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Home My WebLink About4538-zFORM NO. 4 TOWN OF SOUTHOLD BUILnING DEPAR~ Town Clerk's ORice $outhold, N. Y. Certificate Of Occupancy No. Z361,7. ..... Date ............ NOV,. ~ ........ , 19. THIS CERTIFIES that the building located at -Sandy .Beth. Re~d ....... Street Map No..xx ......... Block No.~ ........ Lot No...~... G~eenl)®r~; · .l~,~, ...... conforms substanfiaily to the Application for Building Permit'heretofore fried in this office dated .......... .I/o~' ..... 3'" 19 '69' pursuant to which Building Permit No.. dated ............ Ney- ..-3.-., 19.6~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. pr.~vatoCaecessor.~) · a$.orage. ~u; l~Lng .......... - .................. The certificate is issued to .... F,~rl~..4.4rra . ol .er ...... ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N Building Inspector House ~ 1500 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 AUTHORIZED) N.o 4538 Z at premises located at ............................................................................................................................ pursuan¢ to application dated ..............; ............................................. , 19. , and approved by the Building Inspector. Fee $...5. .................. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................... ...~...~.., i 9...~..? Approved .................. ..?.....~..., 19....,~ Permit No. Disapproved a/c ......... ~ ................................. ~ .................... (Building Inspector) Application No. i~Z" 3 ~'/ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apphcation must be completely filled in by typewriter or ~n ink and submitted m duphcate to the Buddmt Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o, areas, and giving a detailed description of layout of property must be drawn on the d~agram which is part of this application c The work covered by th~s application may not be commenced before issuance of Build,rig 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 shall be occupied or used in whole or in part for any purpose whatever untd a Cerhhcate of Occupancy, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perm,t pursuant to th.- Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulations, for the construction of buildings, additions or alterations,/of for removal or~lition, as herein described The applicant agrees to comply with all applicable laws ordjna~e~~n~ "~,/~.~. ~' //~. /',~ ¢:~} ~ - -.~-~ (Signature ~pplicant, or harrY, f,q corporation) ' -' '-' " ...................... /'"' State whether applicant is owner, lessee, agent, architect eng"~ eer,-- '/general contractor, electrician, plumber or builder if applicant is a corporate, signature of duly authorized officer (Name and title of corporate officer) of land on which proposed work will be done Map No ........................ Lot No k°cati°~=~3nrl, -- /SL~) 0 .~'~t~/~:),~., ~-AC ~-~ ~>t~A.~o ~'J~Z¢")~;~I~''- ............. Street Number - ..... .............................................................. ................ ' ................. State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy .......... b. Intended use and occupancy S ~-~ ~:~ 3. Nature of work (check which applicable): New Building ..... .L~....... .... Addition .................. Alteration ......... P, epa~r .................. Removal .................. Demoht~on ........ ~2.~ ...... Other Work (Describe) ...................... 4. Estimated Cost .................... ~..~.O..~__ ...................... Fee (to be paid on filing th~s application) 5 If dwelling, number of dwelhng units ..........................Number of dwelhng umts on each floor ........................... If garage, number of oars ........................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........................... 7. Dimensions of existing structures, if any: Front ............ ~ ........... Rear ......... ~ ................. Depth ....,./...~-~m...... Height ....... /..! ............. Number of Stories ............. ~.2~/..~..7. ............................................................................ Dimensions of same structure with alterabons or additions: Front .................................... Rear ................ Depth ................................ Height ............................ Number of Stories .............................. 8. Dimensions of entire new construction. Front .................................... Rear ............................ Depth ............... Height .................... Number of Stories .................................................................. 9. Size of lot. Front ....... Y...7/...~ ......... Rear ......... ~. ~ .................. Depth ..... 10 Date of Purchase ........ Name of Former Owner ~,~ ~..,,-~...../'/.1.,.~..'~..~7.-.: ..................... ........................ /..¢.¢ ............. 1 1 Zone or use d~stnct in which premises are s~tuated ............... i~J ........ .4.~a~.~/./..,~. .......................................... 12. Does proposed construcbon violate any zoning law, ordinance or regulation~ ............... ...'~,..~'..2~;..i~;'. ...... 13 Name of Owner of premises ¢~....¢....xA.. ).2?x~¢~xz'z.~,~ddress ................. ~.~ ......... ~r. (. Phone No'.'. .............. . , _~ .. ¢. ,,m~-:)~ ~^K ~V[~. ~ ~,7~ Name of/~rcnitect ................................. ~h¢..c..?.t^..~,/^adres~ ........ ::':'";10'~¢: .... J',4'"¥' ....... PhF°~e~N° ............... Nome of Contractor ................................................... Address ........................................... Phone No ........ PLOT DIAGRAM Locate clearly and distinctly all buddings, whether extsting or proposed, and red,cate all set-back dtmenstans fro~ property lines Give street and block number or description according to deed, and show street names and indicQt whether interior or corner lot ............................................................................................. being duly sworn, deposes and says theft he ~s the apphca~ /~/A 4 f)~larne of ir~d~6t/fi~-~ng apphcat~on) above named. He ,s the ...................................................... ~.);t~.TC.Z~.;~Zf~.;;.~;;~f..~,~;;;;;~.~_.~f;~7~.~; ............ 'of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and fi th~s application; that all statements contained in th~s application are true to ,tJae2 best of his knowledge and belief; ar ti,ar the work will be performed in the manner set forth m the application file~ftJ36rewith. ~..__-.,~ Sworn to before me this , .................... z= day of ............................ Notary Publlc,--~j~.;... ~::~.T,j._..._..:,,).~:y.r ,¥2./~ou~ NOTARY PUBLIC, State of New Yor~ No 52-8125850, Suffolk County Term Exptres March 30,