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Home My WebLink About3374-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...~...~J.'/.~ ........ Date .................... ,~g~.~..~..~. ............. , 19..67. THIS CERTIFIES that the building located at . ~ll~jl:~ .Dr,...& .JJ~OadW/lJ~'..~'~.. Street Map N~ ....... Block No ...X~II~ ....... Lot No. ~ ............. C.Ut, iP,~i:~I~,...~.~.' ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~.iI!.~IEt~ti~...~J ...................... , 19...~.?. pursuant to which Building Permit No ...~..~.?~. dated ~.~..~..~....2. ..........., .............. , 19....~?, was issued, and conforms to all of the requirements of the applicable prowslons of the law. The occupancy for which this certificate ~s issued ~s ........ a~.t~.on t:o ~wei1~ng The certificate is issued to ........... .=lar~n~e..Lo ~lz ................................................................. (owner, lessee or tenant) of the aforesaid building FOR.,~ 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? 3374 Z Permission is hereby granted to: ........... ~.o.~../!e.t~.....iZ.~...~,.],.~...e..n...q.e....~.e..~.~ at premises located at ~la~.OZl D!'. & Bro~d~ater~. Rd .............................. .qy...~,,h..o. ~.e.,L ~.... ~. :. .............................................................................................. pursuon$ to application doted ......................... ~?..~..: ........ .6.. ............... , 19...6.?.., and approved by the Building Inspector. Fee $~.t..O..O.. .............. Building Inspector FOI~I~I NO. 1 TOWN OF SOUTHOLD BUILDllqG DEPART/VlElqT TOWN CLERK'S OFFICE SOUTHOLD, lq. Y. Approved ~ k ~" ~ ~ '7 H ~ .................................... , 19 ........ Permit No ............................... D~sopproved a/c ............... . ............ ............................ ...... (Buddin~ In~ector) .... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o Th~s opphcat~on must be completely filled ~n by typewriter or ,n ,nk and submitted ,n duplicate to the Build,n, Inspector. b. Plot plan show,rig location of lot and of bu,ld,ngs on premises, relationship to adjoining prem,ses or pubhc streets o areas, and g,vmg a detailed descr,ption of layout of property must be drawn on the d,agram wh,ch ,s part of this apphcat,or c The work covered by th,s apphcat,on may not be commenced before ,ssuance of Building Permit d. Upon approval of th~s apphcation, the Building Inspector will issue a Building Perm,t to the .applicant Sud perm,t shall be kept on the premises ava,loNe for inspection throughout the progress of the work e No budd,ng shall be occupied or used ,n whole or in part for any purpose whatever unt,l a Cert,ficate of Occupanc shall have been granted by the Bu,ld~ng Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ,ssuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcoble Lows, Ordinances o Regulat,ons, for the construction of buddings, additions or o lteranons, or for removal or demolition, as here,n describer The apphcant agrees to comply with all opphcable laws, or/dinances and regulat,ons //i/.. (S.~gnotu. e of oppl,cont, or name, ~f o corporation) ' "/' ' .......... ..... State whether apphcant ,s owner, lessee, agent, arch,tect, eng,neer, general contractor, electrician, plumber or bu,lde, ...... ........ ........................................................ If apphcant is a corporate, signature of duly authorized officer (Name and htle of corporate officer) 1 Location of land on wh,ch proposed work wdl be done Map No ....................... Lot No' . . ' ' Streetand Number .~'.~...~....~..~..~.....~...~.. .... /I'~/~ ~ 6 /~/ DI~ )'Y /F-~ ~ ..'~._l~ ~.~.,~/. /.~/ ~ ~t~.~.. ...... 2 State ex,sting use and occupancy of premises and , n~ended use and pa cy of proposed construction a. Existing use and occupancy ........................................................... b Intended use and occupancy ......... .~. ~. Z ~ ............................................................... / 3. Nature of work (check which applicable) New Budding ............. Addibon . ~. Alteration ..... .f~....... Repair ................... R~noval ............... Demohtion ............ ~ Other Work (Describe) ........................ Esb t ~''~'/¢';~O ~ ............... ~ ~ 4 ma ed Cost .......... .~..~... ...... ~ ........................Fee .................................. (to be pa~d on fihng this apphcat~on) 5 If dwelhng, number of dwelhng un,ts ...... ~ ... Number of dwelhng un,ts on each floor .~.~.~.~ If garage, number of cars ............................... 6. If business, com~rcial or m~xed occupancy, specify n~ture and extent of each type of use ................ t ......... ,, 7 Dimensions of existma structures, if any Front . ~ ~ ~ ~ Rear ............... Depth ................... He,ght ~t....~.~].?'. Number of Stones .. / -" .............. ~ ........ ~'t ......................... z'J'''~'- - ~ ........ D,mens,ons of same ~tructure w,th alterat,ons or add,t,ons Front ...~...~ ............ Rear... ~r..~ .............. / Depth .... ~.X .............. He,ght .~ .................... Number of Stones ...... =.~. ........ : ..................... 8 D, mens,ons of ent,re new construct,on Front ...... /~ .~. .. Rear .... ~ .............. Depth ........................... Heigh~../.~.~.P.... Number of Stones . i 11 Zone or use district ,n which prem,se, are ,,tuated-O ~ ~.¢'*.~'.~ .......................................... / 12. Does proposed construction violate any zomna law, ord~nance, qr regulat~onP ....... /~..~ ..... 13 Name of Owner of prem,ses ..~.~.~.~.~ .~ff2~ddress ~/~*L~.~..r. ~... ~h~2e ~~'~'~ .. Add ress Nome of Architect ............................................ Phone No ..................... Name of Contracto,~.~.~.~'.~.*:~ . . .Add,¢¢i~]~,;..~;.~.;~.. Phone PLOT DIAG~M Locate clearly ~nd d~sbnctly all buddings, whether exishng or proposed, and ~nd~cate all set-~ck d~mens~ons from property hnes Gwe street and block numbers or descrtptson according to deed, and show street names and ~nd~cate whether inter.or or corner lot. /fa - STATE OF NEW YORK, ) c c COU~ OF ...................... ) '~ '~ ........ ~.. ~..:..../~./~:.1-~..,~' .............. be, rig dully sworn, deposes and says that he ,s the apphcant ~/ ~(Name of red,we[ual sigmng apphcahon) above named He ~s the ............................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and file this apphcation, that all statements contained m th~s applicat,on are true to the best of his knowledge and behef, and that the wor k w , I I be performed , n the manner set forth , n t h e~swo r n to before me this pi,cat,on f,led.~ a~~therew'th ............. day of .................................. 19. Nota Pubhc, .... County ......