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Home My WebLink About4502-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. 2~ '3683 .... Date ............ THIS CERTIFIES that the building located at ][f~l. L~.~%on- .DX* ........... Street Map No. :r~ .... Block No. ~ ..... Lot No. XX .... Mo~l~;hc~l~ . .N,~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... Dc~;...]0, 19.69. pursuant to which Building Permit No.. I~.~02. dated ...... QOt .... Il+., 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 ... P~viYa.~ O~ .~i. ly. D~llLug ............................... The certificate is issued to Em~.l.~ ·. I,u~:~ier ......... 0~n~l~ ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . N ,.P~, ...................... Building Inspecto~ ~ouse # ~670 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 4502 Z Permission is hereby granted to: l, ee..~ee.;..,~,,~.....sal~.....l,~a~t~ ..... .... ~.-.-l,e/eea...-ti~ .................. ~ .......... : ...... '. .... to ......... ~o..lm~tii..em-.e~.tlea..ll..~m-.~.t~mm.m..e~e~.4me;~;l.t~ at premises located at ............... ~l~.~k.~/lll~ ............................................................................... ........................................................... ~!~ ........ .1I~, .............................................................. pursuant to application dated .............................. ~l .........~0. ....... , 19..~9., and approved by the Building Inspector. Examined ......~....../....~... ........ , 19....~..~ TOWN OF SOUTHOLD / SOUTHOLD, N. Y. Disapproved ,a/~ .................................... 7 ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be ~ompletely 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 detailed description of layout of property must be drawn on the diagram which is port of thie application. ~ c. The work covered by this application may not be commenced before issuance of Building Permit. ~ d. Upon approval o,f this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ~ shall be kept on the pre~nises available for inspection throughout the progress of the work. ~ e. No building shal~ be occu. pi~L ar L~'-,~d iz3whole or-d. part-forany-purpesewhotever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREI~ N~ADE to the Building Depa.rtm_ent for the issuance of a Bull '.c~. Permit pursuant to the Building Zone OrdinanCe o~-the Town of Southold, Suffoi~, ,.~,,~y, New-iYork, and other appli.cable Laws, Ordinances or Regulations, for the constrg~tior~ of buildings, additions o~ alterations, or for removal or dem~ition, as herein described, ce The applicant agrees to comply! with all applicable laws~3rdinances, I~ilding code, housi~3~ code, and regulations. ~ : (Signature'of ,e~plicant, or n~q:ge, if a,eorporat on) /~ -~ ......... ' (Address of applicant) / State whether applicant is °Wnei', lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~Z..~Lr~.t~...~ ................................................................................................................ If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 2~;~26, 27 1. Location__of land on which proposed work will be done. Map No.: ........................................Lot No.: ........................ ....... Loet, on ]~*ive. Sour, ho3.. N, Z, Municipolity 2. State existing use and occupancy of premises and intended use and occupancy of prap~ed construction.' a. Existing use ond occuponcy ...s~.e.~..~.e..s.~.d...e~...e..e.~ ............................ . ................... ~ .............................................. b. Intended use and occupancy ............ ~ ....................................... : ........... ;,.~,~ ....... ; ............ .Z. ....................... 3. Nature of work (check which applicable): New Building .................. Addition ~r ' Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe} ........................................ 4. Estimated Cost ......~....0~.......0~.. .......................................... Fee .......................................................................................... (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 ...~..2...~ .................... Rear ..~..2...I ......................... Depth ..~..I. .............. Height 6 t~ § t Number of Stories - . Dimensions of same structure with alterations or additions: Front :[6t Rear. ].6 t I - Depth ........ ~.. ..................... Height .6.....tg....8..! .............. Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height ................. ;..; Number of Stories ................................................................................................... 9. Size of lot: Front ..~,,~(~ .................... Rear ....~) .......................... Depth ......~ZI,. ~0 ................... 10. Date of Purchase ....... : ....................................... ~ ........ Name of Former Owner ' 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed constru,ction violate any zoning law, ordinance or reau at on.;> .a..o. ............................... 65 Bremmesdow Tame '"~1~"~"~'~'~'?" 13. Name of Owner of premises .~.....[~....s..t,..e..r. ............. Address .[~an~g~l~s..li..y~, ........... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~ A, Iiie~e~, ..................... Address 63 [~jretea ~._..~.. Phone No.P,A.3..,~5~... ..................... · m%'it~'~6~" ~t~. 'l~i' ...... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from whetherproperty interior lines. Give or corner street lot. and block number or description according to deed, and Tow street names and indicate l STATE OF NEW YORK, tee COUNTY OF ........ , .............. ........ '.'.....:..~...,~..../.~.l~.......~..~...y.~.....~....~....,~....,. .............. being duly sworn, deposes and says thaL~he is the applicant (Name of individual signing application) . . above named~-Ie is the ....... ~.....~../l~....~....~...~ ........................ ' '. .... .. (~g icer et .) o ' er or ow , 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 applieat~n 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. Sworn to I~efore me this .~ n' ,/,,,~,,, ~- ~f q , - , ....................... 9~Y/° ............;..'/9, ...... /~x; ............. , I~...../... · UYST)~R. · ~x~ires Z,~arch 30,