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Home My WebLink About5163-zFORM NO. 4 TOWN OF SOUTHOLD BUNchING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. ~-~81 ..... Date . .JlO~r. 25 ................. , 19.73. THIS CERTIFIES that the building located at .. ~0~. F~C,~ala .~ ...... Street Map No .... 1~4~1 · · · Block No ........... Lot No... 8 .............................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . .F~la-'~ .3,2 ........... , 19..71 pursuant to which Building Permit No.. dated . .~aZ'o~ .3.2 ............ , 19..71. was issued, and conforms to aH of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... P~Vat~ .0m~ .I~. D~L1A~ .................................... The certificate is issued to ...... i~l,llm .Fo~tel'. ~X ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .............. ]~ olk, ................. UNDERWRITERS CERTIFICATE No ....................... N.,~, ................. HOUSE NUMBER . ~~... Street... MaCa~ .La~ .~'~maVo~.~;~. ~]~, ..... .... ......... Building Inspector~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Sou'rHOLD, N. Y. BUILDING PERMIT ' (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5163 Z Permission is hereby granted to: ',Building~ . . inspector. ~. ,...~...,.,~ ........... at premises I~cated at ...: ....... ~[..~.....]~[tl, lt.[e~..~]BO.~/llL .............................................................. ............ ' ..................................... ~lleC~a~..I~ .............. ~eealme~ .................................................... pgrsuan,t to application dated .............................. ~lL!E.,.,..12 ............ , 19..,..7.1l and approved by the Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFI4:E SOUTHOLD, No Yo Approved ........................................ , 19 ........ Permit No ...................... Disapproved a/c . .¢ ......... - APPLICATION FOR BUILDING PERMrT Date .......... ,.~...~..e.b .. ~2 19 71 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot pi.an sho. win~. I.oc.ation of lot ,a.nd of buildings on premises, re ationship to adjoining premises or public streets or areas, aha giving a detailea aescriptlon or ,ayout at praperty 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 sha I 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 RB_uil.d.~_n,g.. Zon,e O.r,dinance. oft. he To,? .o,f..Southol. d/..Suffolk C. ounty, New york, and other app !cab · Laws, Ordinances or ~-9u,a[,ons, tar me construction Or oui,a,ngs, aaa t~ons or a terations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ~~'-. Jeseph Diaz I ,,L.,.,'~T,_ --"~ ............. ...~. ~ AV~ ....................... ............. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................. ~t~C.~;~. ................... . ............ Name of owner of premises .......... is a corporate, signature of duly authorized If applicant officer. (Name and title 'of corporate officer) 1. Location of land on Which proposed work will be done. Map No.: ....]~,l~.~,~,~..~_.}LLot No.: ..... ~ .......... ....~ Street and Number ........ ~/.~..l{~_~__n_.,.LaI~ ...... /~ / - / ~' ~ ~' ~uniclpallty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: nd occu n -" a. Existing use a pa c~.....x~.~...~L~r~.. ........................... ~ ................................................. b. Intended and ,.' - ~' ...... use occupanc ........CL~ ..., ,~,.~.~x...~ ~ .~..~,,~.~ ......... 3. Nature of work (check which applicable): New Building ~.....3~.... Addition ....... ~ ..... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .........6'.~0~ ...................................... 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 oocupancy~ 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 same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............. ~.~ .................. Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............. ~....~ia~ .................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~; ........................................... 13. Name of Owner of premises ...T~m,..~e~,~...]~TT...Address ............ I~.~e.e]3~#~.~ .......... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~T. D:L~ -,, Gz'ee~ez't .................................................... ~aaress ............................................ Phone No ..................... PLOT DIAGRAM ' 'Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set.back dimensions from p.m~..rty~ I'.m~. Give street and block number or description according to deed, and show street names and Indicate wnemer inrerlor or comer ~ot. STATE OF NEW COUNTY OF ................................ ............................................... · ]'~al~]~..]~].~ ....................... being duly ~orn, depase$ and says that he Is the applicant (Name of individual signing application) above named. He is the ................................ ~1~1~,~,~1~ ....................................... ';; ....................................................... (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 thaz the work will be performed In the manner set forth in the application flied therewith. Swam to before me this ..................... · ta P '~ P~/~"- - ~ '~/-~' [ ~-~ - J }- ' /]/~ ..... .~..x~...~~ ................ T~. 52-8125~50, Soffolk Couflt~ w~m Expires M~re)t BO, 197__.~