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Home My WebLink About4183-zFORM NO. 4 ' TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No...~. ~8... Date ........... i)Je ....~ ........ , 19..$9 THIS CERTIFIES that the building located at . &'~bO- l)~' .&- ~! ,Lal~ .... Street Map No..~ ........ Block No...~ ..... Lot No. ~ .... /~$1.. ~loX, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 9eO ' '3~' '" 19. (~ pursuant to which Building Permit No..1~..~.~ .~.. dated .......... P®I~ ... ~ ..... , 19. ~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . i~.~m.t$. ~ .f~lY. ~¥~lltng ...................................... The certificate is issued to .. ~llO~d..~,.~.a.a. ....... . .0~...~. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk Cour~.ty Department of Health Approval ~ex~x'tter~ Qert. ~ II ?~6~.1~ · Xov.. 21. lg~9.. ~ .!~,..Y.~,i~ .... Building Inspector % Wous ~ 79~ Albo FOF, D! 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) 4183 Z Permission is hereby granted to: ...... ~*, ~.... Jez,~ebe ..1~i1~ ................................ to ...... l~ut..],~,.~,~...~,m. ~.a~,~....,.~.~,~.,!,l~£ .............................................................................. ................................ (&pi~e4..b~'.. ~1....~l~ea.3.a.,.) .................................................................... at premises located at ...... , vv - ..................................... pursua:nt to application dated .................. ~T:.d",,, ................................ , 19..6.~., and approved by the Building Inspector. Fee $..19~.~ ......... COBHBC'~"~DLOCATI Oil I II/B &lbo Dr:J. ve · I/W o'-de of O,,I,Ls~ot Laurel JJ,~e Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WItOM at IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deedOocation) have been inspected by this department and found to be satisfactory. NOV 2 1. 1969 District Engineer District Engineer ~FORM .NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLF-.RK'S OFFICE SOUTHOLD. N. Y. Examined .................... , 19 .... Approved ..... ~...-~....~. ...... 19 .~.~. Permit No....~. (...~...%...Zr-..... Disapproved a/c .... ~ ~te. ................................. ....... ....... .................... ('fi e i ..................... Application No....~.~. (. ?..~. ..... APPLICATIQN FOR BUILDING P~-RMIT Date ...... .D~ ?.m.b. qF..3..~.~.t. .......... 19..~.8. INSTRUCTION.~ a. This applicati.on must be c.ompletely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing l~cation of l~t and ~f buildings o n premises, relationship to adjoining premises 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 application may ~ot be commenced before issuance of Building Permit. d. Upon approval of this applicati,~n, the Building In spect~r will issue a Building Permit to the applicant. Such permit shall be kept ,~ the premises available for inspectiem throughout the progress of the w. ork. e. No building shall be occupied or used in whole cr in part for any purpose whatever until a Certificate ~f Occupancy shall have been granted by the Building Inspecl~r. APPLICATION IS 1-12J}dE~BY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S'Juthold, Suffolk O~unty, New Y~rk, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for rertroval or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ~rdinances, building code, h.~using code, and regulations. .... .~.s.~:.~I~:6N . .H p.~l~:..C.O ~ 5.T.F~ C%I ON. CP., ,. ,I.N C.... (Signature of .applicant, or name if a corpo~ati.on) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ............. B........U I L D E ~ ............................................................................. Name ,of ,owner of premises . .R..ay.m.p.p.d...Fi.,...L.u.c..a ......................................................... If applicant is a,e~rporate, signature of duly auth,orized officer. ........... .s.~ r..~.t.~..~y. ....... (Name and title of c~porate officer) /described proper~y 1. Location ,of land o.n which proposed w,ork will b e done. Map No ................. Lot No .............. Street and Number . .Np.r..~.h...S.~.d.~.. p.f...A.1..bp...D.r.iy.q..g.q .~.n.q~. p.f...~.:..I.:. L..a.n.q..-...L.a. ~;r.q], ......... Municipality 2. State existing use and ~ceupancy of premises an d intended use and ,occupancy of pm.posed construction. a. Existing use and occupancy ... y.a..c.a.n..~..~.a..n.d ................................................... b. Intended use and ~.ccupancy .. ~rem~;.. A~. s.~=¥..~a~ue. 12~d..d~e.].:liu~ .or~ .prap~r.~y ....... 3. Nature of work (check which applicable): New Building . ~.e..~... Addition ........ Alteration ........ Repair ......... Removal ........ Demolit}on ........ Other Work (Describe) ...................... 4. Estimated Cest . ~.2.2. ,.0.0~.O.,.0. O. ................. Fee ................................................. (to be paid ~n filing this application) 5. If d~velling, number of dwelling units .. ~- ....... Number .of dwelling units on each floor .............. If garage, number ,of cars ...o..n.e...c..~.r.. g.9 .rg.ge. .................................................... 6. If business, commercial ,~r mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: Frant .. n~zue ...... Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front . .n. q0p ........ Rear ............... Depth ................ Height ................ Number of St~ries ..................... 8. Dimensions ,of entire new construction: Front ....5~ ............ Rear ...... 5..~ ......Depth . .2.4 ........ Height .. 2.4 ! ...... Number ~f Stories .... .1½. ...................................................... 9. Size of lot: Front ...9.[~ .......... Rear .. ~.-/0 ......... Depth .209..~..235... 10. Date of Purchase ...J, 1/.27/.68 ................. Name of ,~orrnl]r Owner .F.~.a..~.c.i..s...~.,...&...L.i.1..1.i.a.n...M. 11. Zone ,or use district in which premises are situated "A" van menen 12. Does proposed construction violate any ~3ning law, ,ordinance or regulatkm? .. f.~:o~.~ .y~:ds .......... ,,, _~_~,~ ..... ~ .... ;~.. Raymond R. Luca ~ddroooBox ll?~,Matiituckph~n,~ ~ 722-302 13. ~.~ 'u~ ~,~,,~'~,, ~ ........ o ...................................... ~. ....... ~ .......O .......... ~. Name ~of Contractor A..m.e.~., .H.o..m.~..C. 0p.~$;C.o...C~.~ Address .218~..d~xi~h~..T.[~k~ Phone No..5.4~..-~.~. ~).0 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ,or 'proposed, and indicate all set-back dimensions from p~operty lines. Give street and block number ~r descripti, on according to deed, and show street names and indicate whether interior ,or corner lot. STAT~ OF NEW YORK, )S.S. COUNTY OF .5.U.F..F.0.[,I~ ..... ) .............. ~.~.~ .Y..F.R..~.I.~.~..N.~ ...................... being duly sworn, ,deposes and says that he is the appli- (Name of in.dividual sign!ng applicati, on) cant above named.~Ie is the .......... .C.q .~p.~$p.t.~..0f.f.$g.~ ............................................ (Contractor, agent, oo~"porate officer, etc.) of said owner ~r ,owner% and is duly anthorized to perform or have performed the said w~rk and t~ make and file th~s application; that all statements contained in th is application are true to the best of his knowledge and belief; .and that the w~rk will be perfx~rmed in the mann er set ~ortl~ in the application filed therewith. Sworn to before me this 31st da,, of December ........ .. ..... ,. · ...... ....... Notary Public,. ;i~ft~..,~/-./. ,~;.,. County ~HN W. ~ ~