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Home My WebLink About4177-zFORM NO. 4 TOWN OF SOUTHOLD BUII,I~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy No..Z. 35.42 .... Date ...... July. ..... 11, ....... , 19.69. THIS CERTIFIES that the building located at Ila~.th. Sea .Dr£~e ......... Street Map No ............. Block No. .......... Lot No. JouhholcL,. J~e~e..York. ......... conforms substantially to the Application for Building Pemit heretofore filed in this office dated ..... ~Tarmary .... 27,.., 19.69. pursuant to which Building Permit No..43,77. Z. dated ..... ~ranm~y .... 27,..., 19.6.9, was issued, snd conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... ~riv&~;e. one. ~mu~,ly. ~s3,3,~q .................................... The certificate is issued to . .$~muel. ~kel ....................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Inspector House ~ 725 North 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) 4177 Z Permission is hereby granted to: .............. I~msm]...tte~l~#~L .................................. ................... tt~t~],~ ......................................... et premises located at ...... ~[el~'.t~L. ~'1~,..~'~.11~ ................................................................................. ....................................... 8m~t. bol.d .............. pursuant to application dated .............................. .~.1~,~ ......... ~.. ....... , 19...~., and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING D~PARTMEN? TOWN CY-~-RK°S OFFICE SOUTHOLD, N. Y. Examined. ~ ~'''~ 19 ~ 7 ,pp ed .............. .... .. Disapproved a/e .................................................... APPLICATI(~N FOR BUILDING P~,~MrF Date ..... ~ ......... .J.a..ll.u.a..1'~. .... 2.7 .... 19. 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 of buildings o n premises, relati~hip to adjoining promises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this applicat/on 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 throughou,t the progress of the work. e. No building shall be occupied or used in whole el~ in part f~r any purpose whatever until a Certificate of Occupancy shall have been ~ranted by the Building Inspect/~r. APPLICATION IS 1-~_~k-~y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Oounty, New York, and other applicable Laws, Ord/nances or Regulat~ns, for the construction of build ings, additions or alterations, or for removal or demo- lition, as h~rein described. The applicant agrees to corn ply with a!l applicable laws, ordinances, building code, --~ ~ G. Nickles'..A./..C..S..a.~.:..~.a..r.k.e..1 .......................... (Signature of applicant, or name if a corporation) ........ $o. utkQl& ................................. /~f~ ~ ~d~"~ ~'~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................ '~ ~el~t · o~.. o~r~e.~ ............................................................... Name of owner of premises ........ .S.$1111~L .l~a~kel ................. .~..~-.. ~ ...................... If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No .... ...x~.. ........ Lot No .... ~ ..... Street and Number ..... ~.0r.th. ~ea. Dr;i.ge ...... So.tho.id ...................................... /-~'! 7 1~' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ..... PlI~. ~.~I~],Ir. ~I/e~lJ. illg ...................................... b. Intended use ,and occupancy ........... s..a.ll!e....~.~.th .&IR .$~cll.t.~oD. ........................... 3. Nature of work (check which applicable): New Building ........ Addi'cion .:K,X~... Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ....... ]~.Q00. ................. Fee .. ~.e..~ .......................................... (to be paid ~n filing this application) 5. If ,dwelling, number of dwelling units . .q)p~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: Fr~qt .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions ,of same structure with alterations ~)r additions: Front .............. Rear .............. Depth ................ Height ................ Number of Stories ..................... 8. Dimensions ,of entire new construction: Frant ................. Rear .............. Depth ........... Height ............ Number ~f S?aories ............................................................ 9. Size of Lot: Front ................ Rear ............... Depth ............... . 10. Date of Purchase ............................... Name o~ Former Owner ............................. 11. Zone or use district in which premises are situated...".A. ~.t. .d. ~.~.~. ....................................... 12. Does proposed construction violate any ~ning law, ~)rdinance or regulation? .... ..rl.o. ................... 13. Name ~of Owner.of premises .. ~q o. ]4arke;L ...... A, ddress .. ~.o.g.t]qg~[.d. ......... Phone No ............ Name of Architect ............................. ~ddress ...................... Ph,~ne No ............ Name .of Contractor ..... ~.$1~.q ................. Address ...................... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior ,or corner lot. STATE OF iqr~W YORK, )S.S. COUNTY OF .~..~..f.O..]~. ..... ) ...................... GO.'~lei.b .lqiqk~.e~ ........... being duly sworn, deposes and says that he is the appli- (Name ,of individu.al signing applicati,on) cant above named. He is the ............. agent, of .o~mer. ............................................ (Oontraetor, agent, cm'porate officer, etc.) of said owner or,owners, and is duly auth,erized to perform or have performed the said v~rk and to make and file this application; that all statements contained in this applica~on a~e true to the best of his knowledge and belief; and that the v~rk will be perfe~med in the mann er set fortt/in the application filed therewith. Sworn t~) before me this ............. 27. day of ....... Ja~ ........ 19.67. Nc~t ary Public,