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Home My WebLink About5326-zPOEM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte OI Occupnncy THIS CERTIFIES that the building located at ]l&ll~l&~ .PC~..R~.~ ....... Street Map No. N&sS..1~.. Block No ........... Lot No.. ~ .... ~h~e .... N~ ..... conforms subst~tially to the Application for B~lding Pemit heretofore filed ~ t~s office dated ......... ~...~ ..... , 19.7~. p~uant to which B~ld~g Pemit No .... ~ dated ............ ~..~.., 19.7.1-, was issue, ~d co~orms to ~l of the req~ men~ of the applicable pro~sions of the law. The occup~cy for which this ce~ffica~ ~ issued ~ ....~$V$~. ~9~a~. ~Pg~. ~. ~r~$~.~$..~PP~..~ The certificate is ~sued to .8~h. ~.*..~ ...... ~9~ ......................... (o~er, lessee or ten~t) of the Mores&d b~l~g. Suffo~ Co~ty Dep~tment of Heal~ Approv~ ·. N~, ........... .................. ......... ........... FORM NO. ~ TOWN OF SOUTHOLD i BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 53~6 Z Permission is hereby granted to: ............ r?.....~o~,~ee...~ ....................................... ............ O~z'Ct~e'a" e:t¢'~ ....... ~'~.~.....+l.~f0 ....... to .. J~L.~-r~. a~.~e~t"~...l~J,l,~ J,~g.....~..(.g.~r.~.~.~ ..~..~.~.~ ~ ............................... .............. (~pFr~ver~,.-J~...~-.-A~,~e~t ....... ~..~-~j..-1.9.~$-) ....................................................... at premises located at ' . ......... · ~e~'-6~.....~tt.. ~e:L,l~ '~-..~"~p ..................................................... ...................................... ~./.~...~.,..~**s..n.~...?~..t... ~..o..,.~ ......... .c..~..e..h.e.~..e.: ......... ~....~.** ..................... pursuan,t to application dated .......................... ~ .......................... , ic).~J..., and approved by the Building Inspector. A. M. BEHRBR: 7 BARNES IA. NB -GARDEN CITY, g l,~ ~L _ ,~1500 FO'I~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ , 19 ........ ~ ApI Approved .~.~. ................... ~ , 19..~Z.. Pemit No ..................................... Disopprov'ed o/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT · i' INSTRiJCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot p.lan showing location of lot and of buildings on premises, relationship to adjoining premises Or public streets or are'as, and giving a detailed description of layout ofproperty 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 msue a Building Permit to the applicant. Such permit shall be kept on the prem. ises available for inspection throughout the progress of the work. e. No ..building shall be occupied or used Jn whole or in part for any purpose whatever until a Certificate'al. Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of c Building Permit pursuant to the Building Zone Ordinance of the Town of So}lefiold, Suffolk ,County, New York, and other appl cab e Laws, Ordinances or Regulations, fo, r the construction of buildinils, additions or aterat ons, or for remova or demo tion, as herein described. The applicant/~grees to comply with all applicable laws` ordinance_s, btiildir~g cede, housing code, and regulations. (S~n~p~re of applica~ name, if ~ c~ ;~)'~tZo-or;~'L ..... Stote~hether applicant ~S owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bui der. Ff aoplicant is a corporate, signature of duly authorized officer. land on wh ch r osea '"or" ' .... '"~ )~,~ ~'~7 ~ ' Location of. ' P pp ~_~ ~ w~,~e og_~. Map 'No~. ........ ~. ............................. LOtJ~...J~l~'~... Street and ~ber~:~ ................. N~....~.~........~....~........:..L.~.~..~..~...~"iiii" Municipality ., . ..... f,, State existing use and occupancy of premises and intended use and occupancy of proposed construction: ? a. Exisiting use and occupancy .,.&~-~;.~,':r.I~I.~..~...E ............. ,' ................................ b. Intended use and occupancy ..... a~;~'~. ....... . .~...~,.II~,~..S.~~.~i.~..~. ................. 3. Nature of work (check which apl: e): New Building. .~........ ....... Additi ................ Alteration ................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. t,mated Cost .............. .. ............. l:ee .................................................................................. (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, sp,~cify natyre and extent ~f 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 ....... ~,.~...C .................Rear ...............~.....~ ...... Depth .....~....~.. ........... Hmght ,..../.~.. ........ --__,~sNumber. of Stones .... ~ ............. ~ ......................v'"', ...... ~, .................................................. 9. Size of lot: Front .,~,~..~...-.. ........ Rear ......... i.../....~?...~...~. ......... Depth ...~.....~..,.~.. ............... 10. Date of Purchase~.~.~.'~...Z~..~..,~.. ....................... Nome of Former Owner ............... ~..~:..~.....~.. ............. ] 1. Zone or use district in which premises ore situated ...A .................................... ~, .................................................. 12. Does proposed construction vi,~ate any zg~:lin~q law, ordinance or regulation? ...~..~... ........................................... ".. 13. Name of Owner of premises~/'4~)~....~..:.~....~...J~ress .7. L~,~~.~.../-~ No..~..L..~...~...~.....~ r.~_~'~ ~ ~ CITY/I~ .......... Nome af Architect ..Z ........ ' .......................................... Address ............................................ Pl~o-n~ Na ..................... Nome af Contractor .................................................... Address ............................................ Plane Na ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions 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 NEW )i',~J~-,,~ ,4 ~ ~ 1. c c ' COUNTY Of ...~y/'~.~_.~..c/.. ...... ...... ~~./~I~,~E/I~.~ ................................... being duly sworn, deposes and says thor, he is the applicant (Name of individuaLsigning app,[i~atic~)., above named. ,~te is the .....~..~....~...~..~.]..... ................................................................................................ .. (Contractor, agent, corporate officer, etc.) , and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contoined in this application are true to the best of his knowledge and belief; and that the work.will be perfgmp.ed in the manner set forth in the application'.~d therewith. Sworn to bej[q~ me this ~7~ ............ day o, .................. .,. ...... , ~ ~ ~ ~ · ,n ............... ..~I...~...~...~....~.~..c~...~ ..................... Notary Pu~~w.'/ditC.....~e~.~./... County (Signature of applicant) uah led in NassaU countY Q 't' _ ,,arch 30. t97~ CommiSSiOn ~cxpires