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Home My WebLink About5436-zFOIL,M[ NO. 4 TOWN OF $OUTHOLD B[TTT,T)ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~-~3.~7 ...... Date .. AlISl~t .6~ ............... , 1973k. THIS CERTIFIES that the building located at Pi~111;Ill .ROtlA .l~J. .......... Street Map No .... [ ....... Block Ho .... lC ......Lot No ..... l~l~l~ MIId,QIIs. ~eZs ......... conforms substantially to the Application for Building Permit heretofore ~ed in this office dated .......... J. lil,y. ~0t.., 19 .~. pursuant to which Building Permit No. ~36~.' ~ dated .......... =T..lll4r. 30s..., 19.7],, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .l~.'el.&t4. ,t,lll~etJ[~:l~'..(lt, o;['~l~$ .]l~d,~[t.l~) ............................ The certificate is issued to ...~ .t~...~.e...~..~...e~... ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department oI Health Approval .................................... UNDERWRITERS CERTIFICATE No. ~ ................................... HOUSE NUMBER . .l..~). ......... Street . .PI*..i.V.a..t.S...~.ail. ~. ~, ...................... .............................................. ............. Building Inspecto/ FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TH£ PREMISE~ COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 5i36 Z Permission is hereby granted to: ......... g,~ ..~, ,.. ~.q~ ha.~. ., .......... ........... · ~.,-.~'t. ............................ r ................. to ..... b,~.. ~..~ ~e '~'~' ~L~i~..~ at premises located at ......... ]~'~..~q~i,...,.~i~4""~[/i~"~i~"~ .................................................. ............................................. ~.~..k~.~ ........... ~,~'~ ................................................................... pursuon,t to application dated ................................. *I'~'~F ....... ~--'", Building Inspector. Fee $ ...~.~'.~.~ ........... 19...~'~., and approved by the Examined BUIU)IN~ DEPARTMENT TOWN CLERK'S OfFiCE b. Plot plan showing location of lot and of buildings on prem ses, relationship to adjoining pmmki~ or public streets or~ areas, and girl .no a detail .e~l d~. riptlon of layout of property must be drawn on the diagram whlch Is rt of this Ilcation ¢ The . pa . app · work covered by this appllcotion rn~y not be commenced before issu~ce of Build no Perm t _d....Upon. app..r?al of .this application_, the Building Impectar will Issue a Bul d ng Permit t~,d~e naDllcant. Such hermit snan na Kept on me premtses ava,able tar Ir~pection throughout the pragre~ of the work. -- r---.. ~,~ 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. RB ,A. ,P.P]-I_C~'IOt~ i!S HEREI~,Y.M~,DE to the Building Department for the issuance of a Building Permit pursuant to the~ The a---licant .......... , ...... no~.: ~ t.om or a!.remTions,,~r ..mr rem?at or ~m611tl0~, oJ herein described. ~ P~, uv~ m comp,y WITh an appncaam taws, oratnances, Dulldtng coae, houslno cable, and regulatiOns ~,gnature of applicant, or name, If a corgoraflon) State whether applicant is owner, lessee, agent, amhltect, engineer, general cOntractor, electrician, plumber or builder. ...... ~.~..~.~.~ ........................................................................ .......................................................................................... ,am. o~ o~*r o* ~reml, C~ ~ ~.= ~,~ If oP:::~:, Is a corparote, signature of du~ outhel'!,ed officer. .......... ................... ' ' I. L°catlon of land on whlch progosed work. wlll be done. MopNo.: ......................... LotNo.: ........................ 2.State existing use and occupancy of premises and Intended use and occupancy of pmpMed construction: a. Existing use and occupancy ........ ~. ~ntended use and occu~n¢'~'......~'..~.~..~ ................................ i ..... APPLICATION FOR BUILDING PERM, I~ , INSTRUCTIONS a. This application must be completely filled In by typewriter or in ink and submitted in duplicate to the Buil~ Inspactor. g Approved ........................................ , 19 ........ Permit No ............. I~..4. .......... Disapproved a/c . - ........................... (Building I~r) ~ .................... 3. Nature of work (check which applicable): New Building ~.../~. .......... A~ldition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................................................. Z,...,..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 ........................................................................................ 4.,:, .............................................. 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 same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ / ,, _~ / 8. Dimensions of entire new construction: Front ....,...J..~. .....................Rear ........ ~...~. ............. Depth ........................ Hmght ........~ .......Number o{ S~ori~ ................................................................................................ , .......... 9. Size of lot: Front ...... g.~.r...~..?. ........ Rear ........... .R~..'....~....'~.. ......... Depth ...... /.l..~.~..~.~... ......... ' - - 10. Date of Purchase ..... ..'~...~.~..~...~..:T....~..R~..~. .......... Nome of Former Owner e~.~.~,~.,~.~.C.~-.~,..~..~...~..~..~..~...~..../~ · 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zonina law, ordinance or Fegulatlon? '"'Z ...................................................... 13. Name of Owner of premises ~..~,~.%....~/~'~4.Address ~Lc~.~m.~flG/~.~.~t~.,I/~!?.~hone No. ~..~.2.T./..~..?-. O Name of Architect ................... ; .................................. Address ............................................ Phone No ..................... r. Address ............................................ Phone No ..................... Name of Contractor ....................................... ~ ,te cleariy"~nd diStinctly all buildings; ~hether m lines. Give~ street and bl°Ck/n~ber or descrip nterlor or. cOmer lot. -~' , . ~ ,~.~,-Z~.~ / whether IlAGRAM sting or propo~cl, and Indicate all sat-back dimensions from tion according to deed, and show street names and Indicate F. O ''/ STATE NEW COUNTY L ............ ,.....being duly sworn, depoees'and saye that he ~ of Individual signing application) above named. He is the ............... , ............. ~.....~..~.../~ ............................................... ':~. ....................................................... (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 be~t of hll knowledge and belief; and that the work will be performed in the manner ~et forth In the application filed therewith Swam to before me this ~ . ..... o_,,. ..................... ,.. Notary Publ,c,k~4~..G~-~-~t~J~.,.... County c~ ~'~'~4~ (Signature of ' ~- '/ELIZABETH kN~ pl~:Vltg~/, , ' / ;. NOTARY pUBLI6.:S~te of New Yot~ , No. 52-8t25850, ~lk,_Coun_ty. T~rm Expires M~I~"~O, 19,:1~