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Home My WebLink About4268-zFO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. ~3,833 ...... Date ............ i~l~ ...... ~10", 19. ?0 THIS CERTIFIES that the building located at . i~1~. R. oO,$1.,..ll~. ~a~' li~ Street Map No. 'B~I~' · ............. Block No. .~ Lot No. ~ Or~..~;" ' ',' ' ' ' ' il~[~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Ip~t'l' .. · ~1~ 19-6,~. pursuant to which Building Permit No.. dated .......... &pl'~ '. 30, 1969' ', 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 P.~iv~.f~ .~n~ · f~.~u.~.]~y, d.~,~.~ir~g ..................................... The certificate is issued to ...l~¢hal'~. '~tal'k '&' I~'~'1 · 0~1~1'1 .......... '. ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval House ;/ 1200 bt..Td- eye Rd FOP~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4268 Z Permission is hereby granted to: ............ C~u~e~ .............................................. to ............ ~xiaJ, d...~..~r~..£,~m&;~:~..~,~.~: ........................................................................ at premises located at ........... .~q~.,.M~.....]~:~......~,~.;:i~t...~t. ........................................................... ................................................ O~,&~ ....... ~.~;, ................................................................................. pursuan,t to application dated ......................... ~Jt.~/~.J.. ....... ~; .......... , ]9~,¢)..., and approved by the Building Inspector. Fee $J..O..,...~... ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal , (Give ~2ed ' i(c~tion) facilities for a structure located have been ~nspected by this department and found to be satisfactory. District Engineer 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 lot and of buildings o n premises, relatknkship 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 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 pal~c for any purpose whatever until a Certificate of Occupancy shall ltave been granted by the Building Inspecilor. APPLICATION IS l-m;l~Y MADE to the Building Department for the issuance of a Building permit pursuant to the Building Zone Ordinance of the Town of S~athold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for ten, oval or demo- lition, as herein described. The applicant agrees to cam ply with all applicable laws, ordinances, building code, housing code, and regulations. (Signatt~re of applicant, or, rmme if a corporation) State whether applieant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .... .~~w~... ~ ......................................................... Name of owner of premises . .IO.,~4 :..4:.~. ~~. ~ ,.. ~ ............................ If applicant is a earl)orate, signature of duly authorize d officer. 1. Location of land on whic, h proposed work will b e done. Map No .......... (~/~Z~" .............. Street and Numb~..~c~,~-~...~...- .-~'~-.. ~ .~...~.~-~2~. f~...':.'.~.~..'~.: ...... 2. S~te exist~g use~nd ~p~cy ~ pre~ ~a iniend~ ~e ~ oc~cy of ~ m~aion. a. ~mtmguseandoccup~cy · ~/~ '_';~:V' -_- ~ ~ b. Int~ded ~ ~d ~cup~cy ..... ~..~...~.~.~..~ ~ .... ' 3. Nature of work (check which applicable): New Building /~f ........ Addition ........ Alteratio'n ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ....... ............... 4. Estimated Cost .... 3-- ~'/'t~J ............... Fee ....... l~.~...o~.. (to be paid on filing this application) 5. If ,dwelling, number of dwelling units .......... Number of dwelling units on each floor .............. If g. arage, number ~f 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 o.f SOeries .... .. ...... .: ......... · .,~ 8. Dimensions of entire new construction: Front .... ~..~.~. ~..~... Rear . .~'..V.~. .~...~...~Depth~.. ~.Z..~... Height .... ~ 2..~.. Number of Stories ...../O~....~...~...~%~.....~ .................. 9. Size of byt: Front .. ,7../2~..t. .... Rear .. :l...~...~_~....JDepth~ .... ~.~ .~...~. 10. Date of Purchase ..~..~.].i.~,.~. ........... Name of Former Owner ]~k~..~ ....... 11. Zone or use district in-' ---which premises are situated...~.('-~~ .~~ ~. .... ~. ...................... 12. Does proposed construction violate any z~ning law, ordinance or regulation? .... )~q..~. ................ 13. Name of Owner .of premises f~.'~. '. ~ ...... ~ddress . .~ .~.'7.~r-'y..~.: .~ Phone No.~. ~. ~*.: ~.~-~* Name of Architect ............................. ~ddress ...................... Phone No ............ Name of Contractor ~.~... Address .(~~ ¢.b..,.7. t Phone No. q. $.~.~ ~ ¢.f?~ 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 de script~on according to deed, and show 'street names and indicate whether corner lot. cant above of said owner or file this belief; and Sworn to before ..................... being duly sworn, deposes and says that he is the appli- application) ~ (Oontractor, agent, corporate officer, etc.) and is duly authorized to perform or have perSonned the ~aid work and to make and : all statement, s contained in th is application are true to the best of his knowledge and : will be performed in the mann er set fort~ in the application filed therewith. ~/~ o~-~o-~N°tary Public, ....... ~ ~ ............ Y~~A~)DN A REGEOOUnty ~[o. 52-3233120 Suflolk ~ ~pires ~rch 30, (Signture of applicant)