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Home My WebLink About5783-z~VORM NO. 4 TOWN OF $OUTHOLD BLTH.I~ING DEPARTMENT Town Clerk's Office Soudlold, N. Y. Certificate Of Occupancy No. Z6223 ...... Date .............Tim .2 .......... ,19. ?~. THIS CERTIFIES that the building located at .. ~3~Lt, h. ~rL~m..No~th .... Street Map No. GOOle..li®clkBlock No ...........Lot No.. 2.~..&. ~2... ~.~t3~0~,4.. ]1.~]~... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. A])~*.. '3.., 19..~) pursuant to which Building Permit No.. dated ............Apr,]... 3., 19.~2., was issued, and conforms to all of the require- ments of the applicable provisions of the law, The occupancy for which this certificate is issued is ...pZ.J,lr&t,e. .O~e. ,/~11~ .dVILll/~I~I...v:l.t,b. ~. ad. dj, ti,on ............... The certificate is issued to . Leo~l~d .&. Ber~..Dank ....... 0wner. m. , (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N,R, ............................ UNDERWRITERS CERTIFICATE No...Pending .............. .................... HOUSE NUMBER ..... 1 07~. .... Street :.. I~tt,~...D.~$.v.e..N. 91..~ .ti!. .................. ~OBM NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5783 Z Date ............................ ~lJ~.&~l~.-~, 19..~1~. Permission is hereby granted to: .......... ~.~/.eelle~ .]hl~k~&.~l.tte ..................... ....... ~e~t~o~..t~ ............................................. ................... ~t;¢~be~a~ .... ~i ~Z ~ ........................ to.. ~.e... ~...~ .s...t..t.~....m......e..x...s......s..t.~s.. ~~ ............................................................. at premises located at ...:..,~dl..2~..&..~....~li~ll..~ll~...:~llt~. ....................................... .................. ~&I~..~IF. ~le~,-. ~.. ;~ eee.. ~i~ .-e, oe,~t ............ 6a~Xd'""#iX'i ............................ pursuant to application dated ..................... ~'~'-;J,1,..~ ................. , 19.~j1~.., and approved by the , Building Inspector. Fee $......11.~.~C~ ...... '~ ,E"X/.7 7'"'/ FO~f NO. 1 TO~VN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ^pplicofio~ No. ~'~---~ Disapproved a/c ...' ' 'i ........ ~mul!a~ng insp.~c!orJ A~PLICATION FOR BUILDING PERMIT ' ~INSTRUCTIONS , , . ' ' a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit~l 3 sets of plans, accurate plot plan to scale. Fee ac~:o~ding t° ~chedu e ~-~ b. Plot plan Showing location of lot and of build ngson pram sea, relationship to adjoining premises or public streets or erea~ and~/ giving a detailed de~3riPtion of layout of property must be drawn on diagram which is pert of this application. c. The work covered by the application may not be commenced before issuance of Building Permit. d. Upon apl~oval of this application, the Building Inspector w issue a Building Pertnit to the applicant. Such,~ermlt, shall be kel~ the premiw available for inspection throughout the work. e. No .b6iJdi"g~sha# be OCCupied or used in .whole Or in pert for any Purpose whateVer u,tJl a Certificate of ~ shell havelbeen granted by tbe'Bui!dlhg Inspector APPLICATI°N IS HEREBY MADE to the Building Department for the issuance of e Building I~rmit pursuant to the Building Z~ Ordinance of the Town of Southold, SuffoM County, New York, and other applicable Laws, Ordln~rides or Ragulatim~, fct ~ construction o~ g , or zed inspectors on premises end in buildings fOr (~ig~a~ure of applicant, or name, if e ¢°rporstion) Eas~wo~E Drive,, '~,,- ......... : ............ ........ . (Address of applicant) State whether applicant is owner, lessee, agent, amhltact, engineer, general contractor, electrician, plumber or builder, Owner Name of owner of premises ..... ~.9,.,'3~R'~I,..~.,....,I~{~XI~,.~..~.flX'~.~,..~...D ~,~a .................................. 1. Location of land on which proposed work will be done. Map No.: ...-3-t[63...,... Lot No.~....2.~,...~;.?,~ ......................... Street end '" Municipality 2. State axi~lng use and o~upancy of premises end Intand~l use end o~upancy of proposed con.ruction: a. fixi~in~ u~ and ocoupanoy ............ ~.~..~.~l~i~.