The URL can be used to link to this page

Home My WebLink About4453-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Date .......... ~,,pl'iJ. ..... 18 .... , 19 .~.~. THIS CERTIFIES that the building located at ....... ~/®L]~ .Road ......... Street Map No...ggg ....... Block No... ~ .... Lot No..X~..l~eCO~O .... l~,Y,. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~pt.- 9 "', 19.69 pursuant to which Building Permit No.I~'~Z.. dated .......... 5apt ..... 9.., 19 69., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is I:T~¥&~;®. 0~ .falM.~,y. ~lL$glg ....................................... The certificate is issued to . Pa~i~. ~g. & .¥~.fa ·. 0e~xel', .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . h.~.. !.~..-. !.~. ? .9 .......... UNDERWRITERS CERTIFICATE No .... ~1~ ...................................... HOUSE NUMBF. R .... ~8~ .... Street ......~eJJ.~. ~sll~,d ............................... ....... ....... ..... Bnilding Inspector [ FOF~M NO. 2 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) 4453 Z Permission is hereby granted to: Baker & Fieke ssen ,.A..~... ~.~..1~ ...~..rl ............ ~.~nt3~, ................................................ to .....~.1~!~ .~.. ,~1.~.~(...Q~,.~...~'.~;i~.~...~.~.r~..., ~,.~,o ............................................................................... at premises located at ................ ~......~e.~l~..~..~o~d ........................................................................ .................................................. ~..e..q.C~L~. ......... .~..,J.~ .......................................................................... ~'~'+ ~ 19.6..~...., and approved by the pursuant to application dated ............................ ~.v.z;..~ .......... .z ............. , Building Inspector. INSTRUCTIONS a. This application must be completely filled in by t~pewriter or in ink and submitted in duplicate to the BUilding Inspector. · b. Plot plan showing Iocat,on of lot and of buildings an premiss, relationship to adjoining premiees or public streel~ or areas, and giving a detailed description of layout of prope~, must be drmWn an the diagram which is part of this application. .¢. The work,covered by.:this rCq3plicatJan may not be commenced before i .squance of Building PerraJt. ,-d. ' Upq~,app .Awol of this .aPP. licotion, .tho Building InsPector will issue a Building Pem~it to the applicant. Such perm~ snail be kept an the premises avadable for mepeotian throughout the progress of the work. :. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of'Occapanm/ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pureuant to the ~Build!n.g. Zone. O~inance of the Town of Southold, Suffolk County, New York, and other applic.a, ble Laws, Ordinance. or Kegu[ahons, tar the construction of buildings, additions or alterations, or for removal or demolihan, as herein descr bed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, 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 ../..~,~....~.../..~..~.~.A.....~..~...~....~......~.~/,~.~.:. .......................................................................... If applicant is a corporate, signature of duly authorized officer· · ...~~...~..~ ........ ~.~.~.~.~ (Name and title of corporate officer) 1. Location of land on which prapoeed work will be dona. Map No.: ........................................ L~ No.:.~ ........ Street ond Number _....../~..~.....~.. ........ ~.....~...~. ....... .~.....~..~ ....... ./V...~....~r.....~./..~... .......... , ...................... ..................... 2. State existing use and occupancy of premle"e ond intended use and occupancy of prope"ed o. Existing uee' , , , and occupancy ..........,~.~.~ ................................................................................................................. ' b. ~nmnded.~ use. ahd~oc~apamy .,Z..., .f..~.~,~:/..~.... .- . ~.:..,;.../~.......~....~..c..~ ./.~..~,......' ....... .:;, ......... ;,..:;. ........ .... 3. Nature of work (check which applicable),~ildieg;.~.;~...~....'- .... Addition .................. Alteraeion .................. Repair .................. Removal .......... ~tn~.llt (Tn ........... ;...Other Work (Descr,be) ........................................ ~ Estimated Cost ...........s~'...'~..~.°....°...?.. ................ y...~..:~R;e~:.~;~i~6 ................................................................................ (to be paid on filing this applicotion) · ,~"~ If dwelling, number~of dwelling units ......... ./.. ................ Number of dwe!ling;,units om,each:floor .....~ ..........~ .......... ~ if garage, number of c, ors ........... e~....~...,~.~, ........... ~,..;...,.....;..~..,..~ ......... ,..~, .......................................................... 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 of some structure with olterations~or .additions: Front .................................... Rear ............................ .r Depth ................................ Height .,: ............. :~ ....... ~.. N ~mber i~of ':~tories ................................ 8. Dimensions of entire new construction?Front .."~...?..~ ........ .....~ ........ Rear ....~...Z...[ ............. Depth ..~..6:..... Height ....*~..~..'. ...... Number of Stories ..i../. .............................................................................................................. 9. Size of lot: Front ............................ 'Rear ....~ .............................. ~ Depth ................................ · 10. Date of Purchase ...... /..~..~..7. ..................................... Nome of Former Owner .~....~..:....~....~.~../'...s......~'...S..Z:...~ .............. 1 1. Z0~e or use district in which premises are sitUated ../~....~...~.../.~...~':...~..T....~...~......~w...; .......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;) .....~..q ................................................ 13. Name of Owner of premises .~...~ ......................... ..-....' ................................................... m-~arm No ..................... Name of Architect ...................................................... Address ......: ..................................... Phanl No ..................... ' Phone Nome of ContraCtor ~'-'"'~',.~..~-...~...~.. ../~../..c..'AS..'..~'../'.~'s'"~.../.V'...Address "'"'~i~'i"~'"'~'"~""~'~"~'"i" PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or preposed, and indicate alii ~Joack climemicm from ~,~im~erty lines.' Give~ street and block number or descripti,on according to deed, and show ttmet nemm end indicate ,eflether Interior or corner lot. STAT~ OF NEW' YJI~K~ , ~ e ~ COUNTY 0~: ............... ;, ...... ~.,.,;...,f ~'"' .......... ~ ........ ~....~......~ .................................................... ~ duly ~m, (~of i~iv~t ~i~ ~licmim) .... :.. , , ' - a~ve na~. He is the ...................................................... ~.~..~....-.-~ ......... ~ ................................................... (~ ~t; c~m~ o~r, ~.) of ~id ~r or ~em, and is ~ly a~rlz~ .to ~dm~ ~ .~ ,~~: ~i~,r~ ~,.~ ~ ~ file this ~licafi~ '~t afl' statemen~ cont~ in ~is ~plic~i~ am t~ ~ ~ ~ ot ms ~ a~ ~lief; a~ ~at ~ ~rk will ~ ~m~ in the ~n~r ~t fo~h in ~e ~lic~ fll~ ~i~. Sworn to before me this ,,~ .... .......... ........... ........ Notary Public, ~' I~. ~t~50. Su mk ~e~,~ (Signature of applicant) ......................... ,~rm ~ires March S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date APR 1 6 19 3 Bldg, Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (GiveffdeeH locatio~) ' / have been inspected by this department and found to be satisfactory. Chief of General Engineering Services