The URL can be used to link to this page

Home My WebLink About4896-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. Z. 3.955 .... Date .... S~ptemb~r .. 1,5, ....... , 19.7.0. THIS CERTIFIES that the building located at .... ~xl~n~ .D~lve ........ Street Map No ............. Block No .......... Lot No. ~t~itu~.,..Ne~. Yo~k .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. ~uguzt. 11., ...... , 1970.. pursuant to which Building Permit No..48~6 dated .. Auguat. ~1`, ........ , 19.7.Q., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occup~ancy for which this certificate is issued is ..... p~,iVa~..one..~i!.~. The certificate is issued to ...... ~s.,. ~9i~ .~osh~ ......................... (owner, lessee or tenant) of the aloresaid building. Suffolk County Department of Health Approval ....... : ............................ ,Building Inspector House % 700Marlene Drive FOII, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMEIlT TOWN CLERK'S OFFICE SOUTHOLD, II. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON ,THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4596 Z Permission is hereby granted ~ ~ To et premises located at .................................................................. , .......................................................... i, ~ , pursuant to application dated .............................. ./..( ........ ~.].!:.....~.].., 19...~.,.~.~ and opprov~ by the Building Inspector. Building I~nspector NO. I TOWN CLERK'S OFFICE' SOUTHOLD, N. Y. ^l~roved .................. /..-..,_...p....,~'* ,9......,.ZP P. rmit No ....................... (Buildtn~ Inspector) Application No ............................. ~ APPLiCaTION FOR BUILDING PERMIT Date .: INSTRUCTIONS This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building~~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to:adjoining premises or public streets or areas, and g v ng a data led descr pt on of layout of property must be drawh an the diagram wi' ch s part Of'th e application. c. The work covered by this application may not be commenced before issuan¢~ of Building Permit. d. Upon approval of this application, the Building Inspector will issue o 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 or in port for any ~urpose whatever until a Certificate of Occupancy shotl have been granted by the Building inspector. APPL)CATION 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, Ne~ York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, o~* for removal or demolition, as herein described. The applicant agrees to comply with oil applicable lows, ordin.~an~ces, bu~p~g c?e..~c}?i~g code, an~J regulations. pturecf' ~.iS~ont, or npme, If.,a corporation) Address of/6ppllcant) State wh~et~her applic~owner, lesseej agent, architect, engineer, genliral contractor, eloctrlcian, plumber or builder. If applicant is a corporate, signature of duly a~ized officer. I. L~ation of land on which proposed work will be done. ~a~ No.: .............................. ?.~ ..... LatoNa.: ..................... x~ n~/ ~ 7~ ~ Municl~li~ 2. State e %. g use and occupancy of premises and intended u~e and occupancy of propos~ construction: O. Existing use and ~cupancy ......... ~.~.~,.~ · ...~ ................................................................ 3 Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............. Repair ............ ~'~emoval .................. Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cos~-....~......(-~.....C~....?. ................................... Fee .......................................................................................... , (to be paid on fi!lng this applic~j.en) 5. If dwelling, number of dwelling units.......,....../..........,..Number of dwelling units on each floor--; ........................... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, s,p if , re and ext n f e ' type of use ....~...~-~ ..... 7. Dimensions of oxis~ctures, if any: Front'. ....... ~ ..... Rear .............. Depth ...... Hei ht ,.,~....~.. ~..~.C~7... Nc her '~tori F~'7~ t ° g ..................... Plum or ~ es ...;..../,.~.,..,...-z;~.~~. ...................................................................................... Dimensionso~ ~ame stru.q.ture with alteratiozts~'c~:-addJtions: Front .................................... Rear ............................ ~'~ ~/~/> "-~ ' ' - · ~(~' ~J~--7 Number of Stones' 8. Dimensions,~,sn~re new constructiom Front ................. Rear ...~...~..(~.....f ......... Depth ........ ~....' ...... V. 0,'-- tor,es ..... ...................... ..................................... ,3 / 7' 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ] ]. Zone or use district in which~~pre/~ises a~e sitttg~ted ................. ~...' .............................. ~ ............................................ 19, Does proposed const 13. Name of Owner of premb~'~'~..~.f~..--..[.T....ZZ._;..t~ Phone No ..................... Nome of Contractor .77 ress .................................... Phone No.~...L...T...L.;..~ PLOT DIAGRAM Locate clearly and distinctly oll 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 street names and,,,indicate whether interior or corner Jot. /7~ ~ / ,'/-I.~,..5 c: f [ ' / ~ --'~ .... I STATE OF NEW(Y)ORI~ ~i~ OF ......... ,. ,,.,. ................................. k:~,',~, ...... ~. ....... ~ .................... be,ng duly sworn, d~oses and says that he i, the applicant (Name of ind~iduol signing appJicotion) above named. He is the ............................................. ~ .................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, an~ is duly ~u[horized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tk, a~ the work will be performed in the manner set fo~h in the application ~ted therewith. ~ Sworn to before me this ~ ~ ..... ~ / / ~/~ // ................ ,~' ........ :m ,>'~'"",¥ ~ ........ ~;, ........ r ~~..~.~.~::~ Z~ ~1~ ' ~ ~ I/~Z,, . ~,,~, ~, . ~ ~; ,.' .v._~ ...., ,v" .............. (Signature/"&~t"n~of ................................................ applicant) ~o,=~ .ub,~. ~'~'"~'~':'"'~'"'~,~,,,,, ~,z~....~,o. ~,,~,~,~,~,~/o, ~.~"'ZJ":'~'~,o,, ...... co..~ ..( [:::~. . ~o. 52.8125850 Suffo k On ~Te~m Expires M~rch 30, 1~