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Home My WebLink About5744-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. Z..~[1t~6 ..... Date ............. ~ty...!!? ...... , 19.72. THIS CERTIFIES that the building located at .Na-~an .Drive ............. Street Map No.14asolx ...... Block No ........... Lot No..Z,l¢.% ... C~.~Ch0gu~.. N.o.~ ? ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... N~I' ...... .~.., 1972.. pursuant to which Building Permit No..~?I~Z. dated .......... 14ar. .... .1.3.., 1972., 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 . ~ri~ate. one. family, lulling ...................................... The certificate is issued to Joseph. ~ .i~ar. Jorie..Grurmtal6 ..... .owner. m ............. of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) N.H. UNDERWRITERS CERTIFICATE No...]~. 85~.39... Alit...'tl...'1973 .................... HOUSE NUMBER... '1 ~20 ..... Street... ~t.$Olk .1~1~t .~ ................................. Building Inspector FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTM£NT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? Z Permission is hereby granted to: ................ · 1'o~ ap ~,..Gr~-~.:],~ ........................... ............... ~a~"~t, ............................................. to ...~e,tt~..ex..e~d~tt~c~"m,r-mCl:st;~'g'livo~];illil ........................................................... at premises located at .........~.~.S~..~V ............................................................................................... ................................................................... ¢ ~teke~e.....l~.¥.,. ........................................................ pursuo~¢ to application doted .......................... ~a,~ ....... ;~ ................ , 19...~, and approved by the Building Inspector. Fee $......~..~. ~} ...... /\/ TOWN OF SOUTHOLD ~'~/'~ ~'~ BUILDING DEPARTMENT ~ /,,~,/1")..,, TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~ ...... ~..~. .............. 19 ........ Appl~o....~..Z ..................... Approved .................. .~.. ................... , 19..~.... Pemit No......~...Z...~....~.....~... ....... I~/~/~~ Dmapproved APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 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 issue a Building Permit to the applicant. Such permit 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 Certificateef~)ccupancy shall have be? granted by the Building InspeCtor. ~ ~ · ~ ., ~ ; ~' ' APPLICATION IS I-~RF~ MADE to the Buzld~ng Department for the ,ssuar~ce of a~uilding I~erm~t pu~nt to the Building Zone Ordinance of Jhe Town of Southold, Suffolk County, New York, and other ~op~Jcable Laws, OrdinanCes ore Regulations, for the construction of buildings, additions or alterat ~ns, or for removal or~ demolition, as herein described. The applicant agrees to coml~ly with all applicable ~laws, ordinan~ ~, building code, hou,~ng cede, and regulations. . ~, / ~bign~mre of e~plicant, or name, if a corporation) · : ~ ,~ox 64, Ma~ Dr~ve .,, · ~ ~ ~-~ ~utcbogue, 1i.Y. 119~5 . c~ntractor, electrician, plumber dr~uilder. St~ate whether applicant Js owner, lessee, agent, architect, engi~,' general ' · ...... N,~me of owner of~orem ses · .~.~..~....~.~...~ · · · .'~. · · · .~.. · · ..~....~..~.. ~ .~. · .~.'~ .~. :~ ~../~ ,~.. ~. ~2...~., ./..~. If applicant is a corporate, signature of duly authorized officer. ~'~7~ 7 L (Name and t,tle of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ........................ Street and Number Z .'7.. o~.(.~ /~/t .~..~ ~V' ~...'~..~ /,/-Z:- Municipality 2. State existing use and occupancy of premises and i~tended use and occupancy of proposed canstructian: o. Exisiting use and occupancy ........ .~....,~....~../.~.~l[~r~V;.~...Z~.. ................................................................ b. Intended use and occupancy ...... ~x~...~.../..~--~.~'~.~..~... ................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..~..~.......~..: ..... .~.. . .. 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 ...x~..~/.X.~-..4 ~/.~/..-~..~ 4~...~..~.e...~.."[ ..~. /~f.~.._/~..dXJ/...eT~....{~x/~.5..~'...~..~.../.W'. ........... 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 ...~...~..T..~. ................ 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 ....,~;.~..~ ..................... Rear .,~'.'~.:'..~. ............... Depth ,,~..~..Z..~. .......... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ......~..~..-.;.~...(:{. ....... Rear ....... ~.~:..~..~ .............. Depth ....~.~..~...;.~.-. .......... 10. Date of Purchase ....... ~....~...~....i~.. ...... J..~.~,..~. ................ Name of Former Owner 11.; .~ Zone or use~,distrlct.imv~3io~oremises are situated ..................................................................................................... 12. Does proposed construction v olate any zon ng aw, ordnance or regu at on? ................. , .............. c . ' ....... 13. Name of Owner of premises-t-. _..~ ~U~..~.~.~.h.~..q;.~j~...~?.¢#~....;.Address .../~.~.~..l..~..(~/h~.~.~t~'/7~....4.. Phone No ...... :... ........... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed. and show street names and indicate whether interior or comer lot. STATE OF NIc~Y(~ ¢ ~ e~ COUNTY OF c:;~.~..~...~.,,~..~' ~'~ /~ ... .................. -...~ ........ ~ ........ ~~ng duly sworn, d~es and says t~t he is the applicant (Na~e of individual signing ~plicatJon) . ~ above named. He is the ......................... ~~ .................................... ~ ........................................................... (Contractor, agent, corporate officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this ~lication are true to the best of his knowledge and belief; and that the work will ~ performed inthe manner ~t fo~h in the applicati~ filed therewith. Swam to before me this ................... ............. ......... .. ...... .... ...... Notaw Public,. ........................................................... Coun~ ~ (Sig~ of applicant)