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Home My WebLink About4176-zFORM NO. 4 TOWN OF $OUTHOLD BI. III,DING DEPARTME, NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 7~36~1 ...... Date .............llov,.. 6 ...... , 19.69 THIS CERTIFIES that the building located at .. 'I~/S' 'l;eei;on' Dr ........ Street Map Bio. lax ......... Block No.. XX ......Lot No. ~r .... ~outhold' · l~;~/~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .........Jan' - · 27 · · ', 19. '69 pursuant to which Building Permit No... dated ...........~I~ .... 27'" 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 .... Private 'one' -family' dwelling ................................... The certificate is issued to . ~mnuet. ~ia~'ke:~. · ,v..0~-~ener, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... t~:Rb .......................... , / ......... .... Building Inspector / l~ou~e ~ 930 TO~'N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CFI-IlS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4176 Z Permission is hereby granted to: ........... ~, ..]i~r~e~.~.,.~J..lC~c~k~ ........ ................ I~h~ ............................................ to . Jt~LI.~I,..~IL adflJ..t~.oz~., o~..~..e~l,e.t iZ~l;.. ~m3.;M~t~ ..................................................... Le r. O at premises located at .......... .~..~.~ ....... ~.~.9'..~l .......................................................................................... ............................................................. ~,am.t~o..1.~ ................................................................................ pursuance to application dated .................... ~ ......... Jjrti .................. , 19....(i~ and approved by the Building Inspector. Feo S..~.;.~ ............ ~FORM ,NO. 1 TOWN OF Sou'r~OLD BUILDING DE~PAR"I'MF.~T TOWN ,CT-~tK'S OFFICE SOUTHOLD, N. Y. Examined ...... ..~. .... 19.~.? _ _ __ 6, _ .. qt '7 6 Approvea .................... ,1~ .... Perrm~ No .................... Application No. t~ ~ '-~ ~ Disapproved a/c .... ~ ........................................... (Build'~g InspectS) APPLICAT/O'~' FOR BUILDING P'F.~MIT Date .... · .............. ~Ianuaz~.. 27. 19..6.c~ INSTRDt~'rtONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Lnspecl~r. b. Plot plan showing location of lot and of buildings o n premises, relatio~ship to adjoining premises or public streets .~- areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of thi~ application. 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 available for inspection throughout the i)rogress of the work. e. No building shall be occupied or used in whole o2 in part ~ any purpose whatever until a Certificate of Occupancy shall have been gra~ted by the Building Inspecl~r. APPLICATION IS 1-12~k-~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 Ocunty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- liti0n, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building c~xle, housing code, and regulations. Gottleib Nick!e.s...i.g.e.n.t...f.o..r..3.~1 N~rkel ................. (Signature of applicant, or. name if a corporation) $.~u~hol~l ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ........... ~kgel~t. o1~. ot~er. ..................................................................... Name of owner of premises ..... .~....8~t!. ~..l~.~$~.kt~;],.. ...................................................... If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) Location of lan~l on which proposed work will be done. Map No.. ~ .......... Lot No... ~ ...... t ga.' ..... Sou .. ............................................ Street and Numl~r' . .... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy .... ~welling ..................................................... b. Intended use and ~ccupancy ......... ~a~e. ~ith. ~. adaitiom ............................... 3. Nature of work (check which applicable): New Building ........ Addition ... wrr Alteration ........ Repair ......... Removal ........ Deraolifion ........ Other Work (Describe) ...................... 4. Estimated C~st ... l ~000..~ .................. ~'Fee ~. ~.~00. ......................................... (to be paid on filing this applicetion) 5. If ,dwelling, number of dwelling units .O..ll.e. ..... 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 of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of S~es ..................... 8. Dimensions of entire new construction: Fr(rnt ................. Rear .............. Depth ............ Height ............ Number of Stories ............................................................. 9. Size of lot: Front ................ Rear .... Depth ............... 10. Date of Purchase ............................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated.., mA# ~:~$.~ .... 12. Does proposed construction violate any zoning law, ordinance or regulation? .... I~Q .................... 13. Nan~,e ~)f Owner~f premises .Sam°. 14arke;L ..... Address .... ~01~hOJ.d ....... Phone No ............ Name of Architect ............................. Address ...................... Phone No ............ Name of Contractor . .S~tl~ ..................... Address ...................... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly an buildings, whether existing or preposed, and indicate all set-back dimensions from property lines. Give s~eet and block number ~r description according to deed, and sh~w street names and indicate whet-her interior ~r corner lot. -,.. 77ew Yd-, STATE OF NEW YORK, ' COUNTY OF~ ~1..~l,f.~.~)~.~; .... ............... G~tl~b. l~:l,¢k, tes ................ being duly sworn, deposes and says that he is the appli- . (Name of. individt~al signing application) cant above named. He is the ........ .A.g~]R~;..c~. ~t'4~e~. ................................................. (Oontractor, agent, c~-~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 statemerrts oontalned in this application ax~ true to the best of his knowledge and belief; and th'at the work will be perfiaemed in the mann er set fortl~ in the application filed therewith. Sworn to before me this ': ......... ' .... ................ NOTARY PUBLIC, Stat~ ~ New York Ho. 52 0618100 Suffolk Oou~