The URL can be used to link to this page

Home My WebLink About4608-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z .~923 .... Date ............ Dee .... ~;. ......., 19.72 THIS CERTIFIES that the building located at .. $/.8. Ma. Sa. Road .......... Street Map No... xx ..... ~. Block No. xx ....... Lot No.. xxx.. ~u. tchogue.. N.,Y, ........ conforms substantially to the Application for Building Permit heretofore filed in this office ~608Z Dec 12 69 pursuant to which Building Permit No. ~66~Z' dated .... D'~' ' '~'~ ......... , 19 71' ' dated .Ja~... 2~ ......... 19 ?0 · Dec__~ ., .~., 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 . .Accessor.~. storage..bu~.ld, Sa~ .&. wldit~on, t~ .sam~ ................ The certificate is issued to ...Th®o..Klos ...... Owner ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ~l..y(, ........................... UNDERWRITERS CERTIFICATE No ..... .... N,R, .................................... HOUSE NUMBER.37~.70 ...... Street .... l~.~n .Road .................................. 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) No. ~1608 Z Permission is hereby granted to: to ...~lA.ae~..amems~;l~..~~ .................................................................................. ot premises ~o~ted ot .................... ~tl....~.am,~l ...................................................................... ................................ , ........................... ~remd, e ........... Z~e ............................................................. pursuan¢ to apphcation dated ........................... i~.~It~ ...... ~ ............. , 19....~) and approved by the Building Inspector. TOWN OF SOUTHOU) BUILDIN~ D~PARTMIrNT ~N CLERK'S OFFICE ~OUTHOU), N. ¥. Approved ........................................ , l~ ........ Permit ~o ............................. Di~pp~oved a/c ....... ~ .............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat plan showing location of lot end of buildings on premises, relationship to adjoining p.remises or public streets or areas, and giving o detailed description of Ioyout of property must be drown on the diogram which is part of thi.~ applico~ tion. 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 issuq a Building Permit to the applicant. Such permit shall be kept on the premises aveiloble for inspection throughout the progress of thi work. e. No building shall be occupied or used in whole or in pa rt f~or any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE t? the Building Department for the issuance of a Build!ng Permit pursu.ant to the Building Zone Ordinance of the Town of Southold, .Suffolk C. ourRy, New York, and other ,ppph.c..a. ble La .ws, Oral, .nanc.es, or Regu ations for the construction of buildings, additions, alterations, or mr removat or aemofirion, as nerein aescrJoea. The applicant agrees to comply with all.applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nan~ of owner of Premises ~...../.....~/.....-~..... ................................................................................................ If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ...................... Street and Number ...~ ....... ~ ........................................................................................................... ~ , _~'~' _ Municipality ' 5'7 a .... b Intended use and occupancy ~ ..................................................................... ' 3. Nature of work (check which applicable): New 'Dl~ildin~J-'.: .................. Addition .................. Alteration .................. Repair .................. Rems, a! ..... ~ ........... Demolition ................... Other Work (Describe) - .................. 4. Estimated Cost ............................................................ ~i. Fee ...J ............ ,,,~.~'...-'~.. .............................................. (tobe 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 nat~ure and extent of each ~pe of use ~~" 7. D mens ons of ex st ng structures, f any' Front ~ Rear z,/Jj r~, ~ d 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 ~2. ,~. ' ~- ' .. . ............................................................ Depth ...... ~ .................. / Height ......... ./.~. .............. NiJrnber of Stories .............................. 9. Size lot: Front ......... Rear .......... ............. Depth .....'/"'~'^"'~u, x/ ~,----- _~, ........ ~' '~' .......... · -('../....~/......'{....~.. ......................... Name of Former Owner .~..~..'..../..?...~ .... 10. Date of Purchase 11. Zone or use district in which premises are situated: ................................................. ~-~ ............................................. 12. Does proposed construction viola, te~any,zonina ]aw ordnance or renulatinn~, 13. :Name of Owner of premisas~ ~.~./..'~ ..... Address ..~..~.../..~ ....... Phone No?...'/.~.:'.~..~.~,~j~ Name of Architect ................................................. Address.~ .,~ ~~ ............................. Phone No.........'"'~. ......... of Contractor~ ~i ............. Address ./.~.~ ..~-f~...,..~... Phone Name PLOT DIAGRAM '~'~' ~ Loca~e clearly and distinctly all buildings, whether existing or proposed, a'~l .in~Jicote all set-bock 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, ) COUNTY OF ............................ ) S.S. ................................................................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing applJcatiot~)' above named. He is the .......................................................................... (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 all. statements..ceniained,-in this application are true.'~o.'d~e, best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me ~this .......................... ~./'"'-,,~"~.~ .~- .' '"' '""('~'""~)¥A~C. ~ate of' New York 'g PP' ) ::~ ~ ':~.~'~,.~,, '~ No. 52-3233120 Suffolk " Term Expires ~ch 30, 1~'~