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Home My WebLink About4204-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.. Z. 352.8... Date ...... July ..... 11, ......... , 1969.. THIS CERTIFIES that the building located at Leetnn. Dr.ixse ............ Street Map No ............. Block No ........... Lot No.. $.outhnld,. ~Iew. ~o~1~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~a..~.c.h.....1.1.,...., 19.6..9. pursuant to which Building Permit No..42.04.3.. dated ..... Na.¥.ch... kS.,. .... , 19.§.9., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ... prix~ata .one..family. d~.ellinq. .................................... The certificate is issued to ...Dr,..Sam~¢3,. $ o..~oher~ .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Itealth Approval .................................... Building Inspector '~' House ~ 2030 TOWN OF 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? 204 Z Permission is hereby granted to: .%, ~.. JeJ~o3,~ ..A~...I)z.. ~lemm~.. gei~em ........ at premises located at ................. J~.JL...,J~e~t~i~.J)z'~t~ .................................................................. ..................................................... ~th~l~ ......... N.~. .................................................................... pursuant to applicotion dated .................................. JJ&l~ ........Si.., 19...J~9, and approved by the 8uilding Insl~ctor. Build~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPAR'TM.~-NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved. .................... ,19 '/ Permit N'o. Disapproved a,'c "- ' ~ . .............. APPLICATIO,TI FOR BUILDING PI~RMIT Date I~l~h ll, 19 (~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspec1~or. b. Plot plan showing location of [,cfc and .oi buildings o n premises, relationship to adjoining premises or public streets or a~eas, and giving a detailed description of lay out of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval ,of this applicati, ou, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the w. ork. e. No building shall be occupied or used in whole on in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS l-lkkg. EB¥ 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 Oounty, New Y~ark, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable law.s, ,ordinances, building code, h.mlsing code, arid regulations. (Signature of applicant, or name if a corporation) (Address of applicant) State ~vhether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .................................................................................................. Name of .owner of premises DF, ~aaal$~ -~. Col~" If applicant is a carporate, signature of duly authorize d .officer. (Name and title of corporate officer) 1. Location of land tm which proposed work ~vill b e done. Map No ................. Lot No .............. Street and Number ................................................ ~I{~h'i~i~/lit'~; .................... 2. State existing use and .occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy .................................................................... b. Intended use and ~ccupancy 2. Nature of work (check which applicable): New Building ........ Addition ....~ .... Alteration ........ P, epair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 'i. ['st/mated Cost ..... .~. , .0. ,. 0. .0 ................. Fee . ~.,~. .......................................... (to be paid .o~ filing this application) 5. If ,dwelling, number of dwelling units ...~, ...... Number .of dwelling units on each floor ~, ............ If garage, number .of cars .......................................................................... ~. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: Front . ~.~ ......... Rear . ~.1 ........ Depth .~.1 ......... Height .......... ~,~... Number of Stories . .~, ..................................................... Dimensions of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of Sbories ..................... 8. Dimensions .of entire new construction: Front .. ~.~ ........... Rear . ~.~ ......... Depth . ~.~ ....... Height ............ Number ~f S~ories ............................................................. 9. Size of lot: Front ...~/).~. ........ Rear ...~l? ' . .... Depth 20~,~ .......... 10. Date of Purchase ............................... Name ~ Former Owner ............................. 11. Zone or use district in which premises are situated "'" ...... ~...~ iai; .................................... 12. Does proposed construction violate any z3ning law, .ordinance or regulation? . .NO..` ..................... 13. Name .of O~v~_e~jo~ p~r~m~_s?~, ~..~l,~..~.. A. ddress ..... ~outhold ...... Phone No ............ Name of Architect ' ....~d/~iess ' Phone No ............ Name of Contracgor .. ]/,.. ~.cho,~d ............. Address ..... SnuthoXff ...... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give stxeet and block number m' description according to deed, and show street names and indicate wheiher interior .or corner lot. %- STATE OF NEW YORK, )S.S. COUNTY OF . ~.%LfY.(~k... ) ............... l~$r~th. J~ol~> ~d ................... being duly sworn, .deposes and says that he is the appli- (Name ,of individu.al signing application) cant above named. He is the ...... hg.~..q~'..q~ .$..~n.~ ...................................... (~ontra~or, agent, e~vate officer, etc.) of said owner .~ owners, and is duly authorized to pe~rm or have pe~a~ed ~e said ~k and to make and file this application; that all statements contained in this application ~e t~e to the best of his knowl~ge and belief; and that the w,~k will be pe~ed in the mann er set for~~ in the application filed therewith. Sworn to before me ~is ............ ].~. day~~of ......... ~h,.. 19..~9 '' N,~ Public ..... ~~ .... ~unty