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Home My WebLink About4245-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z. 361~ .... Date ..........0~.~.. ~:~. ......... ,19..69 THIS CERTIFIES that the building located at .. ¥~t~.. 2~ay. &~ ......... Street Map No. 0,l,~.thil~131ock No .......... '.Lot No. ~.~..&..~.~......Z.~...~'.e..1...~:.~...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .........&l~r~ .....~1~ 19. ~ pursuant to which Building Permit No .... ~2~r~ dated ........AIiZ'~I, · .. :ll~.., 19. ~9, was issued, and e°nforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pl~.l~.t.e~ .o~.e..$84~1,11r..cl.v.q]~g ...................................... The certificate is issued to ..... p. htZltp. C.o. ll~ll~l' ...... (helical' ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ~l,]g, .......................... ]h~ule I~ ll~Obray Ave FORM NO. 2 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? 245 Z Permission is hereby granted to: to Building inspector. Fee $.. ~ ................ Building Inspector ,FORM ,NO. I TOWN OF SOo-~-t/OLD BUILDING DF, PAR'rM;ENT TOWN CL~.,RI['S OFFICE SOUTHOLD, N. Y. .'pp,,,v~d ......... /..Y...~... ., ,~ ~. ,'ermit No.. L~.r>:'.. Z... ~ '~-~ '"p'"~' Disapproved a/c ..... ~... ~ ....... ....................................... .... (Building ~nspt~ctor) APPLICATI(~N FOR BUILDING PERMIT 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 lo~ and ~f buildings o n premises, relatkmship to adjoining premises or public streets .or areas, and giving a detailed description of lay out of property must be drawn on the diagram which is part of this application. c. The work covered by this application may n~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 for inspection throughout the progress of the work. e. No building shall be occupied or used in whole o~ in part f~r any purpose whatever until a Certificate ~f Occupancy shall have been granted by the Building Inspecter. APPLICATION IS 1-1t~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building ~one Ordinance of the Town of Southold., Suffolk Oounty, New Y~rk, and other applicable Laws, Ordinances or Regulations, for the construction o~ build ings, additions or alterations, ~r for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, arid regulations. ..... '....'.. :.. .... .... (Signature ~f .applicant, or name if a corpo ' ) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or o~,uv..~.~ ...... ................................ builder ........................................................... Name of .owner of premises P.C. ~- ff ~--~- .~..'~.. ............................ If applicant is a corporate, signature of duly authorize d ~fficer. (Name and title of corporate officer) tZ~J-~ Location ~, land ~l~which proposed work will be done. Map No....~..~./. ........ Strut and Numar ....................... ~ .................. , ........ .....,:.- ....... ~ .... ~"' State exis~ use and ~cup~cy of p~mi~ ~ d inlend~ ~e ~d oc~cy of p~ ~t~ction. a. ~isti~ use ~nd oc~p~cy ........................... ~ .................................... b. Intended ~ .~d eccup~cy ~k- ~1~ ~l 3. Nature of work (check which applicable): New Building ........ Addilion ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other ~.~ (Describe) ...................... 4. Estimated ©~st ......... Fee ~ . ..... (to be paid on filing this applicati,on) 5. If ,dwelling, number of dwelling units .......... Number of dwelling unit~ on each floor .............. If garage, number ,of ca~s .......................................................................... 6. If business, e~rnm~reial ~r mixed occupancy, spec ify nature and extent of each type of use .............. 7. Dimensions of e~st~ng structures, if any: Fl~vnt .... .-~....~. .... Rear . .~..~t. ....... Depth .~...~. ........ Height ...... /~...~. .... Number of StOries .......... .~.~...~.~. ............................ .~.. ....... Dimensions ,of same structure with alto, rations er additi,ons: Front ..... if..~. ..... Rear .....~..~.. ...... Depth ...... '~'! ..... Height .... /.~ ~ ..... Number of S~:rties .... .~...~'..~.~. ......... 8. Dimensions of entire new construction: Front ................. Rear .............. Depth Height ............ Number of S~ories ............................................................. 9. Size of lot: Front 75~ Rear 75'- Depth . ./..--~....O. ...... 10. Date of Putch.ase iii.i~'iiiiil./.~.'.'.~'.'.2f.'..~--.'iiiiiii~'of Former Owner ....... ...--~....7~...M-..].~...~.. .... 11. Zone ,or use district in which premises are situated ........... '~ .~...~...~-./..O. ~..~.. ?../?..~. .............. 12. Does proposed construction violate any zoning law, ordinance or regulation? ,4/O i3. Nameof0wnerofpremises?.%~..?..O..t'.L...~..~... ..... ,ad ess .... Phone ........... Name of Architect J. ........................... -~ddress ...................... phone No ............ Name of Contractor ............................ Address ...................... Phone No ............ Locate clearly and distinetl from property lines. Give s~ee indicate whether interior ,or c< PLOT DIAGRAM )' all buildings, whether e xisting or proposed, and indicate all set-back dimensions and block number ~i- de scription~,, accerding to deed, and show street names and rner ~ot. STATE OF NEW YORK, ) S.S. COUNTY OF .............. ) ,23--* ................ 'x being duly sworn, deposes and says that he is the appli- (Name of individual signing applicati,on) cant above named. He is the ..... . ........ /?..~...~'...-~..]..~ .................................................. -- (Oontraeter, a~ent, corporate officer etc.) of said owner ,or ,owners, and is duly auth,orized to perform or have performed the said vaork 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 th.at the w~k will be perfmuned in the mann er set fortl~ in the application filed therewith. Sworn to before me this day ef ~OTARY PUBLIC, State oI ~L~ York ~lo. 52'8125850 Suffolk C~llt ~ ~p ~es ~rc~ 30, -:, +,.,~. ..,x f.