~. .................................................................................................. b. Intended If applicant Is e corporate, signature of duly autho~zed officer. (Name end title of corporate officer) 3. ~ ~laturc%of work (check which applicable): New Building ....................... Addition ...... ..~.. ........... Al~eretion.~...&. .......... Repair ......................... Removal ......................... Demolition ........................ O~h,er Work. ................................... (Description) 4. ;stima~d Co~ ...~.~.,.~. ........................... F~ ................................................................................... (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 mixe4 occupancy, specify nature and extent of each type of use ..=.-. .............................. 7. Dimensions of existing structures,;j~', rany: Front ...-~0.~ ............ Rear ..3.Q .................... Depth ~.~. ........................... ... ~-'ont - XZ 13 f'~ ' . .... , . .... Height ....~&.~ .... ~ .... ~=,....~ ..................~umoer of Stories ...~. ................................................................... .....'r~:h e add · Front ~0 Rear .$.0' D~mensmns of same structure, w Iterations or t ons~ ....~..... ............... ..................................... .. ~rbnt - 13 Depth ....2.~A ....................... : ......... He,ght ..,~t~[~...=..T~~ ............. Number of Stories ..~ ................................... 8. Dimensions of entire new construction: Front ....T..': ................. Rear ...m.-. .................... Depth .....=.': ........................ -- Number of Stories -- Height ............................................ 9. Size of lot: Front ...~,.~.~.~.~2 .................... Rear ....~1~.0. ......................... , Depth .iQ~,~.~.:~...~...3,D.~.Q{~ .......... Height........ ..........-- ..... .... . ...................... .. Number of Stories ........ .==. ....................................................................... 10. Date of Purchase ......~...~..9/..?..]: .................. Name of Former Owner ...........l~....°.E,..a~.. ..................................................... o~ ~+.;~+ ~.. ~.~ '~.~--:~ o~ o~,~+~ Residential , . ...................................... 11. Zone or ~ ~ .............. ~ ................................................................ ........ 12. Does proposed construction v!qlate any zoning law, ordinance or regulatien: ....~[~ ................................................... 13. Will lot be regradad ........... ~, ...................... W,llexcessf,II beremovad from premises. [ ] Yes [Z] No 14. Name of Owner of promises ..~.~.~r.0,..~ *..~..{~1~.. ~ ~,,~,~..~..~&~ge...~~e~..~[~ ............ iAddre~.. 734-6199 (Phone NO.) Name of Architect ....... ~. ................................................................................................................. .. · · ........ · · · · .- (Address) (Phone No.) Name of Contractor ......... ..-..-.. ................................................................................................................................... (Address) (Phone No.) PLOT. DI .~G R ,. Locate clearly and d~stin.ctiy .alt b~ildin~, whaler existing e~ prelx~ad, and indicate all set~ack dimensions from property lines. Give street and block nbraber or description according t/~idead, and ~how street names and indicate wheth- er interior or corner lot. , me-S~- STATE OF NEW YO~i~,//.~ ) (N~f~.~i~,~fl~ ',',' ~ :" '~ ;~, ,- ' ' He is the ........................ ~ ....................................................................................................................................................... (~n~mr, ~, co~m'o~, etc.) of said owner or owners, and is duly au~ori~ to ~Horm or ha~ ~rfor~d t~ ~id wo~ a~ ~ ~ke and file ~is a~liation; ~ all ~am~n~ ~n~in~ in this a~i~tion m ~ to t~ ~t of his knowl~ a~ ~Jief; and that ~ ~ will ~ ~or~ in t~ ~n~r ~t fo~h in the ap~i~tion fil~ t~mwith. ~_ ~ t 8OK~ ~ ~ ................. ~ ............... dayof.~. .............. ~3..~. , {2 ( ~ , ~k _1 I [ ..................... 103.0~ M,.. kL, :-.~ MA~_ OF Li~ONAQ.>..D ~ *BE~:~ L E. DANK --- · AT /