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Home My WebLink About4560-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z1+196 ... Date THIS CERTIFIES that the building located at S~mmer Map No. t~y~i~lO. ~er~tl~l No. Lot No. 2~ conforms substantially to the Application for Building Permit heretofore filed in this office dated l~o.V. 20 , 19 69 pursuant to which Building Permit No. h ~60Z dated };.e¥. 2¢~... , 19 69, 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..garage (accessory.bldg) ............... The certificate is issued to . Cha~ & D~nna..~N.trbush .. ~Dwners (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N,~, . . ,use 2OO . Building Inspect~ FOR..-'~ NO. 2, TOWN OF $OUTHOLO 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) 4560 Z Dote ' Building Inspector. Examined ... f.V. :. ~. ........ Approved I \ 19 t I Permit No. g? Disapproved a/c .................................................... (Building Inspector) APPLICATIQN FOR BUILDING P~RMIT INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitted in duplicate to the a. Building Inspector. b. Plot1~lan showing location of lot andof buildings on premises, relaticdzship to adjoining promises 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 b e commenced before issuance of Building Permit. d. Upon approval of this application, the Building In spector will issue a Building Permit to the applicant. Such permit shall be kept .on the promises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole o~ in part f~rc any purpose whatever until a Certificate of Occupancy shall have been grmated by the Building Inspects. APPLICATION IS HERF:RY MADE to the Building Department for the issuance of a Building Permit pursuant Ordinance of the Town of Soathold., Suffolk Oounty, New York, and other applicable Laws, to the Building ~one Ordinances or Regulations, for the construction of build ings, additions or alterations, or for ron~oval or demo= lition, as herein described. The applicant agrees to corn ply with all applicable lawS, ordinances, building code, honsing code, arid regulations. .4 v/n · .o. ................. ........... :... (Signature of applicant, or name ff a corporationl (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .............Iwl/ '~ ~ LI--- I<.;"~'''~'J~'''''['~'''~"~'~.'''/'l'~''~ ............................................ Name .of owner of premises ....k.~%......~-~~. ...... ~..~Y~. · · ......................................... If applicant is a corporate, signature of duly authorize d officer. ~'~/~' ,~ 00 Municipality State existing use and occupancy of pre~n~ended use and occupancy of proposed construction. a. Existing use and occupancy .................... .~ ....... ~. ~....'W~ ..... ~: ................. b. Intended use and occupancy .......... ~....~...~~.".[~?~ .......... 3. Nature of work (check which applicable): New Building . ~ .... Addilion ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other_ Work (Describe) ...................... 4 Estimated C~st .... .~. ~._O. ~ ...... i.. i: ..... Fee.~....o~.. ........................... ~ (to be paid ~n filing this application) If dwelling, number of dwelling units ~.. Number .of dwelling unit~ on each floor .............. If garage, number of cars .......................................................................... 6. If business, commercial ~r mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: Front ............... Bear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .............. Rea~ ............... Depth ................ Height ................ Number of Stories ..................... 8. Dimensions ,of entire new construction: Fr~mt ....... ]...~ ...... Rear ..... /...O ..... Depth . .~ ..0. .... Height ............ Number of Stories ............................................................. 9. Size of ~ot: Front .... ./..~.. ...... Rear ..... t~..0~. ..... Depth ...Z'..~r.O. ...... 10. Date of Purchase ............................... Name c~f ~on~er~,~ ............................. 11. Zone or use district in wtiich prem.ises are situated ......... ~ ........................................ 12. Does proposed construction v'A~y zoni~ng law ordinance or gegl~latiqn? ..... ~ .............. ~.. 13: Name of OWnerof pre~nises .~.~ddress . ~t4 Phone No. . Name of Architect ............................. ~ddress ...................... Phone No ............ Name of Contractor ...... . .~..~ .......... Address ...................... Phone No ............ PLOT DIAGRAlVI 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 acoording to deed, and show street names and indicate whether interior or comer l~t. STATE or ~Ol~, ~ )S.S. COUN Z OF . . ...... ~ · .f. · · .~4~.. ·..~b. eing duly sworn, deposes and says that he is the apph- ....... 'i !ri i i/,i ii'ci'ti; '" _ cant above named. He is ... ...'...~..cf.~ .... ~ .................. ; ................. (,] (Oontractor, agent, eerporate officer, etc.) of said owner ~r ~)wners, and is duly authorized to perform or have perf~*med the said work and to make and file this application; that all statements oontained in this application ave true to the best of his knowledge and belief; .and that the work will be perfeauned in the mann er set fort~ in the application filed therewith. Sworn ~o before me this N,o~ary Pu~ ........ ~~[(kmnty NOTARY PU]3LIC, State of New York No. 52-8125850, SuffoJk Term Expires March 30, 19a~_