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Home My WebLink About4698-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No. z~661 ...... Date ........ .~.o.~ ..... 23 ......... , 197.3.. THIS CERTIFIES that the building located at . ¥~n. P~. & Acker. Zy. p.o.z~[ Street Map No...~c. ......... Block No....~c. ...... Lot No.. z. xz~ ... $o.llthg~-~ .... .~. ;.~; .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............Apr~2k.. P_~ 19.70. pursuant to which Building Permit No.. dated .......Apr.~.]... 22 ..... , 19. ?.0., was issued, and conforms to all of the require- ~._.~.._~.m. ents of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P~.~,va~e .ona .£am.~ly. &~e].~.lng ...................... ~ .............. The certificate is issued to . .Henry. ~ .Jea~l .Le.th~ ...... . .C)~n..e.r. $... .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....N. ;.R: ............................ UNDERWRITERS CERTIFICATE No.. p.e.n.d.:~, g ......................... HOUSE NUMBER ....1~9.7.2~ ..... Street .......................................... ............. Building Inspect!r FOB, M NO. "' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4698 Z Permission is hereby granted to: Ol~,da~.~..~..~..~....~..~ to ........ .~f;..A~...~!.:;~.~Lo..~....oA ..~...e. ~,~ ~..t.~.~.~.. ~.~.,:.e..;A~.~a .............................................. at premises located ct ................. ~J, il..3~;~[ ..................................................................................... ........................................................................... ~;o~thel& ...... &.~t ................................................ pur~uor4' to application dated ........................ ..~.J~:.l:..~...~. .......... .~..~.. ........ , 19 ........ , and approved by the Building Inspector. Approved ....................................... 19 ........ Permit No .... ~ ...... TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ~ Application No. ~/~' ~' er-- ~ Disapproved a/c ..................................... (Butldl~g~(.. -~.--t· ..................... AFPLICATION F°R BUILDING PERMIT- INSTRUCTIONS a. This application must be completely tilled in by typewriter Or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showi'ng location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a de,ailed description of layout of praporty must be drawn on the diagram which is p~rt of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Build_igg 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 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 pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, O~dirtances or Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as hereiln described. The applicant agrees to comply with all applicable laws, ord irmnces and regulations. (Signature of applicant, or name, if a corporation) ........ (Xddr;~' ;~/"c~3 ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises....~..~i~'. ....... / If applicant is a co~orate, signa~re of duly authoriz~ officer. ........ ..... ~ (Name and title of co~mte officer) 1. ~ation of land on which pr~ work will be ~ne. Map No: ............................................ ~ No: .................... St~t and Numar ....~..~.....~....~.t~.,..~...~'*~~..~.~ M~iciNIt~ ~ / 2. State existing u~ a~ ~cu~n~ 0f promises and intended u~ and ~cu~ncy of p~d c~t~ti~: a. ~l~,ng' u~ a~ ~c~an~ ......... ~.~~ .............................................................. · : .-. · -. 3. Nature of work (check which applicable): New Building .................... Addition ........ Repair .................... Removal ................... Demolition..; ................. Other Work (~)escribe) .................... 4. Estimated Cast ...... ~P'~I~. ............................................ Fee-~ ....................................................................................... " (to be paid on filing this application) 5. If dwelling, number of dwelling units ........../.. .................... Number of dwelling Units on each floor ............................ 6. If business, commercial or mixed occupancy, specify, nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: FrOnt ...... i.~...~..~.. ........... Rear ...... ..~...e. ......... ;.... Depth ...~.~ .................... Height ..... .~.~ .............. Number of Stories ..... ~./~.- ............................................................................................... ; Dimensions of same structure with alterations or additions: Front ........ .~...'~:... .............. Rear :....~ .................. 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 10. Dote of Purchase ........................................................ Name of Former Owner ........................... : ............................ 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction violate any zoning law, ordinance o,.,r,'regulation?.: .................................................. Name of Architect .............................. ~ ...................... Address. .......................................... ;Phone NO ..................... PLOT DIAGRAM ~ ~ . . , Locate clearly and distinctly all buildings, whether existing or proposed, and ind cote dl set~:~mk dimensions from property lines. Give street and block numbers or description according to deed, and show~ street names and"indlcote whether interior or corner lot. STATE OF NEW YORK, ) $ 8.' ..~.~//'/ COUNTY OF ............................ ) ............ ~.~.,~.;.,. :..~~s~....:,,.being ~ly sw~n, d~s ~and s~s that ~ is the applicant (ma~e OT inaiviaum sigmng ap~lic~f~/ ;' ' ,' able named. He is the~.~ ....... ~4.~.~ .......................... ~;; ...................... ~;..,;,: ........ : ...... '..[ ........................... (~ntractor, agent, co¢orofe officer, etc.) of said ~ner or ~nem, and is duly a~oriz~ to ~rferm ?~ h~ve pe~m~ the ~id ~grk a~ to make and file. this a~plication; that all statemen~ c~tained in this applicahon are-true to the ~ of his ~wl~e and belief; and that the work will be performed in the ~nner. set ~o~h n the application fil~ themwiJb. Sworn to he,re me this ' " ~,, Nota~ Public,