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Home My WebLink About4300-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z. 3524 .... Date ......... Jull~.... 1.1, ....... , 19.6.9. THIS CERTIFIES that the building located at .Lupron. l~.otnt Road ..... Street Map No ............. Block No ........... Lot No. l~tt~Ltuck,..New..York ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... l~y...2~, ........ , 19.69. pursuant to which Building Permit No..43..0.0..Z.. dated ..... May..22, ......... , 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 .. pziva.~e. Or~. family..d~l~lllg ..................................... The certificate is issued to ..... John .Valer~tt .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Inspec~ House % 950 Lupron Point Road FO~M 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) bl°. 4300 Permission is hereby granted to: ............ ....... ................... ................... ~ .......... ~.~.......~__,~ at premises located at ...................... ~'~'~Z~' ........ ~Z~"'~'~"~'~"A~' ........ ~']~r'T ...... ~'~)' .................................................................................... ~. ~...~Z...l.. ~)~.~.¢.~ ............................ pursuant to application dated ................................. ~.~,~.....~,~...~ 19...~and approved by the / Building Inspector. TOWN OF SOUTHOLD BUILDING DIE~ARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...................... : ....... /., 19...../. .......................... No ............................. D~sappraved ale .~ (Building Inspector) Application No....~ ................... ~ .... APPLICATION FOR BUILDING PERMIT oat, INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. PIo. t .pi.an sho. win~ I.oc.ation. of lot .a.nd of buildings on premises, relationship to adjoining premises o~ public streets or areas, ana g~vmng a ae~a.ea aescrmption at layout or property must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of .this app..lication, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the prem,ses avadable for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or In part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bud ng Permit pursuant to the ~Build!n.g. Zone. Or..clinance of ~e Town .o.f Southold, Suffolk County, New York, and other appli.c, able Laws, Ordinances or ~.egu~ar~.ons, tar the construchon of buddings, additions or alterati~ons, or for removal or demo t on, as herein described. /ne appdcant agrees to comply with all applicable laws, ordinanc~ building code, h~ing~:~de, and regulations. /(Tignature of applicant, or name, if a corporation) (~ddress ~(applicont) ,d Ht,l VAL -NTI Name o~ owner o~ prom s~ ............................................................................. I~ applicant is a corporate, signature o~ duly muthorlzed officer. (Name and title of corporate officer) 1. Location of land on which pregc~ed work will be done. ARap No.: ..................... ~.i ................. Lot No.: .~.?~ .......... Str~ a~ Nu~r .................................................................................................................................................... ~ ~nici~!i~ 2. State existinG u~ o~ ~cu~ of p~i~ ~ int~ ~ ~ ~cu~nW ~ p~ ~i~: b. In~ u~ a~ ~- WIT~ ~l~l~ ~ ................................................................. ~ ........................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alterotion .................. Repair .................. Remo~.~),~..--/~ .... Dem01it!0n.~ .............. ;: ~'h~.Y/Vork (Describe) ........................................ 4. Estimated Cost ............................................... :~...;.....;.Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cots ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ - 7. Dimensions of existing structures, if any: Front ............................ Rear ....~ ....... .................... Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of s~me structure with olterotions or additions: Front .................................... Rear ............................ Depth ................................ Height ................. ~l,,~nber of Stories ................................ o 8. Dimensions of entire new construction: Front ' . ....................... Reor .............. ~ ............. Depth ........................ Height .................... Nyrl~b~' of Stories .......... }"O'~ ...................................... /C~..~'....~,~..: ................................... 9. Size of lot: Front ............................ Rear ................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of FO~l~e'~ Own,l~Zc_~.~d_;.~..~./.A. ·~ ..................... 1 1. Zone or use district in which premises are situated .......................................................... ~7~ ................................... 12. Does proposed construction vio~,~,~ny zcj~. ~a~,~inance or regulation.;> ............................................................ 13. Name of Owner of premises ................................ L ....... Address ............................................ Phone No ..................... Name of Architect .;~t~./,i.~........~.l~,.~-/~ ............. Address .....7~)~L~T~....7~.~,Z~. .......... Phone Name of Contractor .................................................... Address .............. ~./Z.2'.¢.f/.X~.~./?~,~... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fram block number or description and show street names and indicate property lines. Give street and . Cee~rLJir~ deed, whether i~terior or corner lot. ' STATE OF NEW YORK, ( ~ ~ couNw ........ ......................................................... ~ ....................................... being duly ~wom, d~ses and so~ that he is the applicant (Name of individual signing application) CL~L,'7/~ ~ above named. He is the ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make ond file th s application; that all 'statements contoined in this application are true to the best _of his kr~wledge and belief; and that the work will be performed in the manner set forth in t.he application filed therewit~ // Sworn to ~ m. th~s /~ ,4 'K ~ ~ / ~ ~ .~ - / ..... .................. .. ....... . ................... L~' - ~ ~ ...... ~.~ ......................................................... .... . .' ....... Coufl~ ELIZABI~TH ^~N NEVtt~ranature of o~olicont) Notary Publm, ..... , ~RY ............................................... NOT PUB!~IC, State of lVe~ york ~J~rm Expires March 3(I.