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Home My WebLink About4222-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. \ \ Certificate Of Occupancy No. z. 36.1,.. .. Date . . . . . . . . . . . . . . .Dec.. .,.. . . . ., 1~" .69 THIS CERTIFIES that the building located at ·'vIIS. .Mechanic. .St. .1.. .' Street Map No. ..D....... Block No. ...D....Lot NO.D...Soutbold,.~.Y............. conforms substantially to the Application for Building Permit heretofore filed in this office \ dated ,..,....... ·A.prll. . 2, 19··69 pursuant to which Building Permit No. . .1t222.Z I, dated .......... .AprU . ·2· . ., 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 . ·&ooe.II01'7· bu114·1n¡········ ........................................ The certificate is issued to . . .1Ia¡' . D1c.k(!r$on . . . . . .O\m..r . . . . . . . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... .I.R...................,... ...... .lJ~~yr~. \. .J.~~...... Building Inspector . . t Rou.e (J 120 \ I' , 1 , \ , ',\ , . ~< I \ i ~. 1\ \ I, , ~ -~.; ." -.;;.. FORM NO.2 TOWN OF SOUTH OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH OLD, N. Y. BUILDING PERMIT <THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NC! 4222 z Dote .....................~l'U..........2............, 19.~9.. Permission is hereby granted to: ... ....RaJ: ..J>.1.cltu...··· .... .... ........... ...... ...... ....... ···...........*eh&Ð.le··$t··a..u.......·······.·......... ···..··..··..··..S.u-tbo-ld···..····· .... .... ....... ........ ...... ..... to ..............a.¡ooak.......eÐlU....u...ñ.t-J:Dc·.aet!......,..~14.qe................ ................................................................................................................................................................ ot premises locoted at .........W/S.....Jlecban.:l.o....t..o;òovtli.......::tt.z.;;O'....................................... ... ... .............. ... ... .... ............. ....... .... .... .:iiovtIaoU. .. ... .....1....... ..... .... ..... ... .... ....... ...... ............ .... ......... ................................................................................................................................................................ pursuant to application dated ...................................A.pr.11........2..., 19..61)., and approved by the Building Inspector. Fee $...~..'OO'........... 1/ -' , ....·..·..:~;~;t;~I;;~;;~~f;;n··:.\;:·\-:·'T..··..··· 'Fo.RM NO.. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined..~... .41.....,19'9- Approved........ <'..... ~'...., 19.':.. Permit No. . ~J.;¡.«...4:... Application No. 'i: ~.;;,~. . .~. Disapproved a/c.................... ............... .~-.-:............. ---- -- ------.- ------- ................ ...................... .............................. ············.p¡~in~~······....·········· APPLICATIO.N FOR BUILDING PERMIT Aprll 2 69 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 10t and of buildings 0 n premises, relatio.nship to adj,oining premises 0.1' public streets ur areas, and giving a detailed description of layout of property must be drawn ,on the diagram which is part cf this applicaticn. c. The wcrk ccvered by this applicatian may n,ot be commenced before issuance of Building Permit. d. Upon approval cf this applicati-on, the Building In spector will issue a Building Permit to. the applicant. Such permit shall be kept an the premises available for inspecticn throughcut the progress cf the work. e. No. building shall be occupied or used in whcle 011 in part Lor any purpose whatever until a Certificate ,of Occupancy shall have been granted by the Building InspectlOr. APPLICATION IS HEREBY MADE to the Building Department fcr the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffclk Oounty, New York, and other applicable Laws, Ordinances or Regulati-ons, for the ccnstructicn at build ings, additions or alteraticns, ur for removal or demo- lition, as herein described. The applicant agrees to com ply with all applicable laws, ordinances, building co.de, housing code, and regulations. Ra7 D1ekerlon .......................... .......................... (Signature of applicant, or name if a corporation) Southold .......................... .......................... (Address cf applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or . Owner - bu11der bUilder....... .............................. ............................................................. Ba7 D1cker8. Name of owner of premises ........................... .......................... .......................... If applicant is a oorporate, signature of duly authorize d ,officer. . ......................... .......................... (Name and title of corporate officer) L Location of land on which proposed work will be done. Map No.. ...