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Home My WebLink About5061-zFOKM ~0. 4 TOWN OF SOUTItOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z.~??.~. ...... Date ..... ! ......A~P.~.~.~...].~. ..... , 197.~.. THIS CERTIFIES that the building located at . .~f.$. D.~e.P. ~°-~..e. D.~. ....... Street Map No... :~ ....... ~lock No...~. ....... Lot No, ~....~f.~.t..t.~.~:~.~.., ?. :.~.. ........ conforms substantially to the Application for Building Permit here~fore filed in this office dated .............. N.o.~f,. 2.(~ 19 ~0. pursuant to which Building Permit No...~.Q.~.]~ dated .......... .N¢,Y.,..20 ...., 197.0.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .~.r.t.v.a..t.e..o.n.e..f.~.m..i~y...dv.e.l.~..i.ng ......... .............................. The certificate is issued to . J.~.o.~.a.r..d..B.: .I?.a.r.z.$..~1...~.~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.~.~..].~..~.~.~... ~..I~.,..~.~.~,.1.a. ....... UNDERWRITERS CERTIFICATE No..N.~.~.~.~.~.7 ..... ~?..~. ,..].?/..~ ................. HOUSE NUMBER .... ~6~.0 ..... Street ... I~eep. ~o~..D.~.V.~ ....... Building Inspector \ FOI~M NO, ~ TOWN OF $oUTHoLD BUILDIN~ TOWN cLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5061 Z Permission is hereby granted to: ...... '..:....:~...~..~.~.....~.,...,~.~. ......................... to ....... :.~..r~,~..~..~..~..~.~...L...: ...... ~i. ........................................................ at premises located at ........... ~,~..,..~.~.~.~O~lt,~.,,...~.,,:..~.i~.,......,..t....,,; ................. . .................... pursuon~ to ~pplication doted ............................. L.~.~. ~ ~..~,, 19.~ ;,: and OpproYed by Building Inspector. ' . : ; ~ , Fee ... .e. ......... :: i~: :~ :NEW YORK'BOARD OF FIRE UNDERWRITERS , BUREAU OF ELECTRICITY ~ ' ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~ ~ be~w ~ int~ by t~ appl~t ~m~ on ~ abr~ application numar in tB prem~s of ~:-:'~ ~?:H,,~L~c~e~n;E/S/of Oeeohole ~o~ 200~ s/o New S~ffolk Avenue, ~30 ~ 1976 ~ fou.d ~ be in compliance with the requirements of this B~rd. 4 Juli Elec. Co. Box 92 Brigh,wa,er's, L.. 11718 - - . ome~.~ This certificate must not be altered in any mcmner; return to the office of the I~oard if incorrect, inspectors may be identified i:~ their credentkzls. BUILI)ING DIPAIITMINT · TOWN CLERK'S OFRCI Approved/ ~ /I 19..~../.... Permit No.....~.~.gl .......... "~-/~/7~- ~ ~ ~ Disapproved a/c .............................................................................................. "~ '/'~-~~/~'' INSTRUCTIONS ~ a. This ~plication must be completely filled in by typewriter or in ink und submitted in duplk:~te to the Building Imi:~:tor. b. PI? .pi.an shc~.~ir~ I.oc.ation of lot 9.nd of bu.ildings on premises, relationship to adjatning promises m' .l~bliG Itreat~ m areal, aria gwmg a aeta,ea aescriptlon of layout of property must be drawn an the diagram whlch II ~ ef~JlM~lkatien. The week covered by this application may nat be commenced before issuance of Building Pem~; Jli ' Upon ppp.r?al of this application, the Building Impactor will lUue a Building Permit to the el:qldlea~t. ~$eh permit ;, t~ kept on tl~ premises ~tollable for In~oection throughout the progrell of the work. ' e. No building sl~all be occupied or used in whole or in part for any purpose whatever until a Ceffifl~lto of O~u~ancy shall have been gmntecl by the Building Inspector. _~ APPLICATION IS HEREBY MADE to the Building Department for the iuuance of a Building I~rmlt la~l~nt to RBUild!ng Zone OrsI. inance of ~ Town of Scmthoid, Suffolk County, New York, e. nd other al~ll~ble ~ ~egulatiom, for the construchon of bullding~, oddltlonl or ol.terotions, or for rer~v~l or demolition, el hl~lfl dllcribld. ne applicant ogrees to comply with all applicable laws, ordinances, building code, housing code, and IlgUldtlenL (Signature cf aPPlicant, or name, if a CmllXee(~m) 9 ~,~de~, ~ Levittown (Address of applicant) .State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eleotrlclan, plumlw, ar builder.I Name of owner of premises ..,~O~.~,~'.~..~.a...~..~.~.e..