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Home My WebLink About4258-zFOR~ NO. 4 TOWN OF SOUTHOLD BIJTLr~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.S .35A4 ..... Date ........~Y. ..... .~],., ...... , 19.6.9. THIS CERTIFIES that the building located at .Main .Road ............... Street Map No ............. Block No ...........Lot No ....3~ ..... (~.ut~to~ue,. Il, If, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......Al~l~ ....~2,,., 19.69. pursuant to which Building Permit No..4~$1~..4. dated .......Aprlll...22,...., 19. &9, was issued, and conforms to all of the require- merits oI the applicable provisions o]~ the law. The occupancy for which this certificate is issued is . .. lrrivate, one. £m~1¥. ~eellincj .................................... The certificate is issued to . .Co~ein. II,. Gr&t. lmoh3. ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ~ ............................... t Ln Road Building Inspector,S' FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 258 Z Permission is hereby granted to: ...................... ~..~,e~ .................................... ............................. ~t.~o~e ....... :~.~., ............ at premises located at ......~.~.~..~.~. ......... ~/.S.,...~$~-.~;)~1. ................................................................ ............................................. g.u.%ch,c~g:~ ....... ~{,L ............................................................................. pursuant to application dated .......................... ~D~.%~. .......... ~2 ....... , 19...~, and approved by the Building Inspector. Fee $,~.QO .............. ,FORM ,NO. TOWN OF SOUTHOLD BUILDING I~F~~T TOW"N ,CL~RK'S OFFIC~ SOUTHOLD, N. Y. O; 14lid. 0 d Application No. APPLICATIO:N FOR BUILDING PL~MIT Date... ~.~..4 .............. 19~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink .and submitte~l in duplicate to the Building Inspecewr. b. Plot plan showing location of l~t and~.~ buiklingson premises, relati~nahip to adjoining premises or public s[reets 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 applicat[~n may r~t be commenced before issuance of ]~uilding Permit. d. Upon approval of this applicati,on, 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 c~ in part f~r a~ny purpose whatever until a Certificate ~f Occupancy shall have been granted by the Building Inspector. APPLICATION IS ~:Ry MADE to the Building Department for the issuance of a Building Permit pursuant ~o the Building Zone Ordinance of the Town of S~atho Id, Suffolk Oo~nty, New York, and other applicable Laws, Ordinances or P~egulatJons, for the construction <~f build ings, additions or alterations, or 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 of ,applicant, or name if a co~oration) ......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ~ ~ .............................. Name.o; ~;'~i ~'r;~ii2' i i i~i i '. '.~'..~ ........................................ If applicant is a earl)orate, signature of duly authorize d .afficer. (Name and title of corporate officer) 1. Location of land on which proposed work will~ b e dop~. Map No ................. Lot No .............. Street and Number ~ ~- ~.../'...~.~ ~'~' -','~-"' ........................ /~' / ............. .~...5 ~ ~...~ / / Municipality 2. State existing use and occupancy of premises an d intended use and ,occupancy of proposed construction. b.a' IntendedExistinguseand°ccupanCYusean~l occupancy ........ ..... i~ iiii ii ii ii ii i ] ii i ii i i i i i 3. Nature of work (check which applicable): New Building ........ Addition . / Alteration Repair ......... Removal,~ ....... Demolition ........ Other Work (Describe) ...................... 4. Estimated Cut ........ ~..f..~(.~, ..o~...i ....... Fee ......... ..~.,..v~. ............. (to be paid on filing this application) 5. If ,dwelling, number of dwelling units ..... /.... Number of dwelling unite on each floor .../ ........... If garage, number of cars ............................................................ ; ............. 6. If business, commercial or mixed occupancy, spec ify nature and extent of each type of use ........ .~ ..... 7. Dimensions of existing structures, if any' Front ,3~ ' Rear ~..~ ~ Depth ,~.~. ". Height ..... . .-~..~ ....... Number. of Stories .... ./. ~ .............................................. , Dimensions of same structure with alterations or additions: Front .... ~ .~ .... Rear . .~;~. f. ....... Depth . .~. .......... Height ~/~. ........... Number of S~ries ..../. f~ ........... 8. Dimensions ,of entire new construction: Front ............ ..... Rear .............. Depth ............ Height..~. g./ ..... Numb~,r of Stories ./...~... 9. Size of iot: Front ..... ~..~. ....... Rear ...... ~.f..' ;' ..... ...................... Depth .... . .~../.~. ..... ~' .......................... 10. Date of Purcl~ase ............................... Name of Former Owner ...... ; ...................... 11. Zone or use district in which premises are situated .......... ~ .~)., ................ 12. Does proposed con~tru~_ion v½~l_~w, ordinance orJegulation? ....... .~..: ............ :.. Name .of Architect ~ .... 't~,' '-'~Y'' ' ' 'c-f~"~'~ddress ' "~" '~"' '" ........... Plane No ............ Name of Contrac~o~r~~. ~ .~Address ~~_~. ~"~.. Pb.one No~..~ .~...-~.f.?7 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or p~oposed, and indicate all set-back dimensions from property lines. Give s~eet and block number or de scription according to deed, and show street names and indicate whether interior or corner lot. · · .~..~.~ ~~ ................... being duly sworn, deposes and ~s ~at he i~ ~e appli- (Name ~ ~divid~l sign~n~ applicat}on) e~t a~vo rimed. He i~ tho ................. ,~.. (Oon~a~or, a~t, ~ate officer, etc.) of ~id own~ ~ ,owne~, and ~ duly auth~ ~ p~orm or have pe~ ~e ~d ~k ~d ~ m~e ~d file th~ appli~fion; ~at ~l statements ~nt~n~ in this applica~n ~ ~e to ~e be~ of h~ knowl~ge and belief; and ~'at ~e ~k will be p~ in ~e manner set fo~ ~ the application filed ~erewith. Swo~ to be[o~ me ~is ~ NOTARY pUBLI~, Stste of Hew york No. 52-8125850, ~ffolk ~un~ Te~m Ex,res Marc~30. 1~