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Home My WebLink About4270-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z' ~76~ ..... Date ............ Ii, rOll..-13 ..... , 19. THIS CERTIFIES that the building located at .. B~a~,. &Ye. & 1~1~i~ ....... Street Map No...~X ........ Block No. x~ ....... Lot No..~ .. IA~l'®l't' .N,¥.o ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~ ..... 1 .., 19..69 pursuant to which Building Permit No.. dated ........... 1~' .... 1.., 19..$9 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' ~ne' f~lly 'dw~Tllng ...................................... The certificate is issued to .. 'John 'Ba' Roaeh~ ........... 0~el' ......... .., ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . t~F..$1 ~- -$~70...b~'. R., .Vii-la .... .......... B' ii in 'I ......... ~ouae ~ 7~80 Pee. l~y Blvd ~ X~O Bray Ave 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? 4270 Z Permission is hereby granted tourj ~. ~l~eJ~ll at premises located at J~l~7 &~ ~: ill'et ~,,SL.~. JJJ~J Ieee ............. pursuant to application dated ....................... ~....~'. ...... .~ ..................... , 19~...., and approved by the Building Inspector. $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: at_ The sewage disposal facilitie~s for a structure located deed location) ; have been inspected by this department and fo~und to be satisfac~tory, District Engineer App~aved .................... ,19 .... Permit No ................. Disapproved a/c .................................................... t APPLICATION FOR BUILDING P~.~MIT '' ' D~te .'.~./..~. ................. 19.~ 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 o n premises, relationship to adjoining promises or public sU'eets or areas, and giving a detailed description of lay out 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 beforo issuance of Building Permit. d. Upon approval of this al~plication, the Building In spector wi11 issue a Building Pe~nit 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 o~ in part f~yr any purpose whatever until a Certificate ~f Occupancy shall have been granted by the Building Inspec~r. APPLICATION IS ~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~athold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or altera~iO~is, or for romoval or demo- lition, as heroin described. The applicant agrees to corn ply with all applicable laws, ordinances, building e~de, housing code, and regulations. (S~natu~e ~'.~pplicant, er name if,'; '(~;~ti;hi' ' ' ~ o. .x. . . . ,.r . (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ........... ~. ~ .t~./.~_. ~ .......................................................................... Name .of owner of premises :.. ~ .~;;~ ,~0/. ~1. .. ~,~ ~.~,. ~ ..................................... If applicant is a earporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location of land ~n whi.ch proq~0aed work will b e do~ne. Map No ................. Let No. ............. Street and Number ..~]/~. ~.~.~.~. ~' ~~ ~~*~ '~"~'~'~~ .... 2. State exist~g use and occup~cy ~f p~mises ~ d in~ended use ~ ~cup~ of ~ ~ction. a. ~istinguse and ~cup~cy....~6~..... .......... .............................................. b. Int~ded ~ ~d ~p~cy .... /~.~J/.~ .~ ......................................... 3. Nature of work (check which applicable): New Building . ,~.. Addition ........ Alteration ........ Repair ......... Rem_ov~ ........ Demolition ........ Other Work (Describe) ...................... ·---------.?<. ~,,~..q~., .;.~. .......... Fee ................................................. 4. Estimated Cost (to be paid on filing this application) 5. If dwelling, number of dwelling units .... [. ....Number of dwelling units on each floor .............. If garage, number of cars ...... .~ ............................................................... 6. If business, commercial or mixed occupancy, spec ify nature aud extent of each type of use .............. 7. Dimensions of existing structures, ff 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: Ffon~ . . ~..~.../..~..I./ .... Rear. ~..-~. ~..~.. t.t.. Depth .~).(~.. ~... Height ............ Number of Stories/ ........................................................... 9. Size of kd:: Front ..... I.c~,.~.~-~. Rear :.L~.ct.,,2..7.. Depth .. 10. Date of Purchase .. Rt.).C~.-. ~. ~'; I .~ ~ Name of Former Owner L~.,.~....~C2. t'~ ~r~./.~-~ 11. Zone or use district in which premises are situated....~ ~ ~ .............. .~ ........................... 12. Does proposed construction 13. Name of Owner.0f premis~ Name of Architect ........ l~ame of Contractor ~: .~.-: Locate clearly and distinctly from property lines. Give sweet ~u indicate whether interior or corn, violate_any zoning law, ordinance or regulation? ..... .~.~-~ ................. '['.' ' ' ~d :'2 ........ Addre~ ...................... P~e No ............ -~~~ Address .~.~e. ~. ~ ~ ~.~. Ph~e No. ~ ~ ~.2~ ~ ~ ~l~~~:r p~s~,.d ~di~te ~ set-back ~ens~ns ~~ ~s~pt~~g to d~, ~d show s~et n~ and Term Expires March 30, STATE OF W~ 7,qRU, )s.s. COUNTY OF ~f~g~. ..... ') -~--~-~?"~-'~ being duly sworn, de~d ~ys ~at'he is ~e appli- .......... ~~:~ ............................ (Name of ~d~vi~ signing applicat~n) ~t a~ve n~e~ is the ............ ~ ............. . ....... ~ . (~n~a~, a~ ~ate ~i~r e~ of ~ld ~n~r ~ o~e~ du~ a~z~ ~ ~rm ~.,have~ ~e~d ~k ~d ~ m~e and file th~ appli~t~n; ~at ~l stateme~ ~ntain~ ~n ~is appli~t~ ~ ~e to ~e ~ of h~ ~owl~ge ~d ~lief; and ~at ~e ~k wi~ be p~ ~ ~e mann er set fo~ ~ the app~eat~n filed the~wi~. Sworn to before me ~is ..... ~ ......... a~ of ........ .~ .. < ......... ~ ~ ~ ~ NOTARY PUBLIC, State of New York I I ,I TT P