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Home My WebLink About3642-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. y. Certificate Of Occupancy No..~..9.92 ..... Date .............. J~;~.y ....9 ...., 19.7.~. THIS. CERTIFIES that the building located at .Bea. ch. Road. ~..Town..La~d. it]~ceet Map No...xx ........ Block No ...... :ex...Lot No...X~X... ~eenport...E,Y.o ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~e~;...26, 19.5~. pursuant to which Building Permit No.. ~,6be2Z, dated ............. Sept;...26., 19.6~., 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 . .Pri.v~te. o~qe. f~J~$1y..dx/el~:~ag .................................. ~... The certificate is issued to . .George. S~,li. ~q .&..~.i£a . .(~4~o~.a.. of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) pending ........................... UNDERWRITERS CERTIFICATE No...podding .................................. HOUSE NUMBER ..... 820 ...... Street ..... Sa~d.y..Beach. Road ................. ...... ' ..... '/ ........ Building,Inspector [ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEKK'S OFFICE SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3642 Z Permission is hereby granted to: ......~..:.~r.g.~.....~.....e,,~;t~ at premises located at ..,..~....e~..~.~......]~..,~..cl....~....~.Q~kl[~, .............................. ~ ............................... ............................................... ~ze~z~_~r~ ........................................................................................... pursuant tq application dated ............................ ..~. ~..~ .......... ~ ........ , 19..~.., and approved by the Building Inspector. Building Inspector BUILDING DEPARTMENT TO~VN CLERK'S OFFICE ~' ~ .-.~ z..:~ SOUTHOLD, N. Y~/~/~ ~'~'~~' Sept 26 67 / / ~ Examin~ ........................................ , 19 ........ Appli~tion No.............................3652 " " 19 67permit No..~..~ ............ /~y ~,,~o~/x,~. Approved ........................................ , ........ ,sapprovea .lc .............. ~ ..... :::::~ ....... ~......~ ................ :-~ ~/,~ ........................................................................ /....~ ......... ~~ / ~ ~ ~ .................. _ . ff ........... ~;~ ..................... ~. ~ ~te ...................... ~.~)~ ~... ~. Thi~ opplic~fion mu~t b* completely filled in b~ typewriter or in ink ond ~ubmiff*d in duplicat~ Ink,tot. b. ~lat plan ~howino I~ation o~ lot ~nd o{ building, on promise~, r~lationship to ~d~oinin~ pmmi~ or publi~ ~r~os, ~nd Oivino a ~t~ilod d~scription o{ I~out o{ prap~ mu~t b* dr~wn on th~ die, mm which c. Tho work cowred by thi* appl~coHon m~y not b* commenced b~for~ i~*uonce o{ Buildino P~rmit. d. Hpon approvol o~ this ~ppllcation, th~ Buildino In~ctor wil~ i~u~ o Buildin~ ~rmit to th~ ppplic~nt. Such ·holl b~ k~pt on th~ pr~mise~ ~v~ilob~ {or in~paction throughout th~ pr~re~ of th* work. · . ~o buildlnO *~1 be ~cupied or used in whol~ or in port {or ony purpos~ whatever until ~ ,boll h~w b~n omnted by th~ Buildin~ Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ~ J /~ ~(Signature of applicant, or name, if a corporation) ...... ............................................................... ~ ~.~ Mattituck ............................. ............................... ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~_~ ......................................................... .~.o~ r.a~.~.ar ....................~ L.~..~ ........................................................ i ...........................~ ~ 5'7 /_~c/~ ~ Name of owner of premises .....Q.$.9.~....~...U~[~.Y..P,~..~..~f~ ........................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number Beach P, aad & Town T.~ndin~ Greenport Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy c]l~'~'llir~ ............................................................. b. Intended use and occupancy same with an addition 3. 4. 5. 6. 7. Nature of work (check which applicable): New Building ' Addition ...... ~ .... Alteration ..~lr, T~ ........ ~Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ %00 Estimated Cost ............ ~,~. ........................................... Fee (to be paid on filing this application) If dwelling, number of dwelling units ........ ~ ............. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................. ...Z .... 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 Stories ................................ 8. Dimensions of entire new construction: Front ........... .2.9 ..................... Rear .............1..~, ............ Depth ........ ~..~. ........... Height Number of Stories OTJ. e ............................................................................................ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Fo~mer Owner ........................................................ 1 1. Zone or use district in which premises are situated ...I!.~]...~.~..~ ............................................................................. ;. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. .~...O. ............................. i ............ 13. Name of Owner of premises ............ l,~.g.'l '1 'i.~..aTJ. ........ Address ..j~..~..e..e...~.]g..o..~...~. .................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor A~'...~.~,~'.Q~.C1, ......................... Address ....... ~8,.~.~.~,.~.1~C]:[ ............... Phone Nol .................... 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 description according to deed, and show ~treet names and indicate wheth~ i,nterior or corner lot. STATE OF YOa S S COUNTY OF .....~?..~..~... .......... }' '' ........................................ .~.......~..a..~.O..~.~.. ........................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............................ C.GD.[~a.(~.~.QZ' ..................................................................................................... (Contractor, agent, corporate 9fficer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make qnd file this application; that oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................ ........................ .......... ......... ............................ I~0TARY PU3L[C, SLe~e oi [~e;v ~'r'} ~]0. 52 3233120 Suffolk Cou '[elrm £xp[res March 30,