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Home My WebLink About4201-zFORM NO. 4 TOWN OF SOUTIIOLD BUILDING DEPARTMENT Town Clerk's Ottice Southold, N. Y, Certificate Of Occupancy No..~, 3.~.93 .... Date ............ ~ep.t ..... 2.9...., 19.6.9. THIS CERTIFIES that the building located at . l~;J; .Ro~.d ................ Street Map N~a~ .~ay. ~loek No.~eC..~...Lot No..~3. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~a~ ..... ]0., 19.69. p~suant to which Building Permit No. ~29J~.. dated .......... ~a~ ..... ~ .., lS. 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 .... ~riwate. ~ne. f~ly..awe~l~g .................................... The certificate is issued to .Re~ ~ .Roh%. Ha~ ..... ~nez .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... ~R~ ............................ Approved by ~d Appeals .......... .... f ....... House ~ 27~, PVt Road FOR~ NO. 2 TOWN OF $OGTHOLD 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? 201 z D~te ...................... ~G~.....e~.,j ............ , 19....69 Permission is hereby granted to: ~,~e~..~t~. ~e ,.A./~.....~e=~e*.~% ......... ~_~r/1;:l,e .......... ~ ........................... to ..... 1~I,t~...e~...e,~.~ :Lt,~,.e~...ol~..em.. ex,~t ~ ~g. · .~w~l:L~8 .................................................. ............ · ,.: ................................................................................................................ ~ ................................ ot premises locoted at ...... ~,Gt ~. ~.~.'~.....G~'~/~e~'~..~'-~t'e~ ................................. ........................................ ~.~*~e..,~e~.,-..:~e~..~"~e~Le~'e'"~,~v ............................................. pursuon,t to opplicotion doted ..................... ~.Z'~,,~ ....... .J.0. .............. , 19..~9., and opproved by the Building Inspector. Fee $...~,*.0,0. ........... Building nspector ~ ,F,O RM ,NO. TOWN OF SOUTHOLD BUILDING DEI:'ARTMENT TOWN CL~:RK°S OFFICE SOUTItOLD, N. Y. App~aved " ., 19 Permit N.o.~./~...0..( ?..-~. ...... Application No.../-'./.A 0. ! ....... Disapproved a/c ....... ~>,~ ................................. APPLICATI(~ FOR BUILDING P~RMIT INSTRUCTION, S a. This application must be c.ompletely filled in by typewriter or in ink and ,submitted in duplicate to the Buikling Inspector. b. Plot plan showing 1.oeation ,of l~t and :c~ buildings o n premises, relati~o:aship to aclj~oining premises ,or public streets ~or areas, .and giving a detailed descripti,on of layout of property must be drawn ,on the diagram which is part of this application. c. The w.ork covered by this applieat[*n may nlot be commenced before issuance of Building Permit. .d. Upon approval ~of this applicati,~n, the Building Inspec~ar will issue a Building Permit to the applicant. Such permit shall be kept ~n the premises available for inspectio.n through,out the progress ,of the w, ork. e. N,o building shall be occupied or used'in whole o ~ in,.,ptwt f~m' any purp~ose whatever until a Certificate Occupancy shall have been granted by the Building Ins p~c~0~. '" · APPLICATION IS IzL~I~E~Y MADE to the Building D epartm, gut for the isst~ance of a Buff,ding Permit pursuant to the Building Zone Ordinance of the ~owh of' S~aathold, Suffolk ©o~nty, New.Y, ork, and o.ther applicable Laws, Ordinances ,or Regulati,ons, for the c.onstruction .3f build tugs, additio,ns or alterations, ,~r f, or rems)vel or demo- 1}tion, as herein ,daeseribed. The applicant agree~ ~5 cam ply with all applicable laws, ~ordirmnces, building eode~ 1,,ausing code,,andregulations~.,r ~ ~ I ~-- ~ ~A ~ U~ 7 G ~ ~ ~r ~ c 7' ~l ....... - (S, ignature ,o~ applicant, or, nam,~,if a eorporati~on) . · . (Address of applicant) tN[,)(, · State whether applicant is owner, lessee, agent, architect; engineer, general contracbor, electrician~ plumber or builder ........... ./~. ...............(~ ~/'- ~) ~ J"' · .... :'. '[ ............................. ;' ..................... Name ~of owner of premises ..... ]-~. ~'./)..