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Home My WebLink About4578-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. z5'380 ...... Date .......... August. IS, .... , 1973.. THIS CERTIFIES that the building located at N./$ .14o~./;h. Road ......... Street Map No. XX ..... Block No .... XX . .Lot No. XX ...... Greenpor. t,. N...Y .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...December .2; .... , 19.69 pursuant to which Building Permit No. 4.578Z.. dated Dei~ember .4, ., 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 ~-'k~sued is Bus:i.~less..Builc%in~i-Resta-u~an~: ................................ The certificate is issued to -Jack Levin ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ............... UNDERWRITERS CERTIFICATE No. P. endi~g ................................... HOUSE NUMBER 58775 ...... Street . iqo~th. Road ............................. .............................................. Greerv~o~t.,..N .Y .................. "' Building I~p;~t' ' ' 'or~ ....... 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? 4578 Z Permission is hereby gran~d to: ..~...~..?....~.e...!~..~.~~ ............. .~.e.~r~.....l~X,, .............................. pursucm¢ to application dated ...................... .D..~..~.~I~. ...... ~. ........ , 19.~j[., and approved by the Building Inspector. TOWN OF SOUTHOLD ::~ ~.."" :--:/ ~' I BUILDING DEPARTMENT . t ~ '-;~ ~'-~ ~'~ -~:/ ~ ~ T~ CLERK'S ~1~ 'J~ ~mi~~...~ . 19..~ ~ ............ ~ ..... ~ ' ~ __ ......................................................... ::: ......... .................... ........... .......................................... :.. ~t- Dec~ber 2 6 ............................................................. , ~9....~ ...... INTRUSIONS a..This application must be completely fill~ in by ~ewriter or in ink and submiff~ in ~plic~e to ~e Building ,n~or. b. PI~ plan shying I~ation of lot a~ of buildings ~ premiss, mlat onsh p to adjoininn nremi~ or ar~s, and giving a d~ailed ~ri~ion of I~t of pm~ must ~ drawn on the diagram w~ is ~ of ~ aomlicati~ c. ~e work c~er~ ~ this apph~hon may nm be commenc~ ~fom i~uance of Buildi~ Pe'~ t. d. Upon ~pr~al of this ap~lic~ion, t~ Building Ins~ctor will i~ue a Buildi~ Pe~it to the ~plicant. S~h ~it shall ~ ~t~ the premiss ~a,lable for i~ti~ throughout the p~s of ~e wo~. e. No building s~ll ~ ~cupi~ or u~ in whole or ,n pad for any pu~e whatever until a Ce~ificate of ~c~a~y ~II h~e'been gmn~ by the Building In~r.. ~ ~PPLI~TION IS HEREBY ~DE to the Building De~ment for the i~uance of a Buildi~ Pe~it ~ant to the ~1~ Zon~ O~,nance. of ~e T~ ~f, ~tho~( Suffolk ~oun~, N~ York, and other ~licable ~, O~i~ or ~ a~lons, ~or me cons~rucnon or DUllalngs~ aaa t ohs or alterations, or for rem~al or demolition, as heroin ~ri~. The applicant agrees to comply with all applicable I~, ordinance, building c~e, housing c~e, ~d ~ulations. ~o~ Goa~ G~ee~o~ . 0~ Name of owner of premises ..,T~,~..~.el~;~i, ........... . ..................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of I~ on which proposed work will be done. Map No.: ....... ZZ ............................ Lot No.: ...Z3~. ............... Street and Number ~7.~.~....][/~...I¢oz'.t;~.~l~...o,~-~.e~po~.t: .......... ]~.o.~r.~ .. . .......... Munici~li~ State exi~ing u~ and ~cu~n~ of premiss and intended use and ~cu~ncy of p~ con~ti~: a. ~i~ing ~e and ~cu~y ...~,.~6 ..... ~e~.~ ....................................................... b. Inte~ use and ~cu~ncy ................ ~ .~.~ ~ .~.~.~ · 3.-~Nature of work (check which applicable): New Building .................. Addition ....... 3:3~.... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ................................ ~ .... 4. Estimated Cost ............................................................ Fee ,.~,~...,..0....0. ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ..~..o...~..e. ............ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use business 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 ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~Q ...................... Rear ....... .~0 ................ Depth ....... 1.~ ............. Height .................... Number of Stories .......... .o.n.e. ..................................................................................................... 9. Size of lot: Front .....2..2..~.._+ ............ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner 11. Zone or use district in which premises are situated ............. ~. ....... I~S.~. .................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~.QI'Le ........................................ 13. Name of Owner of premises ...~T&c}r...Le~r~ n ............ Address ......N...,...~.o..a...d...~r..e...e. Tl.~..o...r.~Phone No ..................... Name of Architect ...................................................... Address ................................. ~ .......... Phone No ..................... Name of Contractor ..... ~ ...... .same .............................. Address ............................................ Phone No ..................... PLOT DIAGRAM 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 description according to deed, and show street names and indicate whether interior or corner lot. See filed plans COUNTY Of ..~..~....z...o...J~... ............. j-~.,~. ........................................ J&¢ir...~r~ ................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ...... ~ Q~'X~. ............. ~ ........................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fire this application; that all statements contained in this application are true to the best of his knowledge and belief; and thar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Notary Public, 4~..../~~ County"~'~~'~re ~'~['ca~i ............................ MILDRED CHAPMAN NOTARY PUBLIC, Sta!e of No. 52-0618100 Sufioi~ c rr /x%L / ,, ' F,..a~U LJ DA'T I ~LJ PL_A L] r L~, L... o J ?._. '" '~p!