The URL can be used to link to this page

Home My WebLink About4206-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~I.02 ..... Date ........... Apl'il .... 23 .... , 19..?3 THIS CERTIFIES that the building located at . .Lako .V].o¥ .Tor.r&~o ..... Street Map No.. XX ........ Block No.. ]lJt ...... Lot No. XX....I~/~. ]}ay. AFo.. E&II*;. Mariol~ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Ma;t'...i.9., 19.69 pursuant to which Building Permit No.ll.206Z.. dated ......... 14a~, .... 'i'9'., 1969 ', 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 ...Pl'iy&te. o~e, family- dwellin~ ..................................... The certificate is issued to . EdWila. ,q~l~lOla ....... Oa~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... l~eR, ............................ UNDERWRITERS CFRTIFICATE No.. ~r,R. .......................................... HOUSF NUMBER..]20 ....... Street... ,[~kO. ~::J,~w. ~o1'1'&11~ ......................... Building In~pcctc~r / FORM 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) 4206 Z Permission is hereby granted to: ...................... .~.~ ~,..~,~.o.~. ............................... to ....... ....~...~..e~lt~o~..a~.~..~L~t ~nS.. ~1,~ ............................................... at premises located at ................. ...~.....~..?..~....e~......~..~.V.~:~g.~l ....... J~,~......~...~ll~ ................................. ............................................. ~,~ ~:.. ?.a~. ~.o~,~...,'i.o.~ ............................................................................ pursuant' to application dated .......................... ...~...~.~,~ ........ ~.~1. ......... , 19...1~., and approved by the Building Inspector. Fee $,..~'.e.~. ........... Building Inspector / FORM ,NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CI~RK'S OFFIC~ SOUTHOLD, N. Y. Application No ................. Disapproved ale ...~..2.~.~,~ ...--~. .............. ..................... APPLICATI(~N FOR BUILDING FERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspec~r. b. Plot plan showing location of k~t and ~f buildings o n premises, relationship to adjoining premises er public streets er 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. Up(m approval of this application, 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 work. e. No building shall be occupied or used in whole o~ in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspects. APPLICATION IS I-lJ~t.l~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 O~unty, New Y~rk, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, er f~r rer~oval or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of .applicant, or name if a corporation) ............ /' 'Jf'a{;d';JJ i) ................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder (~ ~ ~' r~- Name .of ,owner of premises ~-~) ~///]~/ --~/~ ]~ /~/ / ]¥ E]x~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will b e done. Map No ................. Lot No .............. Street and Number ,~lO /_~t(~- FIE-II," ~ ~tc/%i_~7- ,A']ff F'~I O/y ............ ~r'E-]'~'A~_-~ ........................................... Municipality ~ ......... 2. State existing use and occupancy ,of premises an d intended use and occupancy of proposed construction. a. Existing use and occupancy / ~-~ bY/~ ~ .i~ 14z /_~ £ L 1 1'4 ~ b. Intended use ,and occupancy ~'~ ~'/ ~- ,.~'/ ~4.D~1-7-~ t~/,,/ 3. Nature of work (check whjc]~ ~.pli+cable): New Building .... ,~ .o ,'Addilion ........ Alteration ......... Repair ......... Removal ........ --Demolition ........ Oth~i~ Work (Describe) ........... ., ..... 4. Fstimated C~3st ................................ Fee ................................................. (to be paid ~n filing this application) 5. If ,dwelling, number of dwelling units .......... Number .of dwelling units on each floor .............. If garage, number of cars .......................................................................... 6. If business, commercial c~r mixed occupancy, specify nature and extent of each type of use .............. 7. Dimenskms of existing structures, if any: F~nt .............. Rear ~.~5.~ ./D .... Depth ............. Height ......... , ....... Number of Sj~grie~ ...... ................................................. Dimensions/or'same structure with alterat~onsle' ~ or ~dditions:J Frunt .............. Rear .............. Depth ................ Height ................ Number of Stories ..................... $. Dimensions ,of entire new ~/~o~struction: Frant ................. Rear .............. Depth ............ Height ............ Num'~er ~fc~t~__r~s ..................................... ~/ ..../~l ' 7C ;~'~ ;4 '/~ ' ' ' 9. Size of iot: Front ............ '.:~. Rear -7/ 10. Date of Purchase ............................... Name qf Forrne/~Owner .......... ~ .& .............. 11. Zone or use district in which p~mise~re/s.itu~t~c] ..................... ~.~ .................... ~/,~,- 12. ]~oes proposed constructmn wolate any zomng law ordinance or regulation 13. Name of Owner.of premises ..................... A. ddress ...................... Phone No ............ Name of Architect ............................. .~ddress ...................... Phone No ............ Name ~f Contractor ............................ Address ...................... 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 a~d bh)ck number or-de~cripti, on according to deed, and show street names and indicate whether interior or orner i~' I STAq~E OF NEW YORK )S.S.._ ' l / ± cou uO ...... ....... ....... iI~'~',~ 'i~'d'i~i~l~,~i 'si~i~'~ii'c~'t~,~i ....... b~g, ck~l¥:s~r~,.n, ,deposes and says that he is the appli- cant above named. He is the ............................................................................ (Contractor, agent, eo~arate officer, etc.) of said owner ~or ~owners, and is duly authorized to perform or have per~ormed the said work and t~ make and file this application; that all statements contained in th is applicati, on axe true to the best of his knowledge and belief; .and th'at the v~rk will be performed in the mann er set fo~cl~ in the application filed therewith. Sworn to _/y methisbef~ze /~/i~(/_/ ~//,. '~ -~-" ~ .~-..~ ................ day ~f .................... 19 .... N~tary Public, . ................... Gounty .Z-', ~- /Z,/'~" (Signture of applicant) [LIZAB,_'.TFI ANN NEVILLE NOTARY PL!~,r lC,, S'.~to of New York No 52-3l!5~, Suffolk County