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Home My WebLink About4208-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Tow-n Clerk's Office Southold, N. Y. Certificate Of Occupancy No Z ;1478.. Date ....... ~y ....... 9, ........ , 196.!t. THIS CERTIFIES that the building located at iluclr~ll~rly. HI.Il. l~ad.. Street Map No ............. Block No ........... Lot No .... bm.t; .~k~.l.o~,. 1~o~. XOI~I~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... IOtlt'ch..19,., 19.69. pursuant to which Building Permit No. 4200.21. dated ......... P,a~rch..21,.., 19.6~, 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. lvats .on& .£amg~ty. cl~alllLnc~ ..................................... The certificate is issued to .... lira.. Learolr. F,~ar~ .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ................................... Building InspeCtor FORM NO. t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4208 Z Permission is hereby granted to: ........... .~.:~: ........................................................... at premises located at ~...~.../.?..~.......~.~..~...e..]-...~..~...z~...~..~.~.~...~..]:.....~..Q~.8t`~. ....................................................... ............................................................. ~.~..~..r.~t.~ ........................................................................ pursuon.t to application doted ................................ .l~a.r. ....... .19. ........ , 19..~9.., and approved by the 13uilding Inspector. O0 Fee $..~.f,. ................. ~F,O,RM ;NO. 1 TOWN OF SOUTHOLD BUILDING D.'~,PARTI~ENT TOWN ,CL~RK'S OFFICE SOUTHOLD, N. Y. Examined .................... , 19../. .................... Z_ Appmo~ed ~ / /;YIn' ~, 19~.?.. Pemit NO .................... Disapproved a/c ...~ ....... ~'... Application No..~..~. ?...~.. ...... (Building Inspector) APPLICATIOn{ FOR BUILDING P~RMIT . Date ............................ : .~. · elNSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings o n premises, relatiowhip to adjoining premises or public streets ~or areas, 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 ~t be commenced before issuance of Building Permit. ,d. Upon approval ,of this application, the Building In spector 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 oU in part for any purpose whatever until a Certificate .of Occupancy shall have been granted by the Building Inspector. APPLICATION IS 1-~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soath01d, Suffolk Oounty, New York, 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 laws, ordinances, building code, h~using code, a~d regulations. '"i ilnat i.; i.a -pli ant, name' ' ) % f*l£N{-, .......... ................ ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .................. · .~. -F.I. -IZ..D..~ - -~ .................................................. ................ Name ,of owner of premise6 ...................... .~..~'. · · .~.~.'.~..~. .... .1:-~ .~. ! .//'..~-~. -~. -'~. ..................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location ~of land ~n w~_ich propped w~)rk will b e done. Map No ................. Lot No .............. Street and Numoer ...7/.~ ........... %..~ :. r/r.',', ............... / ...........: ...................... ~ t v ~ ~ ) Mumc~p~ty 2. State exist~g u~ and ~ccup~cy of premiss ~ d intended use ~ occu~cy of p~d ~ction. a. ~isting use and occup~cy .................................................................... b. Inte~e~ ~se ,~ ~cuP~e~ ................................................................... 3. Nature of work (check which applicable): New Building ........ Addition .../~..... Alteration ........ Repair ......... Removal ........ .Demolition ........ Other Work (Describe) ...................... 4. Estimated C~st .............. .~..~..~..?-~.. ........ 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 ~r mixed occupancy, spec ify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: Front .............. Rear ............. Depth ............. Height ................ Number of Stories ................................................... , ...... Dlmenmons of sam~ structure with alterations or additions: Front .............. Rear .... g..~.. ?.. .... Depth~)?~.¥..~-..z'/ ..... Height ..... ./?.'. ....... Number of Stories ..................... 8. Dimensions ,of entire r~ew construction: Front ................. Rear .............. Depth ............ Height ............ Number of Stories ............................................................. 9. Size of ~ot: Front ................ Rear ............... Depth ............... 10. Date of Purchase ....................... Name <rf For~er Owner ...... " ........... 11. Zone or use dmtr~ct m which premmes are mtuated .................................................... 12. Does proposed construction violate any ~ning law, ordinance or regulation? ....... .~...~. ............... 13. Name of Owner.of premises .~?.~....Z.~..~.~.Y...~..~?.~..~dress ...................... Phone No ............ Name of Architect ............................. -~ddress ...................... Plume No ............ Name of Contractor ......... ..~:..~.:. ?~...Y.~..~.~-~. Address ........ . .g~../.~..M.~ .... Phone No~. ~.~..--...~.~..~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed~ and indicate ail set-back dimensions from property line~. Give s~eet and block number or de scription according to deed, and show street names and indicate whether interior ,or corner ~ot. STATE OF NEW YORK, )S.S. COI/NTY OF .............. ) ............... .~..~..~.......~?..~. f..7~ ................. being duly sworn, deposes and says that he is the appli. (Name of individu, ai signing application) cant above named. He is the (Contractor, agent, corporate officer, etc.) of said owner ~r owners, and is duly authorized to perform or have perkn'rned the said work and to make and file this application; that all statements contained in th is application ~ true to the best of his knowledge and belief; .and that the w~rk will be p~ed in the manner set fort~ in the application filed therewith. Sworn to before me this ............ ./.~. day of ......... ...~..~..~...d"/'(19.~..~ N ary MARION A. REGENT ~ NOTARy PUBLIC, State of New York No. 52-3233120 Suffolk Coun~ Te~m ~pires ~arch 30, zg~