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Home My WebLink About4262-zFOI~M NO. 4 TOWN OF SOUTttOLD BUILDING DEPARTMENT Town Clerk's Olfice Southold, N. Y. Certificate Of Occupancy No. Z. 3602 ..... Date ..........Oot, ...... 6 ....... , 19.69. THIS CERTIFIES that the building located at ~I/~.. ~ia-in' t(oacl .......... Street Map No.. ~.X ........Block No.. x~ ......Lot No... X~ .... 14at~;i.t;uek. · .I~,%. ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... l;l~r~'~' · · 2h, ' ', 19.69 pursuant to which Building Permit No..h.262~.. dated ............ it~X,:tl...2t~ 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 . .Pr:tva. be. one. £a~ily. ¢lwe;Ll.$ng ...................................... The certificate is issued to ..... Robert..][,, .Berg~l~ ..... 0. wn, l~ ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... I~.,R, ......................... Hou.~e # 1910~ /./ f -~' ..... -(^..I ,~ '..~ . t~ . '; / · . ~ Building Inspector ri TOWbi OF SOUTHOLD BUILDIbiG DEPAgTMEbiT TOWbi CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDIbiG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 42 2 Z Permission is hereby granted to: ................. ~.o.~,~.~:~...L~...~.~e,~..~.,~£~ ....... ................ ~Ja~A~aa& .......................... N~ ~,~c~k ~.~.~ ........ at premises located at ........................... ~/,~....~L~.,,~..~'~O~ ............................................................... ................................................... ...~....t..~ ~, .~.,~.,~,~ ....... ~.~. ~.~.~ ...................................................................... pursuen,t to application dated ........................... ~.~-. ......... ~ ........... , 19.,~3., and approved by the Bui{ding Inspector, ~ui~aing Inspector ( ~FORM ,NO. 1 Examined .. (~....~..., 19.~.~. Approved ....... ;.' ........ *...., 19 .~... Permit No... Disapproved a/c ..................... " APPLICATIO~N FOR BUILDING PER~IT Date A~r.il 2~ 19..6.9 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 l~t and of buildings o n premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diam~m which is part of this application. c. The work covered by this application may n~t b e commenced before issuance of B~ilding Permit. d. Upon approval of this application, the Building In specter 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 oV in pa~t for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS 1-~_~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soathold, Suffolk Ck)unty, New York, and other applicable Laws, Ordnances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with ail applicable laws, ordinances, building code, housing code, and regulations. ........................... (Signature of applicant, or name if a corporation) Mattitue~ .............................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or Owner builder ................................................................................. Name of owner of premises ...R~ber. t. Lo. Ber§~l~ ...................................................... If applicant is a corporate, signature of duly authorize d officer. (Name 'and title of corporate officer) 1. Location of land on which prop~ed work will be done. Nap No.. '~ Lot No. XX Street and Number . )qNr~.S.. ~{aln. Road. . l~atf&tu~k .................................... ~ -' '~' i~t'-.' :a " Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed cunstruction. a. Existing use and occupancy .....D~..e~l,],:~p~ ...................................................... b. Intended use and occupancy ............. ~!~i~P...V~I~:/0,1~. &tld~.tlOi~. ........................ 3. Nature of work (check which applicable): New Building ........ Addition . ...x~.... Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ..................... '. 4. Estimated Cost ...gr..QQQ.~+ .................. Fee . .~,Q.Q .......................................... (to be paid ~n filing this application) 5. If dwelling, number of dwelling units . Olde ..... Number of dwelling units 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 .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of S~ries ..................... 8. Dimensions ,of entire new construction: Frcmt ...... 3.9-..1~. .....Rear ..... 39,-.1t... Depth . 23~-6 ..... Height ............ Number of Stories ............................................................. 9. Size of k~t: Front ................ Rear ...... ......... Depth ............... 10. Date of Purchase ............................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ....... .~.. ~.:~8.~, .................................. 12. Does proposed construction violate any z~ning law, ordinance or regulation? ..... H0 ................... 13. Name of Owner~f premises ....~.qb.e~..]~t. ~.~g~it~lress .... M&~;t;li.~;llCk ...... Phone No ............ Name of Architect ............................. .~ddress ...................... Phone No ............ Name of Contractor .. ]~ll~elle..tioga;Oil ....... Address . l~el~. ~f~k ...... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensk)ns from p~operty lines. Give street and block number or description aceording to deed, and show 'street names and ~ndicate whether interior or co~er ]~ot. F STAT~ OF NEW ¥OP~, )S.S. COUNTY OF 8~f~.~][: ...... ) .................. ~be~t. ~'~emge~ .............. being duly swo~, depos~ ~d ~ys ~at he is the appli- (Name of ~dividual signing applicat~n) c~t a~ve n~ed. He is the ..... ..... ~e~ ............................................................ (~n~a~or, a~t, ~r~ate ~icer, etc.) of ~id own~ ~ owne~, and ~ duly aut~z~ ~ pe~rm or have pe~ ~e ~d ~k ~d ~ m~e ~d file ~ applicon; ~at ~1 stateme~ ~ntain~ ~ ~is applicat~n ~ ~e to the beat of h~ knowl~ge ~d belief; and ~at ~e ~k will be p~ in ~e mann er set f~ ~ the application filed ~e~wi~. Sworn to before me this ~t_IZA~ET~ ANN NEVILLE IlOTAR~y pUBLIC, State of New Yo~R No. 52-8125850, Suffolk Co ~ ~pbe~ March 30, 1~