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Home My WebLink About4552-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. 3779 ..... Date . . April THIS CERTIFIES that the building located at ,Smith Road Map Ne.Ind 1~ Pk Block No. Lot No. Pa-r~ h&6 Street Pe¢onia .. N,~. conforms substantially to the Application for Building Permit heretofore filed in this office dated "l~ov 42 , 19 69 pursuant to which Building Permit No. 1+~;~2 Z dated '"No~t %:~ , 1969 , 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.~,ivate ene .family dvel. llng witbaddi~-en .............. The certificate is issued to . Geor~;e Bernauer. .... Owner ....... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. If,It, ................ House FORM NO. Z TO~N OF $OUTHOLD 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.° 4552 Z ~e ..................... ~ ......... ~.~. ............ , ]~..~ Permission is hereby granted to: purkuon~ to application dated ........................... ~ ......... .~ .......... , lg.~t., and approved by the Building InsPector. ~:ee ~;....,tL~ ......... ~FORM ,NO. I TOWN O~ SOUTHOLD BO'ILI)ING 17~iPARTMr=.NT TOIA~N CL~RK'S OFFIC~ SOUTHOLI), N. Y. Examined ........... .'3 ........ 19.. !] q ~ ~g",~ ~ Approved .................... ,19 .... Pemit No .................... Disappmv~ a/c . .~ ~ ........... '.". ...............' ..... ' .... ' .... (Bulldog ~spec~) Application No ................. APPLICATIO~ FOR BUILDING PERMIT .............. ....... INSTRU(~FIONS a. This'application must be completely filled in by typewriter or in ink and submitted in duplicate to Building Inspector. b. Pl, ot plan showing location of l~t and ~f buildings o n 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 part of this application. c. The work covered by this application may n~t 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 oI~ in part for any purpose whatever- until a Certificate Occupancy shall have been gra~ted by the Building InspectOr. APPLICATION IS I~l~l~!~y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building ~one Ordinance of the Town of S~uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, and regulations. . ................................. (Signature of applicant, ~ name if a ~orporation) ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................... ~~ -/~ .... . ..................................................... Name of owner of premises .... ~..~... ~ ..... ~.: .......................................................... If applicant is a corporate, signature of duly authorize d efficer. (Name and title of corporate officer) 1. Location of land ou which proposed work will b e done. Map No ......... ~ ....... Lot No ............. Street and Number ..... ./. ~.~ .......... ..... ~-~ .~.. ............................................ Municipality 2. State existing use and occupanc~y of p~n~ended use and occupancy of proposed construction. a. Existing use and occupancy ..................... ~'J~~.~ .... ~..~, ..... ~...~( .......... b. In~enaea use ami occupancy ................ 3. Nature of work (check which applicable): New Building ........ Addition ...~. .... Alteration ..~ ..... Repair ......... Removal,~ ....... Demolition ........ Other Work (Describe) ...................... 4. Estimated C~st ........ ~.....(~.. ................ 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 ~f 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 .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Nu~l~b~r of Stories ..... .............. 8. Dimensions ,of entire new construction: Front .... ~/'?a' ...... Rear ...~./...~ ...... Depth . .~..~. ....... Height ............ Number of Stories ............................................................. 9. Size of tot: Front ................ Rear ............... Depth ............... f~ 10. Date of Puvch.ase ................ ./. ~..~..~. ....... Name of Former Owner . .~.'.. ~.~7. ~ ....... 11. Zone ~r use district in which premises are situated .... .~t~'. ............................................ 12. Does proPOSed construction violate any zoning law, .ordinance or~egulation? ......~.. ................... 13. Name of Owner,of premises..~5.... ~...-2-2:T~... .... Address .. ?.:-~-. ............... Phone No ............ Name of Architect ............................. ~ddress Phone No ............ Name of Contractor .[.(':..~).~~ ......... Address i~iiiiiiiiiiii Phone No J, rLOT DL GR Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or de scription according to deed, and show street names and indicate whether interior or corner lot. STAT~3 OF NEW YORK, )S.S. COUNTY OF .............. ) ............... ~.:~.~..~ ......................... being duly sworn, deposes and says that he is the appli- (Name ~ ~o~ '~a~lh ~gning application) cant above named. He is the .................................................. __ (Contractor, agent, c~-t,orate officer, etc.) of said owner or,owners, and is~[y"~'d'th~,-i~ed to perform or have performed the said work and to make and file this application; that all statemerrts contained in th is application axe true to the best of his knowledge and belief; .and that the work will be perf~qned in the manner set fortlf in the application filed therewith. Sworn to before me this Notary Publ ~ (Signture of applicant) ELIZABETH ANN NEVILLE NOTARY PUBLIC, State of New York No. 52-8125850. Suffo,k C,O~y Term Expires March 30,