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Home My WebLink About4405-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Nc~b~(~l~ ........ Date ............. ,T.,O.G~. l~ ......, 19. ~. THIS CERTIFIES that the building located at ~lm .ll~l~. 1)1~.~ ....... Street Map No. 8~1~111. 8~lock No ........... Lot No.. ~ .... Gl'eel~Ol~ .... l~,][-, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J~l~y .... $., 19~.. pursuant to which Building Permit No. Ill~O~.. dated ............. &liS..~.-., 19.(~, 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~. ~1~. [alB~,l~ 4~t.~ ....................................... The certificate is issued to ...~h~l*'l~z- & .l~l~b~l~ .~$1'~gl~ ....... 01~1~... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ma~'. lO .¶9.~r~..b~'. Il,. ~..~& ..... UNDERWRITERS CERTIFICATE No .... ~1[ ..................................... HOUSE NUMBER... ~'~0~ ..... Street .....'~2.~e ']4&I,1 t~n' 1~* ........................... PO/t~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) N? ~05 Z Permission is hereby granted to: ,~. _ _ ~( ,..- - /'~ -- _ ........... .~,.n..~...~...~.;/...!.&....~.~..&,T. R....u...0 ~ ........... /..~.L~..~...9...,..~,~.~..~ ............ ~..7. ' ......... /~....~...L~.....~.~......~ ....... ~....-~.~ ........... ~ ..................................................... ot premises k_.t.6 ..................................................................................... ~.2 ...................................... pu,suon, to opplicot,on do,ed ..................... .~..?....C;..~......,~... ........... . ]9.~.., °nd oppro*ed by the Building Inspector. Fee ,.l.O...~. ...... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Date MAY 1 0 197l Bldg. Permit No. TO ~ROH IT HAY CONCERN: The sewage disposal fa~c~tlitles for a structure J (Give dee~ location) / located have been inspected by this department and found to be satisfactory, C~ie£ of General Engineering Services MAY 1 0 lg72 Examined . · pp / ..... ~...~~ ..... ~ --~ ~.~ ~ ................... ............................ .................. ............ ' ............ 19. APPLICATIi~N FOR BUILDING P~RMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Pl~t plan showing location of lot and of buildings streets or a~eas, and giving a detailed description of lay out part of this applicatinn. c. The work covered by this application may r~ot 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 available' fo~. inspection throughout the p~rogress of the work. e. No building shall be occupied or used in whole Occupancy shall have been granted by the Building Inspector. APPLICATION IS I-m~l;~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soathold, Suffolk Oounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to cum ply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of .applicant, or name if acq~ ) · .~>...c..~. ?.~ c..~...~y.~...,..~.~..h~...d.. ?.ar..k.,' ~ ...~; ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or ~,~ builder . 0t~;v. ............................................................................................ Name of owner of premises .Chac3,ez. W~..and. ~lt z~a~l~ .~ez~rude .......................................... If applicant is' a corporate, signature of duly authorize d c~ficer. ~ (Name .and title of corporate officer) 1. Location of land on which proposed work will be done. Map No..~853. .......... Lot No..3~ .......... o Street and Number . ~.Blae. Me~nl&n. · Dr/_v. .............. ~tlc~n. of. Scut.bald ...................... F-fi/ - /_~ ~ Municipality State existing use and occupancy of premises an d intended use and occupancy of proposed construction. a. Existing use and occupancy . aar~a ........................................................... :.. b. Intended use and occupancy . P~5.g~e.D~P3J.~g ................................................ 3. Nature of work (check which applicable): New Building . .i[ ..... Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost $30~O. QQ~(X~ .................... Fee . .~..0 ............................................. (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 ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions o~ same structure with alterations or additions: Front .............. Rear ............... ................ Height ................ Number of Sixties ..................... 8. Dimensions of entire new construction: Front ~...~... Rear ...~s~. Depth . Heig~ht ............ Number of Stories ............................................................. ~ 9. Size of lot: Front .. ,~. ........ Rear . ]~D.' .......... Depth . .13/~! ......... 10. Date of Purchase ..M~y.;~-~.~-9~:~. ............... Name of Ferroer Owner ..tt.&.F.l~e ............ 11. Zone or use district in Which premises are situated ..... A .... ~ ................................. 12. Does proposed construction_¥iol~te .a~ny~ .zlming law, ordinance or regulation? . .~o ...................... ...... . ~nar-es ~ m~mzab~th~,~__ 3/+ Conn. t~e. ~__ C~ 2-5435 13. name e~ ~wner o~ pr,em!sea Krum~acker ...... :- - '~u~'~Islerrd .Park~. N...~: .... ~-aone l~o: .......... _ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or .proposed, and indicate all set-back dimensions from pro~rty lines. Give street and block number or descripti~)n aceerding to deed, and show street ~ames and indicate whether interior or corner lot. STA'~ OF ~S.S. COUNTY OF .................................................. being duly sworn, deposes and says that he is the appli- (Name of individual signing ~ __ ~~,/~_. cant above named. He is the ............................................................................ (Oontra~tor, a~nt, ~-~-l~orate 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 application; that all statements oontained in this application are true t~ the best of his knowledge and belief; .and th'at the work will be p~ed in the mann er set fortbl in the application filed therewith. Sworn to before me this NOTARY P~BLIC, State of New Yo~, No. 52-3233120 Suffolk County I~m Ex,res March 30, 19..~./ VO~LL BY O, V/Nk)q~FL ~ .~, ~100//,, AHL£RS, New FL BOR~O~ P. CONSULTING L. I.. New Y~rk -% '% 'FE~_ FT3 ~- U ........................ ,~- ,J GORDON K AJ4LERS, P E , CONSULTIIIG ENGINEER 1 85' Checked Date Job #C~t lC