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Home My WebLink About4399-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate Occupancy THIS CERTIFIES that the building located at . l~..~ea. Driva ............ Street the $ ........... Ma~0r~8.n.tr.~Y. ....... ~oc~No .... xX .... Lot No..~...0~$~t,. ~,~,. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Ju3,y. · 29., 19.69 p~rsuant to which Building Pemit No...~3~... dated .......... J~.Y. · · ~'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 ...P.r~r~;e. o~e. $~1]-¥..d~e~L.~.~.ng ..................................... The certificate is issued to . ~Iosel~l~ .Kes~ts · · · 0~,'ne~ .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......... .~..'. ~.' .................... ...... .... ..... Building Inspector 2ouse 9 1370 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 4399 Z ~e .......................... ~.,,aZ.....Z~ .......... . ~...6~ Permission is hereby granted to: .... ~..Ro.r~=.....~ .~........z...o.~.,e.~..~.e.~..s..t..~ ................ ~ge~t...., ............................................ at premises located at ............. ~..~...~.9. ....... (~r~,~efAt~..):~...t~.~...~.~, ............................................ ....................................... lloz. t~..~i~Ll)r~a .............. ~.~u~,....ll,Z, ................................... [ ..... pursuan¢ to application dated .............................. e1')3~'. ....... ~ ........ , 19..~.., and approved by the Building Inspector. Fee $..~.~JX~ ............ ~FORM ,NO. I TOWN OF SOUTHOLD BUILDING IYI~PAR~T TOWN CI,~RX'S OFFICE SOUTHOLD, N. Y. Application No.. ~ .~. ~ ~' Disapproved a/c .. ............. ..................... APPLICATIO~N FOR BUILDING FERMIT INSTRUCTIONS 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 l~t and ~ buildings o n premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of lay out of property must be d~_a. wn on the diagram which is part of this application. c. The work covered by this application may n~t 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 sho]l be kept .on the p,rem~ses available for inspection throughout the progress of the work. e. No building shall be occupied Or' U.~ed in whole or in part for any purpose whatever until a~Certtficate of Occupancy shall have been granted by'flie 'Building Inspec~a'. APPLICATIO:N IS ]:l~l~:~y MADE to the Building Department for the issUance of a Building Pe~nit pursuant to the Building Zone Ordinance of the Town of S~uthold, Suffolk Ck)unty, New York, andother .aPPlicable Laws, Ordinances or Regulations, for the constructio.n o~ buildings, additions or alteratibns, or~f°r rembval or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, honsing code, arid regulations. '~ ............ (Add~;; ';f' ~p~ii~ ........... If applicant is a corporate, mg~ature of' duly authorize d ~fficer. (Name and title of corporate officer) -~ ~- a. F, xlsting use and occupancy...~.~-..5 .................................................... b. Intended use and occupancy ... ~ ~ .~. ·. * .................................................... 3. Nature of work (check which applicable): New Building ........ Addition . ..&~.... Alterati~on_~...~... Repair .i .... Boeploval ..... ~.. Demolition ........ Other Work (Describe)~~. 4. Estimated Cast,'" ~..~.O D,~ ~..~) ................ 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. . ~c mixed 0ccupancy,. specify, naturet and extent of cache type of use ..... ~...........~ ./~.;~. ~. 7. Dimensions of exmt~ng structures, if any: Front ...'.~..0. ....... Rear .. ~..~. ....... Depth . Height . ../ ............. Number of Stories ... / ........................................ : .~ ) ........ Dimensions of same structure with alt~ra~t~0ns oX additions: Front ....~..~. ....... Rear .~. ............ 8. Dimensions ,of entire new construction: Frcmt .... ~..~../ ......... Rear../.g.I. ..... Depth /.~...[. ...... Height ............ Number of Stories ............................................................. 12. Does proposed eonstruction~v, iela~ .any ,~ing law, ordinance or regulation? . ~ .................. 13. Name of Owner,of premises p~.¢.~ ...... /~ddress .....~.~ ....... Phone No ............ Name of Archit~ect . ~2~;,9~1~ .... ~ddress ~.~;~.,.~.,~, ...... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give s~eet and block number or description according to deed, and show street names and indicate whether interior or co~er lot. STATE OF NEW YORK, )S.S. COUNTY OF .~6,,.f..F.~.~ ..... ) .......... .~.~..~. ~.... ~.~. ~/Ltg~. ~. .................. being duly sworn, ~leposes and says that he is the appli- (Name ,of individual signing application) cant above named. He is the . x....~ ................. ~. [./..~.,,c...~. ........................................... (Oontraetor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perg0rm or~ have performed~ the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be perfu~ed in the manner set fortl~ in the application filed therewith. Sworn to before me this NOTAry PUBLIC, Stat~ o! New Y0~ 52-7267800 Suffolk County ~erm Expir~ March 30, 19~0 ......... ~g~{~'~ of applicant) '