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Home My WebLink About4525-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z 3767.. Date . . March 26, ... , 19 .70 THIS CERTIFIES that the building located at lq/Z corner of Cox Lane Street & Main Road Map No ...... Block No .... Lot No. Cutchogue, New York ... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. October 27, , 19 69. pursuant to which Building Permit No. 4525Z dated . . .October.. 27., , 19 ag, 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 business office .&..priva.t~ olue .famtly.dw~lting ........ The certificate is issued to Burr. G, Lewis,. Jl:, ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Maxch. 26,. ].970, Rob$~t .V~ll.a ............ ?: Building Inspector House %'s R3 - 50 Cox Lane R3 - 33105 Main Road TOWN OF SOUTHOLD 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 ^UTHORIZED) 4525 Z Permission is hereby granted to: ............ ~*,~..I~f~..J:~ .................................... tO at premises located at .............. ~<l~.-~l[~Le-'~'-J~4-~"~[~Ni~ ............................................................. ............................................................ ~.~.t~ ............. .~..~ ................................................ '. ..... pu,rsuan¢ to application dated ............ .~. ........... 1:~ ......... ~ ............ , 19..,~, and approved by the Building Inspector.- Building Inspector S-9 SCHD ItEPARTHEN r OF ILEAL T ~IVE~HEAO H SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located / (Give deed location) have been inspected by this department and found to be satisfactory. Diet,let Eng~noer District Engineer 'rOWNOFSOUTHOLD ~ .~.~,/ ,c~,,~. ~ Examined ......... ~.......~.....-'L...., 19..~.....~. Approved ........................................ , 19 ........ Permit No. . . Disapproved a/c .................................................. ~ BUILDINGTowN CLERK'sDEPARTMENT"~'%"/"OFFICE ~ /'~ ~'~'~ 0,)! Sou'moLD, N.Y. Applir. x~'ion No. Z./.,~-,~.~'"- APPLICATION FOR BUILDING PERMIT Date .../la~abe. z:..27.11h., .......................... , 1969 ........ 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 detailed 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 shell 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 and regulations. (Signature of applicant, or name, if a corporation) ................ .9'...~.1~ ~.~ ~.1il.. ~ O~..~., .g.g.~.g ~l,.q., .~.~ .~. .................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................ ......................................................................................................................................... Name of owner of premises ............ ..B~..~..~...~}.~...~]~J,~i.,...~T~'., ............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ........... ~o~.~..l~l,e.t,..aoz-~ezt...~-ox.../.di.aa..J...M~..tn...ILdo.~...~.l~ ..................... State existing u~ and ~cu~y of prom ~s and atend~ use and ~cu~ncy of pr~ constmcti~: a. ~isting use and ~cu~ncy Model Home b. Inte~ u~ and ~cupanw .................. ~.~...~...~.~ ............................ J ............................... 3. Nature of work (check which applicable): New Building '.Z ............... Addition .................. Alteration Repair .................. Removal .................. Demolition ............. ;.... Other Work (Describe) ........................................ 4. Estimated Cost ............. ~.'i'.,.0.0.0.,.0D. ................ ~ ........ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....9.TL~. ................. Number of dwelling units on each floor .......... .o.b.e. ........... 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 ...... 6B. ................. Rear ........ ,~.4-~;...'Z....t13.,. Depth ....~,,~.1; ....... Height ....... ~,~...;~.1;. ..... Number of Stories .............Ql3.e ........................................................ Dimensions of same structure with alterations or additions: Front ...... .s....a~....e .................... Rear se. me Depth ........ ~..~..~.~. .............. Height .......... {~..e.~.~. ........ Number of Stories .....~..a...e. .................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ........................................................................ 9. Size of lot'. Front ...... ~,.~.3..~.. ...... Rear ..~.'/.~..~.o .................. Depth ....... ~0.0...;~.~ .......... 10. Date of Purchase ....~Qt)~..,~l.,...l~l~. ............. Name of Former Owner ~1~l,~.~.Tl....~:g..d...A...~.~..e.?..~.. 11. Zone or use district in which premises are situated ....................~ttg~]~_.ss ................................................ 12. Does proposed constr~ction violate any zoning law, ordinance or regulation? 13. Name of Owner of premises~,l~..~ .~ ,/~.~.~;I,~.~...~X'....Addres~/;X~.~ .]~...~.~c...~...o~.q.ePhone No~..e.~..~..3:...0..8. ...... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~..t....G..t.....~..e...w.~.~.....~.T. ........... Address ..~.o...v..e.. ............................. Phone No....~...~..o...v..e. ...... PLOT DIAGRAM 'Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YQRK.... t, ~ COUNTY OF ....... .~g..z..z..o...z.~. ....... ~.o. ............................... ~tt~'.t;...~..~,,t,~...,,,T~. ........................... being duly sworn, deposes and says that he is the applicant (Name of ind vidual s gn ng appl cation) 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 ~ke ~d file this application; that all statements contain~ in this application are t~e to the best of his knowledge and belief; and that the work will be performed in the manner ~t fo~h in the applicati~ filed therewith. Swam to before me this .... ....... ? ......... ~ ~..~ f~ '~: .~ ....................... [~~~ ....................................... Nota~ Public~.~E~L~unW~ ~ (~nature of ~licant) ~ NOTARY PUBLIC, State of Ne~ ~ork No. 52-8125850, Suffolk Co~ Term ~pires March 30~ 19~