----~'t~ ~ 1. location of la~d on which I~roposed work will ~ done. ~ap No.: .............. ~.~ .......... Lot No.: ....~. ...... Str~ and 'Number ................................................................................ .~ ................................................................... / Munici~li~ 2. State existing u~ and ~cu~n~ of premiss and intended use and ~cu~n~ ~ pr~ con,motion: a. ~isting ~e and ~cu~ncy ~A C ~ ~ ~ b. Intended use a~ ~cupancy ( ~ ~ / ~ ~ ~ ~ ~L / ~ ~ .. T 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other ~n/~'k (Describe) ............ ~....;.....}/ ............... 4. Est mated Cost '/~' ,& 0 .O. O PA~ / O ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units .............. Number of dwelling units on each floor ....... ..O.._/~....Z??~ ...... 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 ....... L .................... Rear ............ : ................... Depth Height ...... .................. Number of Stories ................................................................................................................ ; Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Storie's ................................. 8. D mens OhS of ent re new construct on' Front /'/~/ ~ R~,~,, !~- C/ n~,,,~, c~ O Height ........ ./....-~. .... Number of Stories ................. ~....~...~-. ...................................................................................... 9. Size of lot: Front ........./ ~/O Rear ............ /. O O Depth //' O 10. Date of Purchase ............................... /.~.....~..~... ......... Name of Former Owner ......~....~......~......~....~..........--~...~.....~'..../~......~.. 11. Zone ar use district in which premises am situated ................................~.. ~1 ...~?. .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............... ~ ................................. 13. Name of Owner of premises ................ , ....................... ~ ................... ~_~'~.. mane r~o ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..... .A.......~..//....~.....~... ................. Address .~.! I/E'~/'/L'~I.~ ,,. 7a9'~7 --~,~._~O ......................................... mane INa ..................... 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 acoordJng to deed, and sl~ow street names and indicate whether interior or corner lot. STATE OF NEW YORK, tee COUNTY OF ................................ P- R 77-E Po/.. Y , .......................................................................................... ...~0.,o dul~, sworn, depases and says that he is the applican~ (Name of individual signing application) above named. He is the .................................................. ~ ............................................................................. (Contractor, 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 Jn this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application· filed therewith. Swam to before me this ................. ,.... da, of ...... .._. ....................... o-- ...... .~u~..~.~...(~...~. ............................... ~'~'1~ State of/Hew ¥0t/1 ~ ~?ARFI'H ~NN HEV~c~ .. k ~/ ' ' NOT/~RY I'u~u~,, _t · , 52-8125850, Suflol~ Comity ~'~rm ~pires March 30, 1~L7_~.