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Home My WebLink About4192-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...~.?.~. ..... Date .......... .b, ltg ..... 30. ...... , 19.. THIS CERTIFIES that the building located at . 14~n. & I~io~.ea~t ......... Street Map No..:~X ......... Block No...~ ...... Lot No. ~..BOta~;I~OJ.&..~i,][., .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ /~&a..~ ~.., 19.. $9 pursuant to which Building Permit No.. dated .............. l~b. · ~6, 19.. ~¢~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... L:~s ines s. l~u~lcling- ~-- m.txed - occupancy. -8.~ore. & .Apes, ......... The certificate is issued to . .Wal.~er-At~zola ....... Owne~* ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...I~,~o ............................ UNDERWRITERS CERTIFICATH No..~.,~, ........................................... [lOUSE NUMBER.. ~5~7~ ..... Street .... l~,~r~.ao.a~;....~.5..~O.~4$e&-xl .&'~O ............ ..... Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMiSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Dote · ' Permission is hereby granted to: .................. ~hoL~ .......................................... ad~t t on & ~ a;}.~-~~.~t!91tt~ i~i~ to ~. ~"~ ~ ~ .............................. ............... (~l~e~..o.~c~) ........................................................................................................ at premises l~cted at .................... ~l~..lt=ee~.ib..~i~aet~..~vl ......................................... ......................... ~[~ ............. ,.L, .............................................................................. pursua:n¢ to application dated ........................... ~' .........~' .......... , 19..6~.., and approved by the BuiJding Inspector. Fee $..~..~,,..C~... ............ ' 'r'" Building InspectorI Examined . Approve::l .................... , 19 .... Permit No....~//. ~ .~.. .... Disapproved a/c .................................................... AppLIcATI0~ FOR BUILDING PF. RMIT · ' Date :. :..~ ........ ~.~1~.,...1.~ .... 196.9 INSTRU~;r~ONS ... , a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the.~. Building Inspector. . . ~ b. Pl, ot plan showing location of lot and of buildings on premises, relationship to adjmnin,.g pr~e. miSes or.p.u.bh.c\._ streets .or areas, and giving a detailed description of layout of property must be drawn on me umgram wmcn ~s part of this application. ~h c. The work covered by this applicatkm may n~t be commenced before issuance of Building Permit. d. Upon approval of tills application, the Building In spector will issue a Building Permit to the applicant, t~l Such permit shall be kept on the premises available for inspection throughout 'the progress of the work. e. No btlilding shall be occupied or used in whole o~ in part f~r any purpose whatever until a Certificate of Occupancy shah have been granted by the Building Inspec, i~e. APPLICATION IS kl~_~.~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~uthold, Suffolk O0unty, New Y~rk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, . or for removal or demo- lition, as herein described. The applicant agrees to corn ply with ail applicable law~ ~inances, building code, housing cude, arid regulations. (Signature of applicant, or name if a corporation) ...... ~nu'l;hold ..... N.,.¥ o ......................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 01~nel' ............................ Name of owner of premises . .'~liJ.'c.ez: .~l&i~l~oD. ......................................................... If applicant is a oorporate, signature of duly authorize d officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No .... ~ ........ Lot No..:K~. ....... Street and Number .. ~[/{~..I~. I~. & .~//.~. ~.a~$1~e&l~, .~'.~ .... /~o~ch.a'l d ........................ ]~ ~ -~$-~ 75 .~/ )~,.~ _ 5~._~// Municipality State existing use and occupancy of premises and irrtended use and occupancy of proposed construction. a. Existing use and occupancy .. Hlx~d. a¢cupanc~...¢S~re..&. Apa~.~ent) ................... b. Intended use and occupancy . ~.a]~l~ .¥~t,/;h..~,ddk~;ion .& AXteratian ......................... 3. Nature of work (check which applicable): New Building ........ Addition . ..X~..... Alteration . .:I~X.. Repair ......... Remoy, al ..~.~ .... De4n0!ition ........ Other Work (Describe) ...................... Estimated Cost ........~----,,r.~.~....~f~.....~.: ....... :Fee.. ~,,,,Ofl .......................................... 4. (to be paid on filing this application) 5.If ,dwelling, number of dwelling units ...Qlle .... 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. 14txmr~ ...... 7. Dimensions of existing structures, ff any: Front .............. Rear ............. Depth ............. Height ................ Number of Stories ...... : ............. . .................................... Dimensions of same structure with a!terati~r~s.Q.r additions: Front .............. Rear ............... Depth ................ Height ................ Number of Stories ..................... 8. Dimensions of entire new construction: Front .......... ' Rear .............. Depth ............ ) Height ............ Number of Stories ............................................................. 9. Size of lot: Front ................ Rear ...... ::. '. ..... Depth ............... 10. Date of Purchase ...... J.96~t ................... Name of Former Owner ............. ................ 11. Zone or use district in which premises are situated ..... P.B.~. .blx~illoss ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .. -~O .................... 13. Name of Ownerof p~e~nises, l~at. ter. .Adaso-..~ddress ... ~qontho.ld ........ Phone No ............ Name of Architect . ,~ddress ........... Phone No ............ Name of Contractor i'~.i~[~~.ilAddress .~~ Phone No ......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing 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. STATI~I OF NEW YORK, ) S.S. COUNTY OF . f~.Uff~01k..) (Name of ~dividual signing a~licat~n) ~t ~ve n~ed. He is ~e (~r, a~ ~-~ate officer, etc.) of ~id own~ ~ ownem, ~d is d~y. aut~ ~ ~orm o~ ha~e ~ ~e, ~id ~k ~d ~ m~e ~d file ~ application; ~at ~ stateme~s ~ntain~ ~ ~is appli~t~n ~ ~e to the ~st of h~ ~owl~ge ~d beli~; and that ~e ~k will be p~ in ~e m~n er set fo~ in the applicat~n filed ~e~with. Sworn W befo~ me ~is ............... day of .....................