The URL can be used to link to this page

Home My WebLink About6306-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMRNT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy No. Z~5~6 ...... Date ........ 0c~ober .18~ ....... , 19.. 73 THIS CERTIFIES that the building located at .... l~in. :Road ............. Street Map No... ~G~ ....... Bloek No... XX ..... Lot No..X~ .... So~thol~L ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Dec....22, .... , 1972. pursuant to which Building Pemit No.. 6.~06z. dated ........ Dec,..22, ..... , 19..~.2, was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ~r.~,va.te. acoessoz~, bu$1d~ng.I.Boat..sto~ege) ....................... The certificate is issued to .. W.:l, ll:l.a~n .H,..Lleb~.e~n~..Pol, t. of..Egypt ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... I~,R, ............................ UNDERWRITERS CERTIFICATE No....N. ,.R.., ..................................... HOUSE NUMBER ...~.2.0.0.0.. ~ ~ .......................................... 3outhold ......... FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6306 Z Permission is hereby granted to: ..... ~ .q x'.~ ...~.~...~ g~.t, ........................................... ........ ~ ~.u~,,h ~.1.4.....~. ,:~., ....................................... ~o ...~!.a...,n.e.~..~.9.~.~....s..t.,o.,~.~.e.....b..u...i.~.~,n.~ .............................................................................. at premises located at .......S./.,~....~,~,Ln..~to,~l, ................................................................................... Southold N .Y · pursuant to application dated ........................... D. ec.....22 ............ , 19.~2.., and approved by the Building Inspector. Fee $. ~.Q · ~.Q ........... Building Inspector ( FOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............................................................................................ ~ (Building InspectS) APPLICATION FOR BUILDING PERMIT ^pplJcotion No. g 3 g ~/ Dote .~-c. 2. Z- 7 Z...-- ,,INSTRUCTIONS a. This application must be completely filled in by? 'tYpewriter-- or in ink and submitted in triplicate to the Building Inspector. witl~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b; Plot plan showing,location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on 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 the premises available for inspection throughout 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 bed{n 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, Suffoik County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bu[Idings, 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (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. .............. ......................................................................................................................... Name of owner of premises ..... .~..~.~I~..T.. ...... ..~....F........~..-~....~..~./~.....7~........~....~.....~_.. ..................................................... If app~ic,a~n} is a corporate, signa~re o~ d~ly authorized officer. .... ....... ....... ~ Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No.......................................Lot No ......................... Street and Number ........... .~....~..~....~......~.~.~......~...{~.~..~...~.. ...... ~...~.:.. ...................................................... ~ ~ ~ o c) Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ..~....D...~?..Z~.....~..~...&..~.....~.....~.../.~'~....~-..6~... .............................................. b. Intended use and occupancy ~...~....~.. ,-~...7~....~...~...6:~- ..~...~.J~t/~-- .............. 3. Nature of wdrk {che~k which applicable): New Building ...... .~.....~.. ....... Addition .......~ ....... Alteration ............... Repair ............. Removal.. ............. ... .. .. ... Demolition ........................ Other Work .............................. ............ {Description) 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 ..... ~ .................................................. ~,.-; ........................................................................... 6. If business, commercial or mixed occuoanc¥, specify nature and extent of each type of use .~.~...~....~...~J~.~...~..... / / Rear ..../..t3t~ .............. Depth ....... /...~...4~...~ ............... 7. Dimensions of existing structures, if any: Front ....-/~.(~1. ....... 3~! .. Number of Stories ............................................ ... ....... ... -.... · .. · Height .................................................. Dimensions of same structure with alterations or additions: Front ......... L~...~. ....... Rear ........ ~.~..~,2 .................... Depth ......... ~,.~--,.~'-... ..................... Height .............. ~..(~). .................. Number of Stories ............/. ......................... 8. Dimensions of entire new construction: Front ...... /J~...~. ....... Rear .......... /.¢~...~.. ...... Depth ......~7...~.. .................. Height ................... ~-~..(~. .................... Number of Stories ......................... ../. ............................................................. 9. Size of lot: Front ......... /..~,(~ ................... Rear .......... L~...~... ................... Depth ........ ../~'.~. .............. ,. ................ ?o . ///4. ..... 10. Date of Purchase ....... ~.~.l.~¢...~/. ............ Name of Former ~w~n~r "" '~'-"'~'"'"1~ ............... ..... ~ L~{~ ....... ; .......................... 11. Zone or use a stric[ n wn cn premises am s zua[ea .... ~. ............... ~: ................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... .~'...{~. ................. ~ .......................... 13. Will lot be mgraded ~a~.Z). .................. Will excess fill be removed from premises: [ ] Yes D(] No - ........ ............ 14. Name of Owner of promises ......~.~.~.,Z~.......O./.T...{~;-,-,-,-,-,-,-,-~c..~...~...Z~.. ........... ~ ............. .... (~ddress) L.O_C.4a~- (Phone No.) Name of Architect ......~....~..../~...F~....~......~.....'~....-~'.....L:.. ........... ;...;;J~...u~.['3;~.......~.~--:~.....~.~.,.......~.../.T..0...6...5....~.. ....... {Address) {Phone No.) ... Name of Contractor .~,.~,, ,~,,,.~ ,~,,..~,,,-~,~-~.~./--(~'~d~d'~t;~s)~'~'&''''' '''t~''' ................. i~l~;~"~:j ............ 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 wheth- er interior or corner lot. COUNTY OF ....... ~ ................ ) being duly sworn, deposes and says that he is the applicant above named, (Name of individual signing ~ontract} ~ ' He is the ................................................................................................................................................................................................................. (Contractor agent corporate o~J~cer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file ~his application; that all statements contained in this application are true to :the bes;l:,~f hi~6~c~(l~K,~Rr~:l belief; and that the WOrk will be pedorreed in the manner set forth in the application filed therewith. ~ !L ~, ~,~%~ $~ff~tk Co~ntv_/~ ............................. ' ...... u. -. . ........ ,o,a,y Co ...... ~' ' (Signature oz appttc?ntl 757 I ~ mis ~vE¥ ~y NOV ~