~ 1.~ Z... ~ A,~ p,,~, ............................... ............. If applicant is a carp.orate, signature of duly auth,orized .o/fleer. ................ · ...... 7iZ~YZ ......................... ' , , , · (Name a~nd title of corec,rate officer) '1. Location ,of land ,oJn which ro~osed work will~ be do~e ~I_ap No. 2 7'~ Lot No 7' e/74 Street'and Number. [... i".~..~ ~:.~, .~......~../.~-~'['\ .... ~~..~...'. '.~. '. '. i '. '. '. '. '. '.'.'.'.'.'.-- ....... · ' Municipality 2. State existing use and ,accupancy ,o,f pr~mises and intended use and ,occupancy of proposed eonstraction. a. Existing use and occupancy ..... .~..r~ .~....~-.~. (~..'1 g.\/...~..~.. ?. ~.4 .i~. ]. '.~. ....................... b. Intended use an,d ~o.ccupancy .................... ~ ....................... 3. Nature of ~vork (check which applicable): New Building ........ Additi,on~.~..~ .~Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ...... ~...O...~?.o. ................ Fee .` .~..O.~. :~ ...................................... (to be paid ,on filing this application) 5. If dwelling, number ,of dwelling units .. ¢..'B..e~... Number ,of dwelling units on each floor . .0 .n~ *e&. ...... If garage, number .of cars ..... .%; .... ; ............................................................. G. If business, commercial .er mixed occupancy, specify nature and extent of each type of use ...'~-r ......... 7. Dimensions of'existing structures, if any: Fz,~nt .. ~t ....... Rear ...~.~t ...... Depth . ~.~', ....... Height .../. ~'..~ ........ Number of Stories ....0..~1...e~.. ............................................. Dimensions .of same structure with .alterations .or additions: Front ....~-..~. ...... Rear . ...~,.~. ........ Depth .... ~.~'. ........ Height ..... l.~'~ ~ ...... Number of S~ories ...0...~...~ ........... 8. Dimensions ,of entire new construction: Front ..... /~. ........ Rear .... ]. ~ ....... Depth . ~ .~. ...... Height ... ] ~-..~ .... Number ,of S~sories .. O. :~t ~ ................................................... 9. Size of ~at: Front .../..fl..~./ .... Rear ...,/..0..0. f ..... Depth .../../-~...D. 10. Date of Purch.ase ...'..~.?.~.~.~ .]. :~..'7./. .~.~5-..~. ....Name <~£ Farmer Owner ~.J~i~¢i~.e.r.~..~./~,.~...}.l~e-..,. 11. Zone .or use district in which premises are situated...~..s. ! .~..o~..7'.~..~..L ......... ; ....,. .................... · n ' n z ' r ' · ? Ce~ lr~. ~d 12. Does proposed con.structm wolate a y ?rang law, o dmance or regulation. 13. Name ,of Owner.of premises .~.0~.{'Y.~/./.~¢~'/.. Address ~. ~.,hg.kz. }lli]-k R l) Phone No.,~.& ~-(~]ff- o f ArehxtectA'ddress ....... ' ......... Name o ) .................................................... rn, une ~u ............ Name ,of Contractc~ .~. I.~'JM.~../.~n~..O. ?/ .... Address ~.~,.~ g./.~.~04~% .~.~.~5. Ph,one No.~Yff.~..~./;-.].~50 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex}sting or ~proposed, and indicate all set-back dimensions from p~o,perty lines. Give street and block number .or de script}on according to deed, and sh.ow street names and ifldicate whe~her interior ,or corner 1,at. STATE OF NEW YORK, )S.S. COUNTY OF .............. ) - ?. eX..being du y ,worn, ,deposos and says that he is the appn- (Name ,of individual signing application) cant above named. He is the .... ~..~.."J~..~.~.-/9..~ ~. ¢.l.- .................................................... (Gontractor, agent, e~rporate .officer, etc.) of said owner .or ,owners, and is duly authorized to peri, arm or have peri, armed the said w,~rk and to. make and file th~s application; that all statements contained in this application ~,e true to the best of his knowledge and belief; and that the ~v,ork will be perf~orme.d in the mann er set forth~ in the application filed therewith. Sworn %o lJefore me this Notary Publi~ ¢-~~... Oounty /~ (Si~nture of applic~j:~t) No. 30-812161 ~ ~ Q.ahhcd in Nassau County ~ Comm~ssmn rxp~res March 30~ 191~