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Home My WebLink About4672-zFOJRM NO. 4 TOWN OF SOUTHOLI BUILDING DEPARTMENT Town Clerk's Office Southold, No Y. Certificate Of Occupancy THIS CERTIFIES that the building located at t~e. el~. D.I~,. 14Qo8o..~r,. D.e.?r~t~ett Map No..~9o.~ .~9~Block No ........... Lot No. ~... ~h~...~., ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated .............. !P~l.. ,619 .~Q pursuant to whidh Building Permit No. dated ......... AI~il...~ .... , 19.70., was issued, an~ conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P~I?~..Ogg. ~}~l~ .~$.~l~g ......... '. ............................ The certificate is issued to . DoB~d. &. ~al~:.iZ. ~a~t ...... ~egZ ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.. ............................. Deerfoot Path f~/~;~, (f 25 Moose T~ll ...... Building Inspector '/' Path PORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP, J~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4672 z Permission is hereby granted to: ............. g. or~¢...~.~ ........................................ ............. Beei, e..~. ............................................... to .......... ~b~u~ ..m~.&d~L:Lt ~Lc~..~..e ~c:L~t ~3~ .. d~:e~.:L34~ ................................................... ................... .(..alab..&..~a~.t~.~et...e~let~..lat~) ............................................... at premises located at .............. ~b~e..~&Ve. ........... ~,O~-.~)....~l~tlll..~ ........................... ..................................................... ~lm~.~...~i'~ ....................................................................... pursuant to application dated ............................. ,i,]~=,.~r3' .......... 6 ...... , 19....~G and approved by the Building Inspector. TOWN OF ~OUTHOLD . BUILDING DEPARTMENT'S//'//~ TOWN CLERK~OFFICE ~ ~'*-.,~. ,, ,~, N. Y. b=mine ........... ~.~.~ ............. , A~li~tion No ~.~ A~ed ........................................ , 19 ........ Pe~it No ............................. Di~pp~ a/c ...................................................... ........................... {8 ,a ng .................... ....... APPLICATION FOR BUILDING PERMIT - April 6 7~ / Date ............................................................ , 19.....~._~ , INSTRUCTIONS ~ ~ ~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises oO~ tP~ibslic streets o~ areas, and giving a detailed description of layout of property must be drawn on the diagram which ~s port 's 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 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 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 Bu Id ng 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, housing code, and regulations, Yalerie Card ........ i'i¥ '; ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................... P...'~1..~.~. .................... . Nome of owner of premises ....... .V~l,~e~l:te...~c..~D.o~n ~,~. ....... C~.~rl ..................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) .~,7,_~ 0 / ~ 1. Location of land On which proposecl work will be done. Map No.: ............ ~oo.se...C~e.... Lot No.: ........................ .............. .C tchogua Street and Number ..~.~:.~;~ .... ~_q _/e/g O~'Z-~ ~R:'~ ,/_... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~],~.J~ ....................................................................................................... b. Intended use and occupancy ........... ~a~e...1~t:h..~.Lt.t,l~e..~4~,~,g~..Gll...~&i:a.. ......................................... 3. Nature of work (check which applicable): New Bu ding .....~. ......... Addition .................. Alteration .................. Repair .................. RemOval .................. Demolition .................. Other Work (Describe) ....~.c~.e,~o.~.~- .............. 4. Estimated Cost ............................................................ Fee .,~.,.~.0. ............................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ 9.~.~ .............. Number of dwelling units on each floor ............................ If garage, number of cars ............ 4)['~ ......................................................................................................................... 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 ..... .1.~. ................. Depth ......... ~). ......... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ t 1. Zone or use district in which premises are situated ......... !.l~.~.~...fil.~.~. ........................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ 4.. ............................................. 13. Name of Owner of premises ...T~o~a~,..C~Z. rl ............ Address ........ ~tl~§~'. ............ i Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ 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 whether interior or corner lot. .............. , ......................................................................... .... ~1.1'~'1~. (~.~1"~ . . · ~in0 duly ~worn, d~oses ond s~y~ t~l h~ ~bove homed. He is the ........................... ~ .................................................................................................................. (Controctor, ~o~t, co~omt~ officer, o{ sold ownor or owners, and is duly outhori~ed to pot{otto or hov~ p~rfo~ th~ ~id work and to thi* opplicotion; thor oll ~totemont~ contoined in thi, ppplication ore tru~ to th~ best of hi~ knowl~d~* ~nd b~li~{; ond tho~ the work will bo performed in th~ manner ~t {o~h in th~ ppplicafion' fil~ thor~ith. Sworn to b~{or~ m* thi~ ................. 6.... day of ........ ~x~ ................... , ~....~0 ~ / ~. '. ~ ~, ,t ~ ~ [I.~ 'l)__.ne ' ~~ ..~.~ · ....... ....... ............................ ~ARY pUBLiC, State of New York No. 52-8125850, Suffolk Co.ti ~erm ~ires March ~,