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Home My WebLink About5633-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No...:~5't1.~8 .... Date ....... Seirl;emher '19'~ ...... ' 19'73' THIS CERTIFIES that the building located at '680 '~I~son 'Drive ......... Street Map No.. 'XX ........ Block No .... iX ..... Lot No..iX. Otltohog~e .................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ]{ova' '1'6i ....... , 1973.. pursuant to which Building Permit No..~0~.~z. dated ..... 'Nov~' '1'8i ........, 19.71., was issued, and conforms to all of the require- ~-'~-'~'m~nts of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Pzd. v~te. sccessory(~tora~e).-tm,t-]ding ............................. The certificate is issued to . l~artit~ .Bal~.cen ....................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · I~,'R~ .............................. UNDERWRITERS CERTIFICATE No...~I'oR., ........................................... HOUSE NUMBER ..... 6~0 .... Street.. i~aSOD 'D~';[VO ................................. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5633 Z Permission is hereby granted to: Building inspector. pursuc~t to application dated ................................ ~lJl~.....~t~l~ .......... , 19..:.~l, and approved by the · ( ' Building Inspector, 7-5 Examined ............. , 19 ........ Approved ........................................ , 19 ........ Pemit No. ~'-[ '~ ~ ~ FOIr, M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c Date ............ ///]. ~ ...................... , 19.~..L ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink ond submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings ~ premises, relationship to adjoining premises or public streets or areas, an.d 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 tot'he 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 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, ordinances, building code, housing code, and regulations. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... b.4~../~.....~......~..e~.¢..~..},.~...~-.~...._~.~.~.l~./~ ...................................................... If applicant is a corporate, signature of duly authorized officer. (Signature of applicant, or name, if a corporation) ....... ................... (Address of applicant) g (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...t .......................... Let No ........... Street and Number ......... ~..~..~....~.~.$..e..~.......~..(~.< ...... C~..~...f,,~g..~....(:..., ........................................ u Municipality State existing use and Occupancy of premises and intended use and occupancY of proposed construction: a. Exisitinguse~ndoccupancy ~. ~./~1./.~/ ~'.£,t~.~c~- ........... b. Intended use and occupancy ....... ~J ...... ~ ................................................................................ 3. Nature of work (check which applicable): New Building ................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...........~..~.~...~ ........................... Fee .......................................................................................... (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 a.nd extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..........~,~ ........... Rear ......... .~¢...~'.. .............. Depth ....3'......'~... ....... Height ........ /..~. .......... Number of StOries ..... ~u~..l~. ............................................................................................. Dimensions of same structure with alterations or additions: Front .......... .~. ....................... Rear ............................ Depth ............................. '... Height ............................ Number of Stories .d...~..~.; .............. Rear ...... .'].. .................. Depth ....Z.~.. ............. 8. Dimensions of entire new construction: Front .............. ~ .................. Height ......~..0..{ ...... Number of Stories ....~..~ ..................................................................................................... 0( 9. Size of lot: Front ....:...-Z..~'. .............. Rear ...... ..~...~.. ..................... Depth .....~.....~. .................... ]0. Date of Purchase ..... ~.~..~......~... ................................ Name of Former Owner ....~.~...~.~.J..~ ................................... ] ]. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ..~.~.~.~.1.~/..~.~...l~.._~.l~....~Address .4~..0.,~/~.[~.~....~)//_ ........ Phone Name of Architect ...................... ,,"*!' ............................. Address ............ ~../.~.~l, 6,Jl.~...;.~,~.....,~. Phone No ................. J... Name of Contractor .................................................... Address Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimen~'ns from. property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. - STATE OF N EW.._yo, D,.I(., ! L~ ), c c COUN~ OF .~.~ ........... ~'~ ............... ~i~.~.TL" ....... ~..K.~. ........................... being duly sworn, d~oses and says that he is the applicant (Name of individual signing a~lication) above named. He is the ...................~.~.~.~ ................................................................................................................... (Contractor, agent, corporate officer, etc.) of said ~ner or owners, and is duly authorized to perform or h~e performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and ~at the work will be performed in the manner set fo~h in the application filed therewi~. Swom~o before me this . ~o. $2-812585~, Suffolk Term'Expire~ ~rch ~, i~