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Home My WebLink About4221-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. ;~3~* ..... Date ........... ~a~r,/.' .~t~.. , 19.?0. THIS CEI~TIFIES that the building located at -Pv.t .R.O,~/.. ![/8. Bla~... Street Map No...~ ........ Block No.. ~ ..... Lot No.. 1¢~... I4t~®l.~ .It ~¥.. ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... l~tTch .... 28', 19..~ pursuant to which Building Permit No. h~22~. ~. dated ....... ~,pr~-. - '¶ ...... , 19 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 .Prl~ate. o~e. £&la~.ly .d~o&'t ~;n[ ....................................... The certificate is issued to . .,1 .. N3~TOla .3[OlXl~ ....... 0~l~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... II,R. ......................... ..... ........ House ~ R~8~ Pec TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOL.D, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1~? ~221 Z at premises located at ................... ~.......~:~ ...................................... ~. ......... ............................................................................................... ~.....A....V....~...L-.'..~.: ................................. pursuant to application dated ............................. ..~.~....~.~.. ....... ..,J~,~.,.~....~-~, 19..~,.~ and approved by the Building Inspector. ,~.~ ....... /.../....,..,~..~ ............. Building Inspector ,FORM ,NO. I TOWN OF SOUTHOLD BUILDING D~..~AR'I'~EENT TOWN CI,~BK°S OFFICE SOUTHOLD. N. Y. xamined ........... ~.,~,~...'~..., 19 .... Disapproved pplication No. / ..... (Building Inspector) APPLICATI(~N FOe BUILDING P~BMIT Date ...~.~. C.~..'~....~...,~. ~ ................ 19v~.~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and ~submitted in duplicate to the Building Inspec/xm b. Plot plan showing location of lot and of buildings o n premises, relationship to adjoining promises or public streets or 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 oat 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 o2 in part for any purpose whatever until a Certificate ~ Occupancy shail have been granted by the Building Inspects', APPLICATION IS 1-]2~Y MADE to the Building Department for the issuance of a Building Permit pursuant ko the Building Zone Ordinance of the Town of Soathold., Suffolk Cbunty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for romoval or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, angl regulations. ...L-. / ..... //L.: ..................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .............................................................................................. Name of ,owner of premises . .~}.,..~...F.c~....~e.~-/x9 ....................................................... If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location of land on which propped work will b e done. Map No ................. Lot No .............. Street and Number .~'~ ...~.~..~.~,.nj.'.c...~.~X...~../.~ef.. ....... . .~..~..~. C.~..f. .................... -~ ~ t~ ~, ~?i'7~? 'P~:'cl~c-~ ~/~y l~/.g'~ Municipality 2. State existing use and occui~ancy of premises an d intended use and occupancy of proposed eons, truction. a. Existing use and occupancy ..... .~..~..-W..~. ........................................ : ............... b. Intended use .and occupancy ..... .~./. ...... W/./~/3~/i~d~/ ........................ ~:i.' ............... 3. Nature of work (cheek which applicable): New Building ........ AddRion ....t(~.... Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated C~st ...~..../..?..~.~. ................. Fee ...~....+~.'..~..e ................................ (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 c~r mixed occupancy, specify nature and extent of each typp of use ............. 7. Dimensions of existing structures, ff any: F~t . ..(e....)~..~ ..... Rear ...C...~-~.~ ..... Depth .3. f~....~ ...... Height ... ~-...~./. ....... Number of Stories .. [..//~. ............................................... Dimensions of same structure with alterations or additions: Front ...). ?-../. ...... Rear .. ?..~../. ...... Depth ...~.~. .......... Height ...~..~. .......... Nu~nber of Slxaqes ../...//~., ............ 3 , .... . 7.~' . .... ....~. ....... 8. D~mens,ons ~)f entire new construction. Front ................. Rear ~. ~-/... Depth Height . .~-. ?-../. ....Number of Stories .../.././~. ..................................................... 9. Size of lot: Front .../...~.e~-../. .... Rear .. ~..~..' ....... Depth ../..?~f. ..... 10. Date of Purcl~ase ....~./.?~..~.../.~..~. ............. Name of Former Owner . .~..~.c.//... ?.... ?.v.~..~ ...... 11. Zone or use district in which premises are situated ................................................... 12. Does proposed construction violate any z<ming law, ordinance or regulation? .......................... 13. Nameof Owner,of premises .~.,..~/.~¢.~...~.~..°~9...Address ..~. ?..~..f.~./...../lf~; ~v. . Phone No~-?~.-:.~..~./.~. Name of Architect ............................. ~ddress ...................... Phone No ........... N. ame of 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 and block number or de script~on according to deed, and show street names and indicate whether interior or cornel STATE OF ~ YORK, )S.S. COUNTY OF ~.~..f/?~./.~" .... ) ,j... ]]4..)/r:~o.. ~p..~.~..~ ....................... being duly sworn, de~s~ ~d ~ys mat he is the appli- (Name~f ~dividual s~gning application) c~t a~ve n~e& He is the ...... ~ .~ a ~ ............................................................ (~n~a~r, a~ ~ate ~icer, etc.) of ~id own~ ~ ownem, ~d ~ duly aut~ ~ p~rm or have pe~ ~e~d ~k ~d ~ m~e ~d file th~ applicat~n; ~at all stateme~s ~ntain~ in ~is appli~t~ ~ ~e to the best of h~ knowl~ge ~d belief; and ~at ~e ~k will be p~ in ~e mann er set f~ ~ the applicat~n filed ~e~th. Sworn ~ bef~ me ~is .... ~ing in Suff~ uoun[y ~ NO. 52.7031050 ~mlssion ~pires March 80, 1910