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Home My WebLink About4217-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N..Y. Certificate Of Occupancy No. 7. .36&9 .... Date ............D.ec .... 5 ....... , 19..6.9 THIS CERTIFIES that the building located at R.~0,~/. ~/S. ~umeweta- .BO. Street Map No. -Na.ssau- .l~t $1t~ No ........... Lot No. Pt .2~ ... Cutcho~ue t' I~ o5. .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........E~ ....26'" 19'~9' pursuant to which Building Permit No. )+2~.7Z. dated ...........,~:ar .... 2.7. ·., 19. (>9, was issued, and conforms to ail of the require~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... Prlva. te · o~e · fancily. 4we-~.iir~g .................................... The certificate is issued to .. F~ank..Teehe.t ...... Owner ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Dep~w~ment of Health Approval . - I~.,~ o ............................. Building Inspector ~ous ~ ~306 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o Z Permission is hereby granted to: Geo AIt2e~'I A/C ~r~ .......... .~Q~L~ ................................................ to ............. · .~. · ~ .....~aJ)...O.~... ~. ~,.~...<3D...I~ ...... g. .... ~ ................. at premises I~ated at ..... ~...g.~..~g~..~.....~g~..~.$~..~...~...~ .......... ............................... ~,g.~W.,...~...~....~.~..~ ............ ~~ ...................... pursuchic to application dated ............................. ...]~..?...:.....~.. .............. , 19.....~.,?, and approved by the Building Inspector. -- Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ................. ~ ............... APPLICATION FOR BUILDING PERMIT Date ............... ~....~...~.. .................. , 19....~..~.:... INSTRUCTIONS 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 on premises, relationship to adjoining premises or public streets or areas, and gi¥ing a detailed description of layout of property must be drawn on the diagram which is pa~t of this application. c. The work covered by this application may not be commenced before issuoflce of Building Permit. d. Upon 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 througkout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY/v~DE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bui dings, additions or alterations, or for remora or demolition, as herein described. The applicont agrees to comply with all applicable laws, ordinances, building code, housing c~nd regulations. ........ i~i;;4;/~;;; ~ ~ og;i';~'~;~;~'iT~"~;;~'i;;i~ ......... . State whether applicant is owner, lessee, agent, architect, engineer,/~eneral contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) · ocot~on of land on which propos, d wor)~ wm be dane., t~aP No.: ........................................ 'at No.: ~...%~..~..e.& Street and Number ...... ...~...~:.... ~1~ ........ ~'~- State existing use and occupancy of premises and//intended use and/~)~cuponcy of proposed construction: ' o. Existing use and occupancy ........... .~~.....~ ............................................................... 3. Nature of work (check which applicable): New Building .................. Addition .....~ .... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..................... ./~..~..~.. ......................... Fee .......................................................................................... (to be paid on 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 or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............~. ........... Rear ........ ..~...~. ................. Depth ...~...o. ........... Height ............. ,/..~. ....... Number of Stories .............. ./. ................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear Depth ................ ~.~.~. ........... Height ............ /.~.. ........... Number of Stories ......... /. ................... 8. Dimensions of entire new construction: Front .............. ~ ................ Rear ........... ~.,~ ............ Depth .....~...~. ............. Height ......... ./.~ ....... Number of Stories ....................... ~. ............................................................................................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ /~...,~ 10. Date of Purchase ........................................................ Name of Former Owner ............. .3T.....~......-~...~..-..,~4~. ............ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~ .............................................. 13. Name of Owner of premises . .~...m...~..~......Z'.~.~c~.. ........ Address ............................................ Phone No ..................... Nome of Architect .................................................. .....Address ............................................ Phone No ..................... Contractor .~....~.. ....... ~.~1../~...~.~ ......................... Address ..~..~,~£."...e.~..~...~../.~.~.e,~ Phone No..?.~.~....3~..~../..~... Name of PLOT DIAGRAM wP~OePt~Ler~/i~itn~;sl~erC~irYv~rsn!reerd~ioti!~Yb(~lo~l kbUn~~.a.~, n~[ca, all setT~.rndLm~onnsd fcraOt~ C- STATE OF NEW YORK, ! ¢ ¢ ..~.....~......':T~ ~..~...~ being duly sworn, deposes and says thor he is the aonlican~ (Name c~ ind,wdual s~gn,ng application) /~ above named. He is the .......................................................... ~ ...................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .... ........... day of NOTARY PUBLIC. State of New York No. 52-8125850. Suffolk C0~t2 Term Expires March 30,