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Home My WebLink About4243-zFORM NO. 4 TOWN OF SOUTHOLD BUILI~I~'G DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. ~- .353A .... Date .......J~ll¥ .... 3,3,, ......... , 19.6.~. THIS CERTIFIES that the bu~ng located at $~g. ~.~d ....... S~eet Map No.~l~s. ~.Blo~ No ........... Lot No.~ .33. & .34. ~r~..~.~. confo~ subs~ti~ly to ~e AppHcation for B~g Pe~t heretofore f~ed ~ ~ office dated ....~ .... : ~4~ ~.., 1~.. p~su~t ~ w~ch B~g Pe~it No. 4243. ~.. dat~ .... ~r~Z ..... l&~ ...., 1~9.., was ~sued, ~d co~o~s to ~ of ~e r~ ments of the applicable pro~sions of the law. ~e occup~ for whi~ ~s ce~i~te ~ issu~ ~ ....~va~ .a~ag~ bu~g ....................................... The ce~ificate is ~sued to ..... C~%. a~e~ ................................... (o~er, lessee or ~n~t) of ~e ~ores&d b~ng. S~o~ Co~ty Dep~ent of He~th Approv~ .................................... ~otme ,1~ 800 Onu~ Haxlxn: P. oad FORM 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? 4243 Z Permission is hereby granted to: ................... ~r~.~,..~.c~.a£.~.~ ........................... ........................ .~L.~.a~k.~laae ...................... ............ ~e~.t..~e~..~,J. ....... a~ ................. to ................ ~.~..[hoa~;..hc~..~...ll.tc~.&ge...b.~l~ .................................................... at premises located at .......................... ~O...~..&..~&~.t..~,~ ....... fl--~e~,~..Jl~ll~..-.~- ............. ................................... gaml..tJas'boz.. ~k,ad, ......... e~-e.e~pm, t ....................................................... pursuan¢ to application dated ............................ &~T.~,:L.....~f .......... , 19..~:~, and approved by the Building Inspector. Fee $.e.G.,..'."X} ........... Building Inspector TOWN OF SOUTHOLD D BUILDING DE~AItTMENT TOWN ~'S OF~ /. SOo-r~LD. N. Y. ..................... 19 .... Permit No ................. Application No..~.. ?..~. ~ ....... APPLICATIOI~ FOR BUILDING PERMIT Date ............ ./..?...., .~,..~, .~. · ..... INSTRUCriONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Piotplan showing location of lot ando~ buildings on premises, relati~ip to adjoining premises 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 not b e 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 pro~ress of the work. e. No building shall be occupied or used in whole o9 in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector'. APPLICATION IS I-u~el~y MADE to the Building Department for the issuanceof a Building Permit pursuant to the Building ~one Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions er alterations, or for i~w. oval or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, h,ousing code, and regulations. State whether applicant is owner, lessee, agent, "~'''"~'~ ' ~'--~ " ration " (Add.ss of applic~t) 0 ~ 0 ~ ~ ~chit ect, engineer, general con~a~, ele~ci~, plumber or builder ................. ~. · .~'. · -"~. · #. · .'~. ................................................................... Name ,of owner of premises .. ~...a~.,~.... ~. ........................................ If applicant is a corporate, signature of duly authorize d officer. 1. Location of ,a~d. on which Protx~ed work will be don~. Map No... ?.~/ ..... Lot ~ ,~, .~....~L. Strut a~N;m2~. ~ .... Sff. ~ ...... ~.~ ............. ~ ....... _ ~UmClp~y 2. State exist~g u~ and Occup~cy of p~mi~s ~ d intended ~ ~d occu~cy of p~ ~ction. a. ~isting use ~d oc~p~cy ................. ~ ................ A ~ ........................ ..................... ...... . ............................... 10. 11. 12. 13. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ...... ,... Removal .'.~.'~i Demoliti, on ........ Other WorJ~ (Describe) ...................... Estimated (3ost ............. i ......... Fee ....... f...O.. ~ ................................ (to be paid on filing this application) If ,dwelling, number of dwelling units .......... Number of dwelling units on each floor ............. If garage, number of ears ......................................................................... If business, commercial or mixed oeeupaney, spec ify nature and extent of each type of use ............. Dimensions of existing structures, if any: Front .............. Rear ............. Depth ............ Height ................ Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front .............. Rear .............. Depth ................ Height ................ Number of Stories ..................... ~ Dimensions of entire new construction: Front ...... ]...~. ...... Rear ! ~ Depth Height ....~. ....... Number of Stories ~ A/ ~-~ Size of lot: Front ..../...~..o. ...... Rear ... :/...-~. ?. ..... Depth .... /. ~..~...~.... Date of Purchase ............................... Name of Former Owner . .~/~. .... .~. ?..~..~..].~....ff~ Zone ar use district in which premises are situated .......... ~.'.~..'i..~?.-.S.I..l).r'-..~...T..t .~., ./~. ..... ~ O. ~: ~../~ Name of Architect ........ ...~' ................... Address ..... 61 7.O.~4~3. ..... Phone No ............ PLOT DIAGRAM ~OI - 9qT-~/ a~ 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 scription according to deed, and show street names and indicate whether interior or corner lot. _ ~ STATE OF NEW YORK, )S.S. COUNTY OF .............. ) (Name of individual signing applicati, on) cant 'abeve named. He is the ................... ~...~..~...~...~. ........................................... (Oontractor, agent, oort~o~ate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfermed 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 mann er set fortht in the application filed therewith. Sworn to before me this ....... /iff ..... dayof ....... .~....~..~..'..L'.. 19..~..~ Notary Publie, -~ O £L~, ,£(~S~tu~Sf applicant) NOTARY PUBLI(~, ~{ate of New Yom No. 52-8125850, Suffolk Coli,~t~ ~erni ~piies M/f~fi 30, 19~