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Home My WebLink About5670-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy ............ Date .............. &ugus~;' ~.~ i · ', 19 '73' No. 5670Z THIS CERTIFIES that the building located at · · '~sayvls~r 'Dr' &' 'C~lex .Lan~reet Map No. C~ax'd'~a¥ · · Block No. 'XX ....... Lot No. · '~2S' '~ -1~ .................... ~nforms ~n~lly to the Application for Building Permit heretofore filed in this office . ~,.~l~ted .......... D~c'.' '~;' '" 19.~.. pursuant to which Building Permit No. ~6'7~ ' · ~. dated ...... :" 'DEC'.' '~.6; .... , 197~..., was issued, and conforms to ail of the require- ments of the aPplicable provisions of the law. The occupancy for which this certificate is issued is . g~'~:vat~ 'on~' 'fam:L'ly' dwell:Lng ....................................... The certificate is issued to .. SamueL' 'Frey ........................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approvai .. ~0-.983 ..DLt~d. ~tuq.. UNDER~ITERS CERT~ICATE No ............ ~g ......................... HOUSE NUMBER '60" ......... Strut ~ 'D~e' ~' '1~8S' 'C~-~e .... ...................... " ..................... East' ~o~i 'N'.Y; ............... ........ ...... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE i SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BI~ KEPT' ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL No. 5670 Z Permission is hereby granted to: ...J?~ea..S~aa~a....a~..S~a~l..~ay ......... pursuar~t to application dated .................................. ])~.'.-~..-'i-'", 19...,~., and approved by the Building Inspector. Fee $...~.~.~.~. .......... mu.aing inspector j $.~$ Examined .D.~mhe~. ....... ~.6,....., 19...21. ................................... ~ ~ / , 19 ~2'~Pemit No ................................... ~ ~ ;70 ~-- Approved Disapproved a/c ]~0,g,...~i,t...~e~clJ, x~g...~.,~..v.~,~Z~ng.e .......... .... ........... APPLICATION FOR "UILDING PERMIT FORM NO, 1 TOWN OF SOUTHOLD ./,~/~/~/~ ~, ~.~ :!BUILDING DEPARTMENT ~OWN CLERK'S OFFICE SOUTHOLD, N.Y. ~ ~4 ~ · ,icat,on .............. INSTRUCTIONS a. 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 afl" areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which s part of th s application.~ c. The wore 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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, ordinances, building code, housing code, and regulations, Frederick Gordon (Signature of applicant, or nome, if a corporation) Greenoort N.Y. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buiJder.~n · ..Contractor Name of owner of premises ,~,amu~l, ~.~.e.7. ............................ · If applicant is a corporate, signature of duly authorized officer. T ~- '~' o (Name and title of corporate officer) 1. a o Gard Bay. secI 25 &126 Location of land on which proposed work will be dor.~ N .: ...................................... :[at NI;~ ......................... Street and Number .~e.~.~.e~...~..&..~,ecl~'.;,u=.~z~e..(Ave.).... ~.t..}~,~..~.~)rt: ......................................... ~o ~ / ~ ~ M~.,c,~},~ ~ate existing ~e and ~ncy of premiss a~ intended use and ~cupancy of pr~osed c~stmcti~: a. ~isiti~ ~ a~ ~cupancy v~c~D~ ~ b. Intended use and ~c~y ........ .Q~..~.~...~e:.Z~ .......................................................................... 3. Nature of work (check icoble): New ~Building ..,T~Z~ ........ ion .................. Alterat~6n .................. Repair .................. Removal .................. DemOlition .................. Other Work (Describe) Estimated Cost ................... .bcS. t.0.O0.....~ .................. Fee ...... .1.:0~.Q0 ........................................................................ (to be paid on filing this application) If dwelling, number of dwelling units ..... ~zle, ............... Number of dwelling units on each floor ............................ If garage, number of cars ...... o~e ............................................. ; .......................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... ; ...................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of soma structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............... .~..~ ................ Rear ....~ ................... Depth ....~0.../....1.~ .... Height .................... Number of Stories .~TLe. ............................................................................................................. Size of lot: Front ............................ Rear .................................... Depth ................................ Dote of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are s~tuated ......... ~L~....CL;;LS.t, .......................................................................... Does proposed construction violate any zoning law, ordinance or regulation.;) ,T:.~,5. ......................................... Name of Owner of premises ..S.o-.~'~.e.~ ..................... Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~..~....G...~..O~L .............................. Address ......G]:~e~0e~.t. ................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock dimensions from cE number or description according to deed, and show street names and indicate 10. 11. 12. 13. property lines. Give street and bi whether interior or comer lot. STATE OF NEW" YORK, ! S S COUNTY OF ...$.~t~'~.o..].~ ............ J' ' ............................... ~.I'.~.~.:~&c~...G~cl.orl. .......................... being duly sworn, deposes and soys't~t he is the opl icon~ (Name of individual signing application) above named. He is the ............................ ~.U. fZL~.I:: ........................................................................................................... (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 contained in this application are true to the best of his knowledge and belief; and ~ha~ the work will be performed in the manner set forth in the oltplicatJon filed therewith· /I wom to before me this I~ IJ . /1 ,,"'~,11 ...... ............ .......... ELIZABETH ANN NEVfLLE · ' NOTARy PUBLIC, State of New York No. 52-8Z25850, Suffolk Cougt~ Term Expires aarc~i~z,g~..~=~.; ~