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Home My WebLink About4198-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No...~..~..... Date ............. A~t ....27.-, 19.~,9 THIS CERTIFIES that the building located at .... I~t;at~].e.y..R~a~ ........ Street Map No.~.l~Se.t .IlllOll~ock No ........... Lot No...~.ii .... ]{at;t;lt;llOl~...]~.,X, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... .~lal~h ....~.., 19.6.9. pursuant to which Building Permit No. .~-.1.~.~. . . . dated .......... F~l~o~h ....leJ.., 19 .(~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 . .~r!Y.a.t.e...~.~..f.~.~.i~.,Y. ~w. ~.~.X.l.l.~¢ ...................................... The certificate is issued to .. Nal.t~z,. Jar~,/~o~slci ...... O~e~t ....... ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.llg. ~..~6.9..b~'..I~,..~.tl],a ....... ..... 'q~" Inspector FOR~[ NO. 2 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) N? 4198 Z Permission is hereby granted to: .......... ~.~......~. ~.~.. c . ~ ~.~ ~,.~......m~t~...~ .......... at premises located at .... ,[~D.~ ~. ~. ~$:i;~,~-~ tc,~,,~.- pursuant to application dated ......................... ~.~ ........ ~ ............. , 19.~.~..i and approved by the Building Inspector. Fee $..!,.0,~ ~ .......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage., (Give deed locat~oJ disposal facilities for a structure located have been inspected by this department and found to be satisfactory. District Engineer District Engineer ~FORM ,NO. 1 TOWN OF SOUTHOLD BUILDII~G DE~AI:tTI~tEt~T TOWN CI~E:BK'S OFFICE SOUTHOLD. N. Y. ?1 ? - Application No ................. Disapproved a/c .... (Bui}ding InspecVar) / APPLICATIQN FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and ,submitted in duplicate to the Building Inspec~ar. b. Pint plan showing location of ~.~t and ef buildings on premises, relati,on,ship to adjoining premises or public streets ~m' areas, and giving a deCailed description of layout of property must be drawn en the diagram which is part of this application. c. The w,ork covered by this applicat~an may n~ot be commenced before issuance of Building Permit. d. Upon approval ,of this applicati,an, the Building Inspecbor will issue a Building Permit to the applicant. Such permit shall be kept ~on the premises available fo'r inspectio~ through,out the progress of the w~ork. · , e. N,o building shall be occupied or used in whole or in part far any purgose whatever until a Certificate :of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursu'ant to the Building Zone Ordinance of the Town of F~uthold, Suffolk (kmnty,~New Y~ovk, and other applicable,Laws,~ Ordinances .or Regulations, for the construction .of build ings, additions ov alterations, .ar for removal or demo- lition, as herein described. The applicant agrees to comply with all applicable laws, ~ordinances, building code, h.ausing code, an,d regulations. ~/l]~ ~I,.%Q. ~{Q~l.e.q ~. ~[/:i.(J ~ ..................... (Signature o{ .applicant, or. name if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contract~, electrician, plumber or ~l~q ~1~{~ ......... builder ...... ~ .... '~ ~'~ .......................................................................... Name .of ,owner of premises . J,X~g~.2.q~..~¢~l~ggr?[r~. ........................................................ If applicant is a corgorate, signature of duly authorized .~ficer. (Name and title of corporate officer) 1. Loeati.on ~of land ,on which pr~o.sed work will be done. Map N~. ~f. B. uns.el ..... ~t No... ~.~ ........ Street and Number .. . .q~'. ~ .~t9.q~..'~3Rq~'~. .................................... ~unletpal~ty 2. State existing use and ,occupancy ef premises and intended use ~d occupancy of pmpo.sod oonstmction. a. Existing use and occupancy .................................................................... b. Intended UrS~ and occupancy . ~..F..a.[q~.]..~. D~elllng ......................................... 3. Nature of work (check which applicable): New Building .... X.... Addition ........ Alteration ....... Repair ......... Removal ........ Demolition ........ Other Work (Describe) ..................... 4. Estimated Cost . .~.0..00 ....................... Fee ................................................ (fo be paid ,on filing this application) 5. If ~dwelling, numbe~ ,of dwelling units ...]1. ...... Number .of dwelling units on each rio.or . .. ~. ........ If garage, number .of cars ...~. ..................................................................... 6. If business, commercial ,~r mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: Fl~,nt .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions ,of same structure with alterations .or additions: Front .............. Rear ............... Depth ................ Height ................ Number of S~ories ..................... 8. Dimensions ,of entire new construction: F~vnt . ~1t. ............. Rear .... ~l[ ....... Depth ...~.~. ...... Height ...1,(~ ....... Number ,of S~ories . ...~, ........................................................ 9. Size of ~ot: Front ...1.0.~ ......... Rear . .~[.0.~...' ...... Depth ... J~c)~ ........ ~0. Date of Purch.ase ............................... Name <~£ Former Owner ...~.t;.a. ri...l..o.y ................ 11. Zone .or use district in which premises are situated .................................................... 12. Does proposed conatruction violate any z,~ning law, ordinance m regulat~m~ .................... ,,,.~, .... 13. Name ,of Owner of premises .[./~.~.OlI.R;OI4.~.Ig& ...... A, ddres.s . .B.;'.o.o.i.c.]..~/17, .......... Ph,one No. I]IV~.~0:~ Name of Architect ............................. -&ddress ...................... Ph,one No ............ Name ,of Contrac~o~ .I.r!.]-..a.~.d....~q.m.o.8. ,..l..rt.o.~... Address . .,'.~.o~..~.i~.~.rl ............. Ph,rme No. 7.~.2.~..~.~.~.'1~ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from pr,o,perty lines. Give st~reet an,d block number .or de scription according to deed, and sh.ow street names and indicate whether interior ,or corner ~ot. STATIg OF NEW YORK, ) S.S. OO NT OF ..... ................... .x¢~..~. ~ .......... being duly sworn, ~deposes and says that he ~s the appli- (N.ame ,of individu, al signing app~ration) cant above named. He is the .................... ~.~: ........................................ (Gontrae[or, agent, errcporate officer, etc.) of said owner ,or ,owners, and is duly authorized to pe~rm or have performed the said w,m'k and 'to, make and file this application; that all statements contained in this application a~,e, true to the best of his knowledge and belief; and that the w~ork will be perf~orme,d in the mann er set ~orth~ in the application filed therewith. Sworn to before me this N,otary Public~~' '..rp~. ~ Gounty_..t~tlq~! ~ ........................ £LIZ~.B~TH ~N~ N~ILL~ NOT~Y PUBLIC, ~tate of New Yo~ No. 52.8t25~0. Sul/olk County Term ~ires ~ar~h ~ [~