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Home My WebLink About4162-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.. Z,~287 ..... Date .. Ju3.y. 15 ................. , 19.73 THIS CERTIFIES that the building located at ................. S/S 01d 14ain Road. .......... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .J..~.~..~:~'. 3 ........... , 19 .~.9.. pursuant to which Building Permit No...~.1.6..2.. d~ed .J..~u~.~r. 3 ............ , 19.6.9., 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 .... ~s. lr~.~, b~ldil~g .~. ~ ~ ................................. The certificate is issued to ...... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N .R o UNDERWRITERS CERTIFICATE No ............. .P.~l~.d~.~g ....................... HOUSE NUMBER 62900 ........ Street .. $/$..0~.d. F~in, .1~o~,~. ~0.111;h0l.d.). I~,X., Building Inspector / FOP,~ NO. ~ 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) Permission is hereby granted to: · .Gee~..Batm~.....~t¢....&z~ma4~.C&p~ ..... ................... 8~a,t, tm~l. ......................................... to . .IlliCit.. ~r~..alibi ;LtLIm.. ~.. ~aka.. ~tezat:l~n..ea.. e~tJ Liaj..hulllaaa a...but ldZuj et premises located at ...~/.~......O~J~,..J~.~,l~Ul~ ............................................................................. ................................................. ~.outkal~t....~.. ............................................................................. pursuo:n¢ to appli¢otion doted ......................... ~..~ .............. ~ .......... , ]9..~{~., ond opproved by the Building Inspector. Fee $...~..%.(~.. ............ Building Inspector / F,ORM ,NO. 1 / .~"'",~*- ~ ,'~,~, ~."~-~*a.~ ~* ~"~'- ~ Examined ~ ~ 19 ~ t Application No. ~/ ~-..... D~app~ved a~ ................................. .................................... ~"Z ....... 2 ................. ........... ...... .......................... (Build~g I~pec~) rare ~.~. ~ ~969. ~STRU~ONS a. This applicat~n must be ~mpletely fill~ in by type~iter or in ~k and submi~ in duplicate ~o the Building Ins~. b. p~plan showing location of l~ and~ buildings on premis~, relat~ip ~ a~oining p~mi~ ~ public s~eets ~ ~, ~d giving a d~led description of lay out of p~pe~y must be drawn on ~e di~am which is pa~ of this applica~n. c. The work ~ve~ by ~ applicatt~ may ~ be commenced before issuance of ~il~ng Pe~it. d. U~ ap~val of ~is applicati~, the Building Inspec~r will ~sue a Build~g P~it ~ the applic~t. Su~ pemit s~H ~ kept ~ ~e premiss available for ins~i'~ throughout ~e p~ of the ~rk. e. No building shffil be occupied or us~ in whole o~ ~ p~ ~ ~Y pu~se wha~v~ ~tfl a ~icate ~ Occupancy ~ ~ve ~n grated by the Building ~sp~. ~ICA~ON IS ~Y M~E to ~e Building Department for ~e issuan~ of a Bu~ding P~it pursuant ~o the ~ilding Zo~ O~in~ee of the ~wn of ~athold, S~olk ~nty, New Y~k, ~d o~er appli~ble La~, Ordi~nces or Regulat~ns, for the comt~ion ~ build ings, additi~s or alterations, ~ f~ ~vffi or dem~ lifion, as h~in des~ibed. The applicant agr~s ~ corn ply with all applicable ~ws, o~i~nees, building ~e, h~sing c~e, ~d re~lations. .... .................................................... (Signature ~ applicant, or ~e U a ~ration) ........ ga.in. Road ..... /]outhald ................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ...................... .~ O~.'~ I'~.~ t O~' ................... < ....,~.: .....( ...................... .' ........ Name of ,owner of premises .,~..~.~clo. .C&l)p&. . . (~"~/'~'~' ~ If applicant is a corl~rate, signature of duly auth<)rize d ,officer. .................................................... (Name and title of corporate officer) ~ IJ""*'**'~ ~ ~"~- '~ ff3~~' 1. Location of land on which proposed work will b e done. Map No.. ~ ........... Lot No. ~ ........ Street and Number Sits O'ld Y,.a:l.n I/oad Southo.l.d. ................ ~t ~ ~ ~ ~ ~ 0 Municipality 2. State existing use and occupancy of premises an d intended use and ,occupancy of proposed construction. a. Existing use and occupancy . RXl~:LI~$S..bu1~:~l~g. · ,~ .Ras~;&ur~n~; .......................... b. Intended use .and ~ccupancy ..... same. ~.i~;l:t. ~12. &dd:t~;Lol~ ................................... Nature of work (check which applicable): New Building ........ Addition . ;I;~1~... Alteration ... ~. Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ...~.~t0.Q0....l~f~ ...... : ....... Fee . 5.00. .......................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ... ~ol~e. Number of dwelling units on each floor .............. If g~rage, number of cars ................. ......................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each ty~e of use. ~l~l:~e~as.. 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 Stories ..................... 8. Dimensions ~)f entire new construction: Front . .~0..~ ........ .. Rear .. 20 ......... Depth ...~0.-~.... Height ............ Number of Stories ............................................................. 9. Size of lot: Front . 270. -~ ....... Rear ......... ...... Depth ............... 10. Date of Purch.ase ...1.c258 ...................... Name of Former Owner .../]&l~.l~attea~ ........... 11. Zone ar use district in which premises are situated...n.B.~.../I:~S.~ ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.* . ~10 ...................... 13: Name of Owner'of l~'emises . Al~alldo. Ca!~pa. · A~ldress ... ~ollthOl~l ........ Phone No ............ Name Of Architect ............................. Address ...................... Phone No ............ Name of Contractor .. C~O. ]~a~l' ............. Address .... Sov, tho3,d ........ 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 .treet and block number or de scription according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, )S.S. ~,~ ~ . ~[ ~:_ Y ~'* ~r' ~ '6 L (Name of ~:v~:$~nin~:J~c~t~ ~'n~:~::y sworn, de~z~ ~d ~ys ;;t he is ~e appli- c~t a~ve n~ed. He is ~e .... ~~ ........................................................... (~on~a~r, agar, ~ate ~icer, etc.) ol ~id own~ ownem, and ~ duly au~ W p~orm or have pe~ ~e ~d ~k ~d ~m~e ~d file ~ appllca~n; ~at ~1 stat~e~ ~nt~ in ~is applicon ~ ~e to ~e be~ of his knowl~ge ~d belief; and that ~e ~k will be p~ ~ ~e mann er set fo~ in the applicat~n filed ~emwi~. Sworn to belom me ~is ............ ~.. day of ....... J..a~..l~... 19. MARION A. REGENT NOTARY PUBLIC, State of New York No. 52-3233120 Suffo k Count~ Term Expres IV/arch 30, 19..~