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Home My WebLink About4970-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z~..~3.~. ...... Date ................ &ugus~...13, 19..71 THIS CERTIFIES that the building located at .N/$. ~a~..t..Road, .(pv.~).... Street Map No.. ~ ........ Block No..~ ....... Lot No. conforms subst~ti~ly to the Application for BuildMg Permit heretofore ffl~ in this office dated .......... Sep~... 25.., 19.7~ p~suant to which BuildMg Permit No. dated ............ Se. pt... ~, 197~., was issued, and conforms to ~1 of the requ~e- ments of the applicable provisions of ~e law. The occup~cy for which this ce~ificate issued ~ .. ~.~$V~%.~. 02~..f~llY. ~ell~g ..................................... The certificate is issued to .. 0~.to. L~de~yer ..... 0~ ........................ (owner, lessee or ten,t) of the ~ores&d buHding. Suffolk Cowry Department of Health Approval .~,2.* .............................. House ~ 2025 Hyatt Rd N. ....... ~;n~' I~pecto;'' '[ ....... TOWN OF sOUTHOLD BUILDING DEPARTMENT! TOWN CLERK'S OFFICE r $OUTHOLD, N. Y, BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 4970 Z Permission is hereby granted to: ~ ...... a, ..~,a~L .a,~..:~.~.../~.~. to ........ ~aa~a...aa..~u~..,L.~..~,~ :. ~-!~.~....-..~~ ........ at premises located at ..... /.....~'~.~..~;~,~.,.~,~ ....................................... pursucm¢ to application dated .............................. tJ~ .............. ~,~. , 19 .... ~ and approved by the ~ -'-- uRuildinn Insnect'or. ' ' ' ~ ' ..... · or soUwaoc ~UILDIN~ DEPARTMEN? TOWN CLeRK'~ OFPlC! SOUTHOLD, No ¥o Approved ........................................ , ]9 ........ Permit No .... Disappro~ a/c ......................................................................... APPLICATION FOR IUILDING PERMI~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted In d~plicate to the Building Inspector. b. Plot plan showing location of lot and of bu.ildings on premises, relationship to adjoining premlees or public streets or areas, and giving a de,ailed description of layout of property must be drawn en the diagram whlch Is port of ~hle application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permi'te*,~ 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 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 Building Permit punmont to the~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appllaoble Laws, Ordinances or Regulations, for the construction of buildings, additions or al.rotations or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. Robt. HTatt (Signature cf applicant, or name, If a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................ Cnn~.a~t o~. ............................................................................................................................. Name of owner of premises ......... .O...~.~.o.....~....;~..d...e.~'..e.?. ..................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) .H.y, att O.D.~L. xxx 1. Location of land on which proposed work will be done. Map No.: ...................................... Lot No.: ....................... Street and Number ........... ~.~.~..~.~c~.~-P.]~.`~D.~.Q~L~.~.~.~.1~.~1~;}.~-~- ......................... g~'~*'~u?~ I ~7 ~ Municipality 2. State existin a,nd occupancy of premises and intended use and occupancy of propaeed construction: a. Existing use and occupancy ....... .cl...~.~,~,~g, ........................................................................................................ b. Intended use and occupan:', . .....................ae~e..v~.~..en..~d&~.~,o~ ........................................................ 3. Nature of wo~k (check which applicable): New Building .................. Addition ......31~ ....... Alteration ~ .......... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost .... ~...c~J~.. ...................................... Fee ....~...e.~ ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... O~e .......... Number of dwelling units on each floor ......................... If garage, number of cars ............................................................................................................................................. 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 same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size at: lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... .~!~.."....~,1,~.t;. ........................................................................... 12. Does proposed cor~structlon violate any zoning law, ordinance or regulation? -...rig ................................................... 13. Name of Owrer of premises .Q.t[;.~...~,,I~.~..~.~..~.~,~.~.:~.Address ....... ~.f~.13,.1;~.~.~ ................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..... ~.~....~.~..~..~..~ ........................... Address ....... ..~.g.1~,.t~,~ ................. Phone No .................... 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 street names and indicate interior or corner Jot. STATE OF NEW_YORK, !-- 'COUNTY OF ...~.1~'~.0~.........;..I~' ........................................... .~be,~.~...~r&t,.t, ........................ being duly sworn, deposes and says t~t he is the applicant (Name of individual signing application) above named. He is the ............................... ~O~&O.~. ........................................ 'J ........................................................ (Contractor, ag~t, co~orate officer, ~c.) of said owner or owners, and is duly authorized to pe~orm or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this application are tree to the ~st of his knowledge and ~lief; a~d that the work will be performed in the manner set fodh in the application filed ther~ith. ...... : ............. .............. . m - / ~0. 52-3233~20 Suffolk Coun~ ~e~ ~ires ~rch 30, [~ f