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Home My WebLink About5172-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. g098 .. Date . .Apr,il.. 23 , 19.~'3 THIS CERTIFIES that the building located at Gillette Dr . Street Map No.I~triola P,a_~o~Iock No. .. Lot No.. 62 East Marion conforms substantially to the Application for Building Permit heretofore filed in this office dated . l~r ].8 · , 19 ~.1 pursuant to which Building Permit No. ~] 72Z dated .. 14aly . 18 , 19 7]., 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 Private. oho fataily dwelt, tnl~ .......................... The certificate is issued to Johri Ducal ... Owrie~ ........ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No ItOUSI:NUMBER ~.~ Street Oi!!eSte D~ Btuldmg Inspcctt~r 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) N? 5172 Z Permission is hereby granted to: .... ~.,... ~,,~a.L ...,L.'~.....,T.elm...~lta. L1. ........... pursuc~* to application dated .............................. ~..~. ..... .I,.~. ............. , 19.~..~.., and approved by the Building Inspector. Fee $..a~.,e,{~. ............ FORM NO. I 'rO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, bi. Y. ...... " " " 3"'/7 Z Approved ........................................ , 19 ........ Permit No ............................. APPLICATION FOR BUILDING PERMIT March 1 8 ~71.:... Date ............................................................ , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Bu,ldir Inspector. b. Plot plan showing location of lot and of bu_ildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn cn the diagram which is part of this applicatio 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 pert; 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 Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY N~kDE to the Building Department for the issuance of a Building Permit pursuant to tJ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. George Bauer (Signature of applicant, o~ name, if a corporation) Main Road S outhold (Address of applicant) State whether applicant is owner, lessee, agent, architect, englnHr, general contractor, electrician, plumber or build- ................,,..,,................ .~~n~r~c~t~r. ............................................................................................................................... Name of owner of premises ,.,,~1~'~,~,~ ..................................................................................................................... If applicant Is a corporate, signature of duly authorized officer, (Name and title'of corporate officer) F ~ b 3 3 1. Location of land on which proposed work will be done. Map No.: Marion Manor Lot No.: 62 Street and Number ..G.:~,,e.,l~,~.~, Dr ~,e.,,~,~ I,:ario~ ~.Y. ,~"7 ~ ~ Municipality 2. State existing use and occupancy of premises and Intended use and occupancy of proposed construction: dwe ~ng ............................... a. Existing use and occupancy ................. ~F ....................................................................... b. Intended use and occupanc,', ......... .~,0,~.,,e,.,~..12,.,~,,~,~,t~.;1,,9~ ........................................................................ 3 Nature of wotk (check whici~ applicable): New Budding .................. Addihon ...~ ..... Alteration .... Repair .................. Removal ................. Demohtion ................ Other Work (Describe) ................................. 4 Estimated Cost .... .~.~.QQ.Q.. + ...................................... Fee ...~..*.Q.Q ...................................................................... (to be pa~d an f~'ing th~s apphcat~on) 5 If dwelling, number of dwelling units ....... ~ ............. Number of dwelhng umts on each floor ........................... If garage, number of cars ............................................................................................................................................ 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use .......................... 7 Dimensions of e×ist:ng structures, if any: F~ont ........................... Rear ............................... Depth ................... Height ....................... Number of Ston~ ................................................................................................................ D:mensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height .......................... Number of Stories ........................ 8. Dimensions of entire new construction: Front ............ .1.2 ................... Rear ........ J..2. .............. Depth ......... ]..2. ....... Height ................... Number of Stories ........ ~ ........................................................................ 9. Size of lot Front ....... ]..0..0.. ............ Rear ................................ Depth ...1..2..~. ............. 10. Date of Purchase ....................................................... Name of Former Owner .................................................... ! 1. Zone or use &strict m which premises are s,tuated ........ !!~-!!..~..~; ................................................................... 12. Does proposed construct;on ~iotate any zoning law, ordinance or regulohon? ............ ~ ..................................... i3 Name of Owner of premises ...... .~.o...D.~e~'l .............. Address .......~., ..~a.Z'J. Ot~ ............ Phone No .................. Name of Architect ..................................................... Address .......................................... Phone No .................. Nome of Contractor ...CT.t....~...a..~...e..z'. ............................... Address ....~.9..~..~.~...°.~.~.. ................. Phone No .................... PLOT DIAGRAM Locate clearly and dmtmctly all buddings, whether existing or proposed, and mdmate all set-back d,mensmns from property hnes. Give street and block number or descript,on according to deed, and show street names and indica,e whether ;nterior or corner Jot. STATE OF NEW YORK, t. ~, COUNTY OF ..~Itff. ook ............. .~o.o. ...................................... ~eo~e...~e~. ............... be,rig duly sworn, deposes and says that he ,s the apphcan (Name of indwidual s,gning apphcat,on) above named. He ,s the ...................C..Q~.~,Q.~.Q~'. ............................................................................................................. (Contractor, agent, corporate off,cer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the sa,d work and to make and rd: this application; that all statements contained in th,s applicot,on are true to the best of his knowledge and belief, an~ that the work will be performed in the manner set forth ~n the applicatioT~ filed therewith Sworn to before me this , (/ 1~ da,, of ........... .%~.~.e...h ........ ]~..2J. 7x _ ~ ~ //~,' ,~ _ ....................... .......... . ' . .............. .... lXlotae, Public,~.~~~. County~~ (~t~re of applicant) No 52 8]25850, Sulfolk Count,/ Term £xmres ,~arch 30,