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Home My WebLink About4231-zFORM NO. 4 TOWN OF SOUTHOLD BUff,r~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy BIo.. Z .3533.. · Date ......... July. ..... &~,, ...., 19.6.9 THIS CERTIFIES that the building located at ~h~.p¥~c~ Lane ........... Street Map No ............. Block No ........... Lot No.. F~t. Maz~o .~m .YC~k ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... AprA1... fl~..., 19.69. pursuant to which Building Permit No.. 42.$~..Z. dated ....... &p~rJ.l. · · 8, .... , 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 .... ~N~¥. bul,l~q .............................................. The certificate is issued to ...... ~&lt.~ .Sommek& .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... .......... Building Insp~t'o' ''~'':' '''' ''~'r // '~p' Houoe ~ 3.26S Sh:i. pFazd Lone FOI~M 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) N? ~31 Z Permission is hereby granted to: .............. L~..~.Z..~L.~..~ ............. ~.~..~.(.~!.?~ l at premises located at ....................................... ; .......... ~ ~ ................................. · ~.....~..~....fi.~../....~.., 19...~....~ond approved by the pursuan,t to application dated Building Inspector. .~ee *......~.~.~ .... Building Inspector ~FORM ~NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTM~,NT TOWN CL~RK'S OFFIC~ SOUTHOLD, N. Y. Disapproved a/c ...:..k~-v~77¥........~x............. ................ .................................. ...... (Building Inspector) APPLICATI(~N FO~t BUILDING PF..RMIT INsTRucTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plotplan showing l~cation of k~t and~f buildings on premises, relatkmship to adjoining promises or public streets .crt 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 applicatiqn may ~t be commenced before issuance 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~f~r inspection throughout the progress of the work. e. No building shall be occupied or used in whole o1~ in pa~ fbr any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS 1-1~I~I~Ry MADE to the Building Department for the issuance of a Building Permit pursuant ~o the Building Zone Ordinance of the Town of Southold., Suffolk County, New York, and other applicable Laws, Ordinances or Regulathyns, for the construction of build ings, additions or alterations, or for ten, oval or demo- lition, as herein described. The applicant agrees to eom ply with all .applicable laws, ordirmnces, building code, housing code, and regulations. ................ (Signature of applicant, or name if a corporation) State whether applicant " (Address of applicant) agent, arc'it ect, engineer, general contractor, electrician, plumber or builder ................................................................................................... Name .of owner of premises ............. . .~..~...~..-~...~...~. ...... .'~..~..~...~...~. ?..~...~..~.. I ..................... If applicant is a corporate, signature of duly authorize d c~ficer. 1. Location of land on which proposed work will b e done. Map No ...........~ Lot No ...........~. Street and Number ...... /..~...~...~. ....... . .~..~.l..~...x(..~..~...~.....L~...kt. ?. .... . .... .~..~...~.....~..~..'~. ).D..KJ Municipality 2. State existing use and occupancy of promises an d in~ended use and occupancy of proposed construction. a. Existing use and occupancy ......... ./...~r?..~./../.Lt..~ ....... .~...~.-~.~../..~..~. ~ .~..~?. ............... b. Intdnded use .an,fl occupancy ..... .~...~../~.. ~ ........ .1~. ./. {--'7. ./'t ...... .~-..,a~..~'..~...~-...1_~. ............... 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... Removal ........ Demoliti~on ........ Other Wo~l~ (Describe) ...................... 4. Estimated C~st ........... J..~..~. ~. ~ ....... Fee ........ ~ ~ .............................. (to ~ paid ~ fil~g this appli~tion) 5. If ,dwe~ing, number of dwelling units .......... Number of dwelling uni~ on each fl~ .............. ~ g~rage, number ~ c~ .......................................................................... 6. If busings, eomm~cial ~ mix~ oc~pancy, spec ify nature ~d extent of ea~ t~e of u~ .............. 7. Dimens~o~ of existing s~ctures, ff ~y: ~t .............. Rear ............. ~P~ ............. Height ................ Number of Stories ........................................................ Dimensions of ~me s~ct~e wi~ alter~t~ns o; additions: ~nt .............. ~ ............... ~p~ ................ Height ................ N~b~ of S~es ..................... 8. Dimensions of entire new ~ns~ion: F~t ....... ~.~. ...... Re~ ..... f .~ ..... ~pth . .~.l.... ..... .... ............. ........................ ~. s~ o~ ~, ~o,~ .... /. R. ~. .... Re= ..... ?. R .... ~th 11. ~ne ~ use ~s~ in wht~ p~mises ~e situa~d .................................................. 12. D~ pro~s~ co~ction v~l~ ~y ~ing law, ~din~ or ~lati~? ...... ~ ................ . 13. N~e of Own~ of p~m]ses ..................... ~ddre~ ...................... P~e No ............ N~e of ~chite~ ............................. ~ddre~ ...................... P~e No ............ ~e of Con,acer .......... $h.~.~7 ......... Address ...................... Ph~e 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 description acoerding to deed, and show street names and indicate whether interior or co~ net lot. ~ STATE OF NEW YORK, )S.S. COUNTY OF .............. ) 10o ~ ~d/~ ~.'T/~-7~ SOS A/~)S t~.[ being duly sworn, deposes and says that he is the appli- (Name of individual signing application) cant abe,Se named. He is the ....................... ~...~..~..~ ....................................... (Oontractor, agent, oorporate officer, etc.) of said owner or owners, and is duly authorized to per, tm or have periermed the said work and to make and file this application; that all statements ~ontained in this application are true to the best of his knowledge and belief; .and that the w~k will be p~ed in the mann er set fort~ in the application filed therewith. Sworn to before me this ................ day of ...................... %'L1ZRGT114 RNN NE~I.~LE (Signture of applicant)