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Home My WebLink About6860-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. 6.~ .~ ..... Date . J~_D .~1%.. ., 19..~' THIS CERTIFIES that the building located at .lq/S M~cldle Road ........ Street 1V~ap No .... .xx .... Block No..:g~X ..... Lot No..X,X,x .... ~.u.t. qh.oa't~...N.:Y.: ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Se.pt · 12 , 19. -7.3 pursuant to which Building Permit No. 6860. z. dated .Sept.. 11~..., 19.73 , 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 P.r.~.vg.te .agc.e s. sory...( .s.t.o.r..age ). bu..il.d .ing ................ The certificate is issued to . Le$.l.ie. B..at.e~..&..W.l..f~e . ...owner.~ ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N,R., .......... UNDERWRITERS CERTIFICATE No.. ~.:R. ~ ...................................... HOUSE NUMBER 16,bgg . Street ...F~td~lle. aQa¢l...(CR22~ ................ Building Inspee%or TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N.o 6860 Z Date ........................ ~qe~ ........ I..l+. .......... 19.~.3... Permission is hereby granted to: 3. e.~[-'.[~ .. ~.t,e ~ .. ~ ............................................. ....Qu.~.a?~ g~e ..................................................... to .~.~.~....n..e.:~.. ~....c...e..s...s..o. ~.....Cs. ~..o.~..a. ~.e.. )....~.~).~ .L~ .............................................................. at premises located at .......... ~./~-.-~.$~-e.-.~el~L~ .............................................................................. .................................................. 4~e~o~te ........... h%¥.~. .................................................................. pursuant to application dated .................... ~13'~ ....... .lJ+ .............. , 1~....., and approved by the Building Inspect~o~r. Fe~ ~1. .0. . ,. .0. . .0. ....... .L.. Building ln~,pe'ctor q P...4d. BUILDIN~ DEPAIrrMENT TOWN' a. ERK'$ OFFICE ~OUTHOLD, N. Y. Approved ~ ~ ../.~.. ........................................ , 19.. Permit No ..................................... Disapproved a/c ............................................................................................ · ' - _ (Budding Inspector) / ~-~ e APPLICATION FOR BUILD/I~G PERMIT Date~...~..../.....~......~ ........................... , NST ,ONS o. lhi~ ~lic~ti~ mu~I be compl~t~l~ fill~ in b~ ~writ~r o~ in ink end ~mi~ed b. ~lot plon ~h~in~ ~ti~ o{ Io~ ~ o{ ~uildi~ ~ pr~mise*~ ~lotion~hip to adjoinin~ premise~ or public ~tr~t~ o ~re~, and Oivi~ ~ d~il~ d~ripfion o~ la,out o{p~ mu*t be drown on the die, mm which c. ~ work c~r~ b~ thi~ ~lie~tion mo~ n~ be eomm~m~ befor~ i~uom~ d. H~n ~ppmv~l of ~i~ applicoti~, th~ Buildinfl Ink, tot will issu. ~ 8uildin~ P*rmit to th~ opplicant. Such p~rmit shall be ~t on t~ premises available for ink,ion thr~gh~t ~ work. e. No building shall ~ ~cupi~ or ~ in whole or in pa rt for any pu~ose whatever until a Ce~ificate of ~cu~nc shall have ~en gmnt~ ~ the Building Insp~tor. ~PPLICATION IS HEREBY ~DE to the Buildi~ De~rtment for ~e issuance of a Building Permit pu~uant to the Budding Zone O~inance of the T~ of ~ld, Suffolk Count, N~ York, and other applicable Laws, Ordi~es or R~ulations, ~r the co~truction of buildings, additi~s or altemti~s, or for removal or demoliti~, os heroin d~cribed. The applicant agr~s to comply with all a~licable laws, o~inanc~, building c~e, h~si~ c~e, and r~ulati~s, a~ to admit outhoriz~ in~o~ ~ premiss a~ in buildi~s for n~a~ i~tions. (Signature of applicant, or name, if a corporation) ..... (Address of applicant) v State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . Name of owner of premises .............................................. ..... .~ .............. / ....................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate of~ Builder's License No ..................................... ................ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ' '~ t f n h'h No ~ ~ Loca ion o and o w ic progosecl work ~11 be dor~. hA~p .: ............... :..~.-~......-A~....,,... Lot No ...................... I.. Street and Number ..... ..,~/.../~.~.. ........ .../~..~:~....f~..~.~L...~ ........ ~,dL.,,~-~ ......................... l.. / ~, ~/~ ~ u Municipality ' State existing use and occupancy of ~.,':e.s ;~. intended Use and occupancy of proposed construction: a. Exisiting use and occupancy ...~.L ................................................................................ b. Intended use and occupancy ..... ~ ........................................... ~, ................... ~r ............ 7' ......................... 3. Nature of work (check which applicable): New Building ........... Axldition