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Home My WebLink About4722-zFORM NO. 4 TOWN OF $OUTHOLD BUff,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..z1+2.52 ..... Date ............... t,i~... 28 .... , lg.~.l. THIS CERTIFIES that the building located at .8/tk. ~lason .D1, ............ Street Map No...ga.s.e.n. .... Block No...]~. ....... Lot No.....x~X .... .C~l.t.c.h.~[ .~... N.:y: ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .Ap~.l.. 28, 19. ?.~ pursuant to which Building Permit No .... dated ............ .~p. lT~.!' .2.8.., 197.0.., 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 . Pr. ira.re, cna .fairly. d~elling ....................................... The certificate is issued to .l/ar. tin. &.Caf, herine .Bakkan .... /)w~era ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health ApprovalAl~r.i.1 .. ?. '$97~'' .by. t~, .Vi.tla ...... Underwriters gert..~_l~8397668 i / ............ { .......... 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) 4722 Z Permission is hereby granted to: ........ ~.~..s.~.t ..~.e.........~.~.....~...t.~.~....~t~s~ ~mam at premises located at ............ .~....~..........~...~...,1~,,..~.?.. ................................................................................ ................................................................. .C..~ ............... ~.:.~.~. ................................................. pursuant' to application dated ..................... ~,~ ......... ~. ........... , 19...~.0, and approved by the Building Inspector. ~ ~l~ll~l~t, IIIl~ll~J~t~ ~ lle~I II~t~I el~l ~:ee $ ........................ Building Inspector I APPLICATIOn' ~OR BU/LDING INSTRU~.'rlONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspec~r. b. Plot plan showing l~catlon of l~t and of buildings o n premises, relati~dmhip to adjoining premises or public streets or areas, and giving a detailed descriptior~ of lay out of prope~y must be drawn on the diagram which is part of this application. c. The work covered by this application may n~t be commenced before issuance of Building Permit. d.' Upon approval of this application, the BUilding inspector will issue a Buildin~g 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 o~ in part f~e any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Ins APPLICATION IS I-IEi~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of SouthOld, Suffolk Oounty, New York, and other applicable Laws, Ordinances or Regrllations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as h~rein described. The applicant agrees to comply with all applicable laws, ordinan~ces, building e0de, housing code, and re~ula, ions. .~.~.~ L~. b.~.~e~b2~(' x (Signature of applicant, or name if a corporation) x ..... (Address ef applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................................................................................................... Name of owner of premises .... ~/~.lt .~. 1~ .~?.. ~ ~.,~.~ ¢.,...~....~.~ .~..~.et<t. t~. ¢. ~.¢..~..~. ............... ~ If applicant is a 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 6.'..o..~..a/2/~ ~,~, ~,~.p.. ,.,. ,~./~.., ~...4tf'~'p.,q'../~.~ .,. Oe ~.¢~. p. ql.C/. ~., ........... ~tate existing use and occupancy o~ premises an d intended u~e and occupancy of prol~6ed construction. a. Existing use and occupancy .................................................................... b. Intended u~e .and occupancy .../....,~. ~..~..-...~..e..~/. t~t.~.C f.~ .................................... 3. Nature of work (check which applicable): New Building . ..~.... Addition ........ Alteration ........ Repair ......... Rem,oval ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cast ....~./.~t.~.~ .-.~. 0 ........... Fee ............................................ (to be paid on filing this application) 5. If ,dwelling, number of dwelling units .6.~..~-~ .... Number of dwelling units on each floor . ~.~..~. ........ If garage, number of cars .. A ~1 .~... 6. If business, commercial or mixed occupancy, spec ify nature a~d extent of each type of use .............. 7. Dimensions of existing structures, ff 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: Fron'~ .... ~} ~ ........ Rear .... '~.~. ...... Dept)l . .~..~. ....... Height ~..~. Number of Stories ~)~.-~.o,~¢1'a¢~..~..~.~.,o'.~. F.~o,~). ~tl,~/.~'~lg7 9. Sine of lot. Front ..... ~'~. ~.. .....Rear . ../-/ ........... Depth . ..~ .~/~ ....... 10. Date of Purchase . .J:~...~7. ~..;{ .?.?.? ...... Name of Former Owner . .~.~..~...~/~.~;.~.~: .~. ...... 11. Zone or use district in which premises are situated .................................................... ~2.' Does proposed construction viola'~e any zoning law, ordinance or regulatiotn? ........................... 13. Name of Ownerof premise&~/~.~. ~{~t~..~ ..... .&ddress ~ .~(~¢/,4,~..1~..~-:. Phone No~.~.?/.:.'~..o.? ~ Name of Architect t~ .. ~ddress ~ Phone No. ~' N~trne 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 s .treet and block number or description acoording to deed, and show street names and indicate whether interior or corner lot. ST*T )S.S. cOUnTY ........ OF _ ................ :~,-~,.,~/~. . being duly sworn, deposes and says that he is the appli- " (Na,,,~ ~. individuol signing application) cant above named. He is the ............ z$~?~) .................................................... (Oontractor, agent, corporate officer, etc.) of said owner:or oWners,'and is duly authoNzed to perform or hav~ perftormed the said work and to make and file this application; that all statements eontained in this application are true to the best of his knowledge and belief; and that the work will be p~ed in the manner set fortlf in the application filed therewith. Sworn to before me this 52.8125850, Suffolk S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. Ohiof of General En~inmmr~ n District Engineer !q plumb~rig E L EMz~ T / O fV PLAN F-?A M lNG ~ D tA C~ f?A M , ",PL 'O'OR:. '"PLA N Io'g' ,PL.O T PLAN ' F ~_0 _.N_._T_CuL._¥ V_ '~_T_ / q_N