~ ........................................................................................................... If applicant is a corporate, s~gnature of duly authorized afflcor. (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done. Map No.: Street and tUum~-r . . .~./..S....D..e...e.]~...H.~!.e' ,.D..r.. Nattituck N.Y. · ' ..... ............................................ ...................................... 2. State existing use and occupancy of premises and Intended use and occupbncy of pmpased comtruotlon: a. Existing use and occupancy .....T.l~,~g~. ........................................................................................ b. Intended use and occupant, . ................ Qz~e...f.a~i~...~(e.~,l,~) .................................................................. 3. Nature of work (check which applicable): New Building ,..:[~MI;~... Addition .................. Alteration .............. Repair .................. Removal ....... ........... Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost ..'l-6.~0~.O ....................... ~,:...~ ............Fee ..... .1LQa.0.0 .............. j .......................................................... (to be paid on filing this application) 5. If dweUing, number of dwelling units ....~t~ ................ Number of dwelling units on each floor ............................ If garage, number of cars ................. ~QTAe .................................................................................... ~i...i ........ L~"." .......... 6. If business, commercial or mixed occuparicy; 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 ¢onstruction~ Front .~..! ....... i ....... ;~.~. ......Rear ~ Depth ....2..~.. ................ Height .................... Number of Stories ........ .O]:le. ...................................................................................................... 9. Size of lot: Front .....~..,0....: ........ ..... Rear ........ ..2..0...0. .................... Depth ...1,~/.....1~. .......... 10. Date of Purchase ........... .1~6~ ................................... Nome of Former Owner ........ ~...,.....~..~...]:..e...s..~..~ ....................... 11. Zone or use district in which premises are situated ....... ~L~....(L:LS~ ............................................................................ 12.' Does proposed construction violate any zoning law, ordinance or regulation? ..... D.O .................................................. 13. Name of Owner of premises ..~...~Rt.T:.s..~.~ ...........~....Address .....~e.v....t..~...~..o....~.. ............. '..... Phone No ..................... Name of Architect ...................................................... Address .................................. :.....:... Phone No ..................... Nome of Contractor ..... ~.~Li~e ...................................... Address ........................................... *. Phone No. · PLOT DIAGRAM · ,: Locate Clearly and distinctly all buildings, whether existing or proposed~ and indicate all set-bock dimensions from property lines. Give street and block number or description accOrding to deed, and show street names and indicate interior or corner lot. .~, STATE OF NEW, YORK., COUNTY OF ..~.,.~...].?....-!~.. ............. )'~'"' ................................. J~Ot/,~:fil......TL~LZ'.~IB,13, .............................. ~ing duly sworn, d~es and says t~t he is the applicant (Name of individual signing appficati~) above named. He is the ....................... ~ ............................................................. '~ ........................................................ ~ (Contractor, agar, co~r~e officer, etc.) of said owner or owners, and is duly authorized to pedorm or h~e perfo~ed the ~id work and to ~ke and file this application; that all statements contained Jn this application are tree to the best of his knowl~ge and belief; and that the work will be perfo~ed in the manner set fo~h Jn the applicati~ fil~ ther~ith. SWam to ~fore me ~is .............. 20 ,.~ of . .~ . . ..... ....... ................ Notaw Public,~~.~.. Cou~l~j (Signa~re of applicant) ~ NOTA;~'~[~, ~,, 0, New York term ~xpires ~rch ~ SUFFOLK COUNTY HEALTH DEFARTS{ENT ~ ~'~-/VC/~--- --- ~ ~.~ JAN 1 6 1973 O- Chief of General ~gineerin~ . ~ Se~tce~ ' ~ i ~.. · t~ATH a.~tlo