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Home My WebLink About4272-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~ .3,~. .... Date ............ THIS CERTIFIES that the building located at ... B~.. Jo~ke]r. Cl*eelE .DI':~eet Map No...~ ....... Block No.~ ........ Lot No.. ~t ..... 8o~thol~ .l{,¥+ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~lal, el~ "18', 19 '69' pursuant to which Building Permit No. I~... dated .......... I~' .... 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 ... The certificate is issued to ...111.$~. ~®l~ ............. 0~mX' ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval FOKM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TC)WN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~272 Z Dot, ......................... ~ ...... .~ .............. ,19....~.. Permission is hereby granted to: .............. ~TJdrr/...l~eek.. l~l~m ..................... ot premises located at .......................... ~....~Jll~...~J~e~lL...JJ~,~lJ .......................................... ................................................................... J. imt, bel& ....11.,,.%.~ ........................................................... pursuo~¢ to applicatiOn date~l ............................... JlJJJl~J....J~ ....... , 19...~J, and approve~l by the Building Inspector. Fee $.~.e,J~J ............. FORM ,NO. I TOWN OF SOUTHOLD BUILDING I:~EPARTMEN"F TOWN rv~mK'S Orr~C~ SOUTHOLD, N. Y. Application No. ~ ~ ~" '~ APPLICATION FOR BUILDING PERMIT . Date ' . .......... .l~..r..C.h. .... 1..8 ....19..6.9 INSTRU~;i'IONS .... · a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building InSpector. b. Plot plin showing location of lot and of buildings on premises, relationship to adjoining premises.or public streets or areas, and giving a detailed description of layout of property must be drawn on the disgrara which is part of this application. c. The wo~'k covered by this application may not be 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 shaU be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole on in pa~t for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS I-I~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Gounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo- lition, as hm'ein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, h~using cede, and regulations. ...... .T.e.r. ry. ................... ........... (Signature of applicant, or, name if a corporation) Southold N (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.......... · .0'Ar~. · .e~.'. . ~.kl~d. ~. .................................................................. .... of p E~[~:i.s Terry & ~/~fe .......... Name of owner remises ...................................................... If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location of land on which propped work wili be done. Map No .... ~. ........ Lot No. ~ ......... Street and Number .... ~/~....J.O~;~y..~r.e.~l~. ~.~:~:¢.~ ..... ~.~l.~ho~l.d. .............................. ~ ] - ~..~ Municipality 2. State existing use and occupancy of premises an d intended use and occupancy of proposed construction. a. Existing use and occupancy .... 011~ .f~:[.l.~ .~lw~1~..:ida§. ....................................... b. Intended use and occupancy .... Same..~b..ala .a/--tachect .Ga~aga .......................... 3. Nature of work (check which applicable): New Building ........ Addition . ....~... Alteration Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ...1 ~..2~D..~. ................. Fee ... ~..00 ........................................ (to be paid ~n filing this application) 5. If.,dwelling, number of dwelling units . .Olle ..... Number of dwelling unit~ on each floor .............. If g. arage, number of cars .. ~hgO .................................................................... ~..~"business~ commercial or mixed occupancy, specify nature and extent of each type of use ........ 7. Dimensions of existing structures, if any: Fm~t .............. 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 ...... 2be ........ Rear ..... .23-b,... Depth .. '2~ ...... Height ............ Number of Stories .... .o]ae. .................................................. Size of ~ot: Front ... 1.00 ........ Rear .. i..100. '. ..... Depth .... Date of P~vch.ase ............................... Name of Former Owner ...GoI'I.~exz'¥..l~s.t;at, e ... Zone or use district in which premises are situated....~A"., r115.~ ...................................... I~oes proposed construction violato any z~ning law, ordinance or regulation? ....y~S ................... Name of .Owner ~f .premises ... l~.].l.a. T~rr.y.... Address .... ~olltho ~ ....... Phone No ............ Name of Architect ............................. -~ddress ...................... Phone No ............ Name of Contractor . S~lll~ ..................... Address ...................... Phone No ............ 10. 11. 12. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensk)ns from pmgerty lines, Give s~eet and block number or desgription acoo.rding to deed, and show street names and indicate whether interior or corner lot. ~'~" D ~ $ T -- OF NEW YORK~ )S.S. COUNTY OF Sliffollr ..... ) ................ Ellis. ll~$$'l'.y., ..................... being duly sworn, deposes and says that he is the appli- (Name of individual signing application) · cant above named. He is the .... . .... . .0l~lt~'..-...blJ~ij.c~I' ................................................. (0ontractor, agent, eorp0rate officer, etc.) of said owner or owners, and.is duly.aUthorized to per~o rm or. have. pex~ormed the .said va)rk and to make and file this application; that ail statements contained in th is application ave true to the best of his knowledge and belief; and that the v~m-k will be p~ed in the manner set fortht in the/application filed therewith. Sworn to before me this ..... ..... Notary Public,~ ~ .~. ~ ~ty ' ' ' ~i~l~ure of ~pplic~) ................ MARION A. REGENI NOTARY PUBLIC, State of New No. 52-3233120 Suffolk County Term Expires March 30~ 19.._gTt~