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Home My WebLink About4520-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. i~.~6l~ .... Date .......... Dae... ff .... ,19 69 THIS CERTIFIES that the building located at ig/$. ~rth Sea. Drive ... Street Map No...Xt~ ...... Block No..Ill; ....... Lot No...XX ..... $OUthel~ · .N.,.~., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... 0et; .... ih-, 19 (59 pursuant to which Building Permit No. 1~52O. y,. dated ......... .0.C. 1; .... 23..., 19 $9, 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. ol~e. f~il.y .dwelling ...................................... The certificate is issued to .14ignore. ~.,..Ry~ ....... Owner ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... Ii.IL~ ....................... ! ..... ........... Building Inspector k ~ouse ~ ~625 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL. COMPLETION OF THE WORK AUTHORIZED) N? 4520 Z Permission is hereby granted to: ,/ at premises located at ............ ~J[~..~.~llr~ .......................................... ~ ...... ~.:J.~. ........................ .......................................................... ~~ ....... ~'~I~' ................................. ,:"? ........................ pursu~ to oppfi~tion dnt~ ...........................~ ......... ~ ........... , 19...~~ ~n~,~ppr~ by th~ Building InspectOr. ~ i ~ ~, ~e ,..~ ............ ' i ... C~...~;~,~;~ ~ ~....~;~~,~.,. ....................... II'O~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥o Examined .... ~ .................... , 19..~..~. · A pro, ed ........................................ , P.,m t Disapproved a/c ............................................. ; ................................................ ./ AppliCation No ..... ;.....~ ........... 2~, APPLICATION FOR BUILDING PERMIT Date Oct. 14 th 1969 19 ............ 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 showin.g, location of lot and of buildings on premises, relationship to adjoining premises or pub c streets or areas, andgiving a detaded 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 ~is application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premmes 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, buildin~ code, housing code, _~e~ulations. (Signature of applicant, or name, if a/corporation) ........... ........................... . (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................................... .......................................................................................... i. Name of owner of premises M.l.~..~.On T. R~..~..n If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ........ ,~'.~..~.~&..~3?J,~.~. ........................ ~.~.~9.~.0... ............ i .......... ,. .n,c po,ity .............. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~J~L~...(~.~.~..~Jtt~L~ .................. . ............. b. Intended use and acc p cy ........................................................................................................................... 10. 11. 12. 13, Nature of ,wo~(ef~ck which app,~J~e): New Building .................. Addition .................. Alteration .................. Repair .'......//".......~-/Removal~ '"~ O-'"5 ............ Dem0ijtio~ ........... ~ ..... ~her Work (D,cr be) ~t mated Cost ../~.~.~.~....~. ................... ~ Fee ~ ....................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ............................ Number of dwelling units on each flor ............................ If garage, number of ~rs ............................................................................................................................................. If business, commercial or mix~ ~cupan~, speci~ nature and extent of ea~ ~pe of use ............................ Dimensions of existing structures, if any: Front ....... : ....... : ............ Rear ................................ Depth .................... Height ........................ Nu~er of Stori~ ............................................................................................................... Dimensions of same structure with alterations or additions: Front ....................................R~r ............................ Depth ................................ Height ............................ Number of Stories ................................ Dimensions of entire n~ construction: Front .................................... Rear ............................ D~th ........................ Height .................... Number of S~ries ................... F .............................. ~ .......... r ......... ~ ............................................ Size of lot: Front ....~.~ ............... Rear ....... /..~.~ .................... Depth .~.~. ...................... Date of Put h ~..~,~ ~ O c as, ........... .,....~,.~.,.: ........................ Name of Former ~,er .~.~~.:..c,.~.~ Zone or use district in which premises are situated .................................................. ~. .............................................. Does proposed construction violate.any zo~g law, ordinance or regulation? ...... /~.~ ............................................... Name of Owner prem sas ~Z~..'.~......Address ./~'~...~P~.~.. Phone No.~.~.~ Name of Architect ...................................................... A~ress ............................................ Phone No ..................... Name of Contractor .................................................... A~ress ............................................ Phone No ..................... PLOT DIAGRAM. Locate clearly and distinctly all buildings, whether existing or proposed, anita all set-back dimensions from property lines. Give street and block number or description according to deec --~nd ' ~ow street names and indicate whether interior or corner lot. t ,/"/au S p_ Z~.,,,/,~ Heu~s a ,I STATE OF NEW YORK, COUNCil.r/ .................... (Name of individual signing appli66tion) above named. He'is the.....~..~ ................................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke ~d file this application; that all statements contained in this application are tme~to the. best:of his ~owledge an~ belief; and that the work will be performed in the manner ~t fo~h in the applicati~ fil~ ther~ith. Sworn to before me this ........ ............. : .............. ........... ELIZABETH AN~ ~EV1LLE NOTARY PU~LIO. State of New Yor~ Te~m Expires ~r~h