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Home My WebLink About4503-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Zt~262. Date THIS CERTIFIES that the building located at Map No. X~ . Block No. ~;~ · Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 0et · lO , 19 69 pursuant to which Building Permit No. ~0~ dated -Oe~ ll~ , 19. (i~ 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~Iva/;e. Ola~ f~. ¢tW, ll;h~ .......... The certificate is issued to E1;~Z&beth EeCane$ .... (l~ae~' (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval lt,ll ................... Building In~ector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) N? t503 Z Permission is hereby granted to: ............. ...~,~m~..Z,e .................................................... to .. .......... ~1~.. ~111~.. ~ .. ~.-.~~ ................................................................. : ....... at premises located at ...................... ~lll~..~.t~ll.....~t.~.~t.~rdl~e..~ .................................................. .............................................. %%mlm~m~m..;Kma~Um~ ......... ~,%. ............................................................... pursuan¢ to application dated ......................... l~ltt~ ......... ~JO ............. , 19.~jlt., and approved by'the Building Inspector. J:ee $..~OeOl~L ......... FORM NO. 1 .[OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~...../....(~ ........ ,19.....~...~ Approved c~ 19.....~... Permit No. /-/,5'~C~ 7--- Disapproved a/c~ ............................................... _ ""L": ...................... ................................. APPLICATION FOR BUILDING FERMI'[ D~te October 10 ]9 69 INSTRUCTIONS a. This application must be completely_ filled in by typewriter or in ink and submitted in duplicate to the Buildin, Inspector. ~ b. Plot plan showing Iocahon of lot and of buildings on premises, relationship to adjoining premises or pubhc streets c areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio, 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 perm shall be kept on the premises available for inspection throughout the progress of the work. e. No building sl~tl be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY/V~DE to the Building Deportment for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances , Regulat,ons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. .A., John Gada General Contracting. Inc. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant ,s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Contracl;er Name of owner of premises ..F...Z.?....z[..~..b..e...l:..h....~..,.,...N..c.,C.?..~.c..e. .................................................................................................... If applicant is a corporate, signature of duly authorized officer, // ............... .. nL .. (Name and title of corporate officer) x~/ ~,.~-c.---C/,~ 1 Location of land on which praposed work will be done Map No.' ...... .N..o..z?.e.. ......................... Lot No.: ..................... Street and Number ..... ~'.9~;..Av.e~tltl~'.,z~ld,.~a.gL~..~.,~a. ce ............................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ......... ..~.~.~.~9.~1.1;I~i%Z. ............................................................................................... b. Intended use and occupancy ....... l?~es£cle~ce ................................................................................................... 3 Nature of work (check which apphcable) New Budding ..... ..~. ......... Addmon .................. Alteration ............ Repair ................ Removal .................. Demohhor .................. Other Work (Describe) ...................................... 4 Estimated Cost ...~.4...O.,..0..0..O..~..0..O. ................................. Fee ..........~.O..e..O..O. ................................................................... (to be pa~d on filing this apphcation) 5 I~ dwelhng, number of dwelling umts ...................... Number of dwelhng units on each floor ........................... If garage, number of cars .......................................................................................................................................... 6 I[ business, commercial or m~xed occupancy, spec,fy nature and extent of each type of use .......................... 7 Dimensions of ex~stmg structures, ~f any: Front ............................ Rear ................................Depth .................... Height ....................... Number of Stories ............................................................................................................... Dimens~ons of same structure with alterations or add,hans. Front .................................... Rear ......................... Depth ................................Height .......................... Number of Stories ................................ 8 Dimensions of entire new construction' Front . . ~..O t .O.t.*. .................... Rear .....4'..O.L.'.g.'.'. ........... Depth .....2..~..'...'~...'.t. .... Height 20~"'0' Number of Stories 9 Size of lot' Front .S..~..?....~.}.~.~...o~..ff.d... Rear .......................... Depth ............................ 10. Date of Purchase 1964, Name of Former Owner 11. Zone or use distr~ct in which premises are situated ..~.~.~,~.~,t~1~.¢.~.~,~, ................................................................... 12 Does proposed construchon wolate any zoning law, ordinance or regulation~ .......................................................... 13 Name of Owner of premzses ]Z]$..~.~I~.~.~..~.~. N~.i~r~t~idress~.~,.$~e~...T,~,~l,..~x.-lr., .... Phone No. '~..8..8.~..~.~g.... Name of Architect ...?.~...~gg.o.~.~. ............................... Address~.s...b.~...~.Z..~..g.d...~....¥.? .... Phone No ................... Name of Contractor .A.~ ..~.o..~.~....~..~.d..~.. ...................... Address .?..~,.s..b.?..~.~..~.~.~..d.....N....~.,.. Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate QII set-back dimensions fro, property lines Give street and block number or description according to deed, and show street names and indicat whether interior or corner lot See Attached STATE OF NEW YORK, ~ S S COUNTY OF .S..~.o..Z.M ................ ~ · · ..................... .~..:..r.O'..O..~..~....~.~..d.?....~.~..". ..................................... being duly sworn, deposes and says that he is the applica (Name of ,nd,vidual signing applicat,on) above named He is the ................ .C..o..n...l:.~.~.g..t.9.~ .............. ~..~ ......... ....(~'.,~1~ ~:¢~m~..~. .............................. 'il~or~t'~actor, agent, corpor~l~ officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make a~d f th~s apphcahon; that all statements contained ~n this application are true to the best of his knowledge and belief; a, that the work will be perform~e~zl ]~;/th. ej manner set forth in the application flied therewith Sworn to before me this XO~h 0 tober_ 69 ........................ day of ...~[,.~.,~;~/~ ................... ,19 ....... ~-~ ~ Pul)lt~, Stye 0! ~e~ ¥0r~ .... ;~.~../r/c..~r.r..'~,~. ..... .-:...~ ............ .~ .............................. Notary Public, ...~Idm~m~t01~t~...~ff-.l~.62-~]~l? ......... Count~ ~// (Signature of apl~cant) [~ommlsslon Expires March 30, j ~'~ h tflX" o' ~ // ~P ~'~ I j I j I I / i