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Home My WebLink About5454-zNO. 4 TOWN OF $OUTHOLD BUTLBING DEPARTM~,NT Town Clerk's O~ce $outhold, N. Y. Certificate Of Occupancy No. Z~3~ 6 Date Jaly 26 19 73 2~ ~ Foua~h Street THIS CERTIFIES that the building located at ............................ Street Map No....8.6.1. ...... Block No ........... Lot No...6.~..8~.. .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ?..u.~..~.~.. ~ ........... , 19.??., was issued, and eonfoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private One Family ~eell~ag a~ Aeeelll~l? ~l~tld~ The certificate is issued to MI', & Mrm. Daniel & K~th].ee~ Ke~h (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Pendi~ UNDF, RWI~ITERS C~RTIFICATE No ............................................. HOUSE NUMBER 21~ Street Fourth Street~ Laurel~ N.Y. FOEM HO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5454 Z Permission is hereby granted to: ......... .-~ad, e;t,. & .,lr~eea.....~el~, ........... to ~.~.-~t~-~.-~~-~~ .............................................................. at premises located at ...... ~tt--~r..-4~[.~-~-~ ...... , .................................................................. ................................................. ~v,*d~-et ......... ~.-..l~g~ ......................................................... pursuan~ to application dated ............................ ~ll~'"'~ ............... , 19..~j~j., and approved by the Building Inspector. Fee $.~. ............. Examined .. // , ........ ... Approved ........................................ , FOILM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.~/.. Application No......~'..?...~..~... ............ 19 ........ Pemit No .................................... Disapproved a/c ~" '~'"~'~' ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........... ~ ...... .~....., 19...Z,~... INSTRUCTIONS 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 ofpraperty must be drawn on the diagram which is part of this application. 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 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 part for any purpose whatever until o 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 or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordi nonces, building cede, housing code, and regulations. ............................. ~e,~ ~ / ~77c e °f applicant,~9~z name, if a c°rp°rati°n) .... ........ ........ ....................................... State whether applicant is owner, lessee, agent, architect, engineer, general contract~'r, electrician, plumber or builder. Nome of owner of premises ~.~Tr~..l~...~.. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. location of land on which~p~raposed~w/~rk will be done~ Map No.: ...... .~...~..../. ...................... Lot No .~...~.....~'....'~...~... Street and Number ....~.."~. ........ ..~.......~....~ ........ ~ .-'.~...~ ............ ~ ! ~ ! Municipality ........ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ExisitJng use and occupancy ............................ 4' ............ : .................. '~'"~..~...J..~ ........................... b. Intended use and occupancy ...... ~.~.~i ...... ~"'~'-~ .......... ..~"....~..~.....~..~.. 3. Nature of work (check which applicable): New Building .... ~ ............. Addition .................. Alteration ........... .[ .... Repair .................. Rem~gval ................Demo t or,. Other Work (Descr be) ~i~.~...~..~.-~.0.~,..~ 4. Estimated Cost ..... ~...~....~.....-~...O...~.. ................... Fee ............ : .............................. ~...~. ~..~'~.O~..~'_'J..~...c'~.. (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 eac_._h type of use ............................ 7. Dimensions~f 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 ~,~ S~ries ...................................................................................................................... ................................ .F.. Depth ...... 9. Size of lot: Front ..... .......J~.~......7. Rear 10. Date of Purchase ........................................................ Name of Former Owner ~ ~j1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;> ........................................................... 13. Name of Owner of Premises~f~...~/..~`~...7.~.~.~..~~...~....6~..~.~.:..~..~`~.~..~..z~//~/~~.~.~.~ O ~ - Name °f C°ntraCt°r '~'~':~'Z'~'"~'"'g~O'{'~"~'"l'Addmss ~' "'~"'~'"'~" '~'~4Z'~ p~ne N~'~'I~'~ ~Name of Architect ................... i .............................. .t..A~ress ............................................/Phone No ................... (~ PLOT DIAGRAM joLocate clearly ond distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from perry lines. Give street and block number or description occording to deed, and show street homes and nd cote ether interior or corner lot. STATE OF NEW ~)Rl~i~, ,,~/ ~.~- ,, COUNTY OF ..~ ......... ................. ~~...'".'...~.~ ...................... ~,ng duly ,orn, d~s and sa. t~ he ,, the applicant ~ame of individual s~gning ap~cation) , o,e n, ed. H, i, th, ........ ......... (~ntmctor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e pe~o~ed the ~id work and to ~ke and file this application; that all statements contained in this application am tree to the best of his ~owledge and belief; and that the work will be performed in the manner ~t fo~h in the ~plicati~ fil~ therewith. Sworn to ~fore me this ~ ....... N~a~ Public,~~.~~oun~ ~~ (S~r, o~pplicant) ...................... ~ New York/ pUBL C. State of N0~AR~ ~t25s~ Sut elk Cou~