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Home My WebLink About4628-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z382~ ...... Date ............ June...8 ....... , 19 .70- THIS CERTIFIES that the building located at -14a~l.-Road. ................ Street Map No.. X~ ........ Block No...~,w ..... Lot No.. ':11~ ...... l~utho2;d' ' N';¥~ ...... confoms substantially to the Application for Building Permit heretofore filed in this office dated .......... Feb .... 26 ·., 19. ?0 pursuant to which Building Permit No..br628Z. dated ............ Feb .... 2~" 19. ?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 .... Bus~meslr 'bUfLlrlLUg ..... Basle 'of£:~ce .............................. The certificate is issued to . North' F~rk. t~ank. ~k 'Trust' 'ao ....... 0w~el* ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approvai ..... N~R',' .......................... l ouse 1,970 · 0~ NO. ~ TO~N O~ $O~T~OL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4628 Z Permission is hereby granted to: at premises located at .................... ~/l~......~.tli,~. ]~ ..................................................................... .................................................................... 1t~ ......... li,,~,, ..................................................... pursuc~t to application dated .................................. ;~ ...... ~ ....., 19....~1~i and approved by the Building Inspector. Building Inspector FORI~ NO. 1 Approved ..................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........... , 19 ........ Permit No .......................... Apphcahon No ..~....~.').'~..~. APPLICATION FOR BUILDING PERMIT Date ............... ~,~ .'~....~ ~.... INSTRUCTIONS o This opphcotion must be completeJy f,Hed in by typewriter or in ink and submitted in duphcote to the BulJdin, Inspector. b Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or pubhc streets o areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of th~s application c The work covered by this opphcot~on may not be commenced before ~ssucnce of Build,ng Permit d Upon approval of this apphcation, the Building Inspector wdl issue o Building Permit to the apphcont Such permi shall be kept on the premises available for ;nspect~on throughout the progress of the work e No building shall be occupied or used in whole or in part for any purpose whatever untd o Cerhficate of Occupanc shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Deportment for the issuance of a Budding Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buddings, additions or alterot,ons, or for removal or demolition, as herein described The apphcant agrees to comply with all applicable lows, ordinances, budding code, housing code, and regulahons State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde~ ...................... Name of owner of premises ....... If opplicg~ is a corpor~e,~nature o.f_,duly authorized officer ............ (Name and t~tl/e of corpi~te o 'cer) 1 Location of land on which proposed work w~ll be done Map No . Lot No Street and Number ................. J~k.t~ ...... ~..~...O~1~ ............................... ...~.t::~kJ.~b~.~,,.l~.. ...... ~' ~7/~'7 '7' ~ Munic,pality 2 State existing use and occupancy of premtses and intended use and occupancy of proposed construction a Ex,sting use and occupancy ............... ...~J~ J~.~.~ ........................................................ b Intended use and occupancy ............. ~ I~..~..~..~ ......................................................... 3 Nature of work (check which applicable). New Budding ............... Add~hon ............... Alteration Repatr .................. Removal .................. Demohhon ................ .~ther Work (Describe) ................................. 4 Estimated Cost .................. .~,...: ................................. Fee ....~.....~..'.~.]'.. ........................................................ · (to be po~d on filing this opphcahon) 5 If dwelhng, number of dwelling un,ts ............................ Number of dwelhng un,ts on each floor ....................... If garage, number of cars ............................................................................................................................................ 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of useC.~.~.~,¢m.~~ 7. Dimensions of exishng structures, if any: Front ............................ Rear ................................ Depth ................... He,ght ........................ Number of Stories ......................................................................................................... D~mensions of same structure with olterot,ons or additions: Front .............................. Rear ...................... Depth ................................ Height ........................ Number of Stones ................................ 8. Dimensions of enhre new construction: Front ..................................Rear ............................ Depth .............. Height .................... Number of Stories ............................................................................... 9 S,ze of lot: Front ............................ Rear ...................... Depth ........ 10 Date of Purchase .............................................. Name of Former Owner ........................................... 11 Zone or use d~strict in which premises are s~tuated ......................................................................................... 12 Does proposed construchon violate any zoning Iow, ordinance or regulahonP .......................... 13 Name of Owner of premisesN~.'~.l~..~.....~l~ ............. Address .. I~/~../~.'~.~.~.~,/..~ ........ Phone Nc~.~.8..'..~.$.(~..~ Name of Architect ......... ~ ................ Address ~ Phone No ..... ~..;.~..; Name of Contractor ~t..L'~..[~_~.~.J.~.~,..~t~..Address ~.~..I.~,.~twl~'~.l~.V.¢~.~ .... Phone No PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~sting or proposed, and red,cate aH set-back d~mens~ons fro~ property hnes Gwe street and block number or description according to deed, and show street names and indicat whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ~.I.~.¢¢.-.~.~.~ ........ ......................... ~.LI~g.t~O....~.~.,.L~-~,I~.~....~.I~ , . being duly sworn, deposes and says that he ,s the apphca, (Name of mdw~dual s~gning apphcahon) above named He ,s the .................................... .~.~.~,~4.~,.....~.~.~'..~.~'.1~.~_.. ........................................... (Contractor, agent, corporate officer, otc ) of sa~d owner or owners, and is duly authorized to perform or have performed the said work end to make and fi this application, that all statements contained ~n th~s apphcat~on are true to the best of h~s knowledge and behef, ar tha~ the work wdl be performed in the manner set forth in the application filed therewith. Sworn ~;o before me this l-~CT'~R'~ PUBLI~' ? ,~e of New ¥'or~ ................. J~F~,IDIN~ IN ,:,~F .)LK COUNTY No. ~2-~' ,590C ~,~..~ (~emmSsslon Exp:~ March $~ .......