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Home My WebLink About4682-zFOBM NO. 4* TOWN OF SOUTHOLD BU~.DING DEPARTM~.NT Town Clerk's Of[ice Southold, N. Y. Certificete Of Occupancy No. 2~6368 ....... Date ............ .~le, rCh...1~ ..... , 19.7..~. THIS CERTIFIES that the building located at . .~c~ln~s. Road. ............. Street Map No... xx ....... Block No ....xx ....Lot No. zxz...Q~ler~t.. ~...Y., ............ conforms substantially to the Application for Buflcling Permit heretofore filed in thJ.~ office dated ............Al~r~...1.L~ 19.70. pursuant to which Bufldlng Permit No..1+682Z. dated .......Ap~.f.1...11~ ..... , 19.7~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thJ, certificate is issued is .. Pr. iw.t.~ .o~e..fe~.l~. ~I~ l~ ..................................... The certificate is issued to ,1~..r..~. ?..r?..J.o..s.e.~.h...G.l.o.r..~.a ...... . .C~..e.r..s ................ (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval ?..a?... ~. 3.. ?. ~7~....by..~.....7.~.1..1.a .... UNDERWRITERS CERTIFICATE No..p.e.n.d..~.g ................................... HOUSE NUMBER. 600 ......... Street .... ¥o~n~s · Roed ......................... Building Inspector FORiVl NO. ~ TOWH OF $OUTHOLD BUILDING DrPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER/9,1T (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? ~682 Z Permission is hereby granted to: · .(~.,...D~.Zaw~l;t....AZfT...,T,a~.~la..~$e~.~. ..... pursuan¢ to application dated .................... ~l~,~.J,~ ......... ].~ ........ ....., 19..~.~., and approved by the Building Inspector, ~:ee ~;.J.O.....~. ......... SCHD SUFFOLK COUNTY DEPAHTHENT OF HEALTH ~ I $ ~7 Bid;. Feruit No. TO ~HOH IT HAY CONCERN: The sewase disposal fac~lities for a structure 0 (Give deed local,.on) ' located have b~en inspected by this department and found to be satisfactory, lVLaR '1 ~ 1075 · Chief of General Engineering TOW. O~ ~T.O~. BUILDING ~PARTMENT TOWN CLERK'S OFFICE MUTH~D, N.Y. /~/7~ Approved ........................................ , 19 ........ Permit No ......... Disapproved a/c Application No ....................... (Building inspector) / APPLICATION FOR~ BUILDING PERMIT .... , INSTRUCTIONS o. 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 or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this applica- tion. c. The work covered by'this application may not be comnhenced 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 pa rt 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 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 alterations, or for removal or demolition as herein described. The appl cant agrees to comply w th al appl cab e laws, ord nonces and regu arians. (Signature of applicant, or name, if o corporation) (Addr~sof applicant) / Sto(e whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises ......~..,..~(....)dl*a~.~....~ Name of If applicant is o corporate, signature of duly autho'rl'zed'' 'oFficer. ..................................................... 1. Location ofland on which proposed work will be done. Map No.: Lot No.: ......./~....L ....... 600 .............................................................................................Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. /%__ o. Ex s.ng use and occupancy ....... .......................................... : ......... b. ,n,de u. iP" 3. Nature of work (check which applicable): New-Bui.lding ~......~. .......... Adc~ition .................. Alteration .,.i:..~ ......... Repair .................. Removal .................. Demolition .................. Other Work (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 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 of lot: Front ..... /.~Z//.. ............ Rear ..... /......~... .................. Depth ...,~.~ .............. 10. Date of Purchase ....... ~U'"'~/"/'"'~"~ .................../r-~ . ~ ~- ~ ~Narn~, of Farrier Owner .~~~..~~. 11. Zone or use district in wh,ch premises are Situated..J.~.~...~f~...~..~ 12. Does proposed construction violate any zo~Jn, gJaw, ordinance or re~ulat~ion? _. ......... .~......~....~ ~ .................................. 13. NameofOwnerofpremLses_~f~...t?...~....../...~..~ddress ..... ~;../?. ~...~.. ..... PhoneNo Name of Architect ...~~~.,.. Address ....... ~ ..................................... Phone No ................... Name of Co tractor .__~ Address ,.,...~.,, Phone No PLOT DIAGRAM Locdte clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. / STATE OF NEW YORK, ,I ~ q COUNTY OF ............................ ) ~'°' ....... ~...~en~.~ ................... .....being duly sworn, deposes and says that he is the applicant (Name of indivTdua] signing application) above named. He is the ................................................... ~,~.e::¢~. ................................................................... (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 and file this application; that oil statements contained in this application are true to the best of his knowledge a=nd belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...... o, ...... ................ . _ .................... Notary Public ~' ~{~ Pu~~ ~0~unty/'/~~ (Signature of applJcain,) '" ?e~m I~xpires M~rch 30.