~......... Lot No. ~......... Street and Number ~ .7"'?'4. .~~~1~. .~:t. .~~~~...... .~~~~~~~~.... .......................... Municipality 2. State ex;sting use and occupancy of premises and intended use and occupancy of proposed oonstruction. a. Existing use and occupancy ..... ~~~.~~~~ . . . .. .. . . .. . . .. .. . . .. . . . . . . . . . . . . . . .. .. . . .. .. .. . . . . . b. Intended use and occupancy.... .~~~. ~.~~.. .~~~~~~~.~. ~.~..~~..~~.~~~.II.C?~ .~~~S 9. 10. 11. 12. 13. (check which applicable): New Building........ Additi.on . U.... Alteration... xu. Removal. .. .. ... DemolitIon.. . .. ... Other Work (Describe) ...................... . .. . . .1.oo...t. .. . .. . . .. .. .. .. .. . Fee ... 5..00.. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. .. .. .. . (to be paid on filing this application) 5. If dwelling, number .of dwelling units .......... Number of dwelling units on each floor ............. . If g.arage, number of cars ...................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If 'busiræss; commercial '?I' mixed .occupancy, spec ify nature and extè.nt .of each wpe of use.. . . . . . . . . . . . . . 7. Dimensions of existing structures, if aný: Fl'~nt ,............... Rear ............. Depth ............. --'- ,.. Height ................ Number of Stories .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with .alterations or ~dditIons: Fl'ont .............. Rear ............... Depth ................ Height ................ Number of StJories ..................... 8. Dimensions of entire new construction: Front. .. . . .... . . . .. ... Rear.............. Depth............ Heigl1t ..... . . . . . .. Number of Stories. . . . . . ., .: . , . . .. . . . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - - - . \ \ ~.. Size of Lot: Fr.ont ................ Rear ..... .'. . . . . . . .. Depth ............... Date of Purchase.. ...1_8..................... Name of Former Owner... 87Mad. ·htaù······ Zone or use district in which premises are situated. ... ~A'!. d1st.... ., .... . . .. ...... ...... ........ .. . Does proposed constructi.on vi.olate any 2Kming la w, ordinance .or regulatian? ... .... . . . . . . . . . . . . . . . . . . . Name of Owner of premises. . .~y. . Ø1ouraQD. Address ." 80111;h0-14. . . . . . .. Phone No. ........... Name of Architect ............................. kddress ...................... Phone No. ........... Name of Contractor .... ...... . . . . . . . . . . . . . . . . Address ...................... Phone No. ........... 3. Nature of work Repair ... .... . . 4. E,stimated Cost PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing .or proposed, and indicate all set-back dimensi.ons fr.om property lines. Give street and bl.ock number or de scription ac.oording to deed, and show street names and indicate whether interior or cocner l.ot. / t"", / ~ì1. - ¥"-"-~ --~~ --- ---- -- -~.- --- -~_.. STATE OF ~~ )S.S. COUNTY OF ...... ."'......) . .. .. .. .. .. . . . . . .~1. .1>1-.C!JçIl[lJ'.lI!on. .. . . .... . . . . .. .' , being duly sworn, deposes and says that he is the appli· (Name of individual signing application) cant above named. He is the ..... IIWDAU". - . bu11d.e~ . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . . . . . . . . . . . . . . . . . (Oontractor, agent, corporate officer, etc.) of said .owner or oOwners, and is duly authoOrized toO perf,arm or have per1J.ormed 1:he said work and to make and file this applicatioOn; that all statements oontained in th is applicati.on are true to the best of his knowledge and belief; and that the w,ork will be per1ìocmed in the mann er set forth! in the applicati.on filed therewith. Sworn to before me this .. ....... ..~.... day of ...... ~p~A... ... 19(;.9. Notary PUbl~...... S~'?\~~. .r2counz ~t:I~~ ~ ~'< 'k £LIZABETH NrJ '"VILLE NOTARY PUBLIC_ St:::t¿ nf rJew York No_ 52-812525,0)_ SlJffnlh: CouJ!.ty Term Exp:res rvlJrc:1 3'J. 1910 ) (a~ ~-:')' ( (~JL2.1...ð tN"\ ......J.,................... .......................... (Signtul'e of applicant) .