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Home My WebLink About4280-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Occupnncy THIS CERTIFIES that the building located at R.0,Iq. B/~. Bay. lice~. Roa~Street Map No~.~,ll~e..rt. - Block No ........... Lot No. 1~ · · · Bo~thold · · I~.~g. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... l~a~ ·. · 6 ....., 1969. pursuant to which Building Permit No...~280. Z. dated .............. i~al...6.., 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 . .i~riv&te. oae. E~iF..dve;LlJ.ng ...................................... The certificate is issued to .. C .. Igh~tn~], · · - 0~er ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... I,R. ........................... Building Ins~c~r aouse FORM NO. '~ TOWN 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? 4250 Z Permission is hereby granted to:~L~ ~0 B/q bt ~ ~ aT premises iocateo at ............................................ =_...~r ........ ~.....~ .......................... pursuant to application dated .................................................. .~-......, and the Building Inspector. Building Inspector Examined ......... . .~...~...'~..~., Approved .......... Disapproved a/c ................ ~ ..... ~ .......... (Building Inspector) Application NO. ~''~ APPLICATION FOR BUILDING PERMIT Date ............. .~...../~. · ./~..~. · ...... 1O.~/~ INSTRUC~rlONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Pl. ot plan showing location of lot and of buildings o n premises, relationship 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 premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole o~ in pa?t for any purpose whatever until a Certificate ~f Occupancy shall have been granted by the Building Inspector. APPLICATION IS I-i~t~y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S(mthold, Suffolk Oaunty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, add~i~ns or altera.tions, or for romoval or de.n~ lition, as herein described. The applicant agrees to com ply with/,~ll applicable ]~ws~prdinances, building eo~e, housing code, and regulations. ~/~'~'d ~~ ........ ...... (Signature ~f applicant, or, name if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or ~U/~ ~- .~. ...................... builder ................................ ~ ..... ~)~ ./...~ ./~-~_' · ~ ................. Name of ,owner of premises ............................................................................... If applicant is a corporate, signature of duly authorized ~fficer. (Name amd title of corporate officer) /~//l.l.~l~ pOfA/r A z/'~ ~'~_~ Lot No 1. L~)cation ~f lan~ ~n which pr~ w~rk will be done. Map N~ ...................... ~ ........ Strut and Number ~)- ~ ~Y H6m~ ~ · ) .......... ) ........................ 'y ........ .................... 2. State exist~g use and oeeup~ey of premiss ~ d intend~ ~ ~d oem~n~ of pm~ ~m~eti0n. a. ~isting use and ~cup~cy ...... ~ FA~ I~y ~-LL ~ ~ b. Intended ~ .and ~cup~cy ~ ~ ~DI~I O~ ~A1 3. Nature of work (check which .applicable): New Building ........ Addition ........ teration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ....... -~.00.O..~. ............ Fee ....~..~. ..................... __._ __.: .. :_.--: --(to be paid ~n 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 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 ................ Number of S~r~ies ..................... 8. Dimensions ,of entire new construction: Front .~.0.... Rear .... ~ ..... Depth /.0 ........ Height ............ Number of Stories ....... ~/~.L.~. .............................................. 9. Size of lot: Front ................ Rear ~' Depth ............... 10. Date of Purchase .................... /.~.6 .... Name q~ Former Owner ............................. 11. Zone or use district in which premises are situated ............. ~. ..... ~.~.~.~ .Q.~..N. ?./..~..~. ............ 12. Does proposed cor~s~ruction violate any zoning law, ordinance or regulation? ........................... 13. Name of Owner,of premises ....... J~/~ ~ ~.~.£.~.. A, ddress . ~. ~..~.1.~ .~. F.....~..D... Phone No ............ Name of Architect ............................. A~ldress ~-~ -ty-~ ~ z ~ Phone No. Name of Contractor . .~'~ ~. ...... ~ ~ ~Y~.... Address ..... ~..~.W.~3.0.~' .D. ....Phone No~'b. ?~....~..7..~.~1, PLOT DIAGRAM Locate dearly anti'distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give s~eet and block number or de scription according to deed, and show street names and indicate whether interior or corner iot. '/ STATE OF NEW YORK, ) S.S. COUNTY OF .............. ) Notary Public, ..... ,.~4Y..~.~. ~.~/~. County ELIZABETH ANN NEVILLE NOTARy PUBLIC, State of New York NO, 52*8125850, Suffolk :h~'nl ,EXpires Marc, 30, i~ ............ .~.~. ........ ~.~. ~ .Yf~ ............ being duly sworn, deposes and says that he is the appli- (Name of individual signing applic~ion) cant above named. He is the ............................ ~..//./..~./-~ ~- ?'.~. .... of said owner or owners,' and is duly authorized to peri. tm or have performed the said work and to make and file this application; that all statements oontalned in this applioation are true to the best of his knowledge and belief; and that the WOrk will be performed in the mann er set fortl~ in the application filed therewith. Sworn to before me this · · · · .~..~/~. ~~C~<C.. ........... of ...... ....' /(Sig~l~Ure o~ applicant)