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Home My WebLink About4328-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~-..!*137. .... Date ............. J~....1.8 ..... , 19 71 THIS CERTIFIES that the building located at . ~//.S. I~z Av~. (¥:l.~,],.. I~) Street Map No..:1~ ........ Block No .... ~ .~ .Lot No... ~ .... 01':].ellt.. ~I.,¥, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... J.u~e .... ~.., 19.69. pursuant to which Building Permit No. h~32[~.. dated ............ June .... 9.., 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 .Pl'~,.v~t®. I~.G .. ~'~o. Far~].l~..dvel].:l. ng ................................. The certificate is issued to . I)a¥:[¢l .$1~1~ ...... (hfllel' ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval t[ouse ~ 2760 .... N.o~ ,, ........................... .... t .y-9~/...?c. Ii...,.~. :.,:: ./-~, ............... Building Insl~ector FORM NO. e TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4328 Z Permission is hereby granted to: ....... g~Jti~Jd'""ll',~', ....................................... at premises located at ............. Mi/~.....~l~..&~..(~.J~..~.&je...J~jll.)...~..~l~.~J,) .............. ........................................ e,l't.~ ......... II¥~Z'~ ...................................................................................... pursuan$ to application dated ................................. eJ~l~e ......... .~....., 19..6~, and approved by the Building Inspector. ~Fee $.JJ,~OO .............. Building~'lnspecf BUILDING DEPARTMENT ,c~4,4.~/ .? ,~ TOW~' rt =Rv,e ~FtrE ,, ~HOLD, N.Y. /;~/~ ~amined ~ - - ~ ~ . I Y ~ nnl'cflf"nn Nn Approved .................................... , 19 ........ No ...... ................ APPLICATION FOR BUILDING PE~IT INSTRUCTIONS a. This 6pplication must be' completely filled in by typewriter or in ink arid submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings On premises relationship to adjoining pre.m ses or pub ic streets or areas, and giving a deto led descr priori of ayout of property must be drawn On the diagram which is part of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will. issue a Building Permit to the applicant. Such permit shall be kept on the premises avc~lable fo[ inspqct, iqn throughout the progress of the work. e. No building shall be occupied or used in whol~ or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. / . . ~ APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Bu ding'P&Fmit pursuant to the ~uild!n.g. Zon~ Or.,clinance.of t.h.e. To.wp o.,f..Southol,d, Suffolk County, New York, and other applicable Laws, Ordinances or Kegu~ar~ons, or the consrrucrlcyn at OUlla~ngs, aaaitions qr alterations, or for remova or demo t on. as herein described. The applicant agrees to comply with dll applicable laws,~rdinance~ 'and regulations. · (Signature of applicant, or name, if a corporation) (Address of applicant) " State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.......~..t~.^.....~.l~,{~....~_~;l~:~,.,.:: ........... : ...... : .................................................................. If applicant is a corporate, signature of duly authorized officer. u' (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: .................. ~. ................. Lot No:,....~......i ........ Street and Number ..~I~G-~.~......~...~. ...... ..~ ....... .~..I~¢L. .......... ~..1~'~.. ........................................................ /~(- ,~7~ ~/',~.~ <:~.~,~ Municipality · 7 o 2. State ex,s ~t~ng ~se and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......'~.~.~1~-~' ............................................................................................... b. Intended use and occupancy ............ ;~t.~ ....... .~.L....~. ..................................................................~ :' ...... 3. Nature of work (check which applicable): New Building .................... Addition.....~. .......... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ..~.6.J~...~,~ ....................... ~ .............. Fee .....~...~.:~ ........................................................................ (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, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front .........~...~. ........ .Rear ......~...~....Jl~.: .......... Depth ....~.~: .............. Height ~q Number of Stories 'z~ Dimensions of same structure with alterations or additions: Front ......... .?..~.....,~,; .......... Rear ....... ~,~.....'~.: ........... Depth ....... .~. ~......~.. ......... Height ........... ..~...~ ............... Number of ' ~-- Stor~es ................................ 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories.....~ .......................... ~-- 9. Size of lot: Front ......].~..~r~..~.~... Rear ....... J.~,~ ........ Depth ....... .~,~...e~. .... .,~,.~ 10. Date of Purchase ..UNt~I4~.N .................................... Name of Former Owner ..~ ............................................... 11. Zone Or use district in which premises are situated.....~'~a,~r~J~.'~.L, ....................................................................... I~2.~ Does proposed cons,t~uction,violate any zoning law, ordinance or regulation? .~lr~.....-~...LT. tq..~.Uj~.l.~OEd~...r' % 13. of premises..r~.,.~L~.,.~l~O~i~l, .......... Address ~f~....~;.,..(~..t~... Phone NO ..................... Owner of Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor C~RLO~BA.~'TM...~.~ ............... Address ..~:~l/c~..~.,&(~ ....... Phone NO. ~'&~.'..~..q.)...~.. PLOT DIAGRAM Locate clearly and distinct y all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK ) S.S. COUNTY OF ..... ; .................... ) ....... I~t~ ........ ~eoL. O.~..W~..~.'~t~.,., ................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing apPlic'atton)__ above named. He'~s the ...~r.~.~..~D~..~.~E,' ....... .~..'~t~.....~C. .......................................................................... ; ....................... (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 file this a. pplication; that al/ statements contained in this applk;atjon, are true to the best of his knowledge and belief; and that the. work will be performed in the manner set tgrth in the application filed therewith. Sworn to before me this ...... ....... of .............. ......... .... EI.IZA~~ NOTARY PUBUC, State of New York No. 52-8125850, Su~j0Jk County Term Expires earcPX;:~gll~ture of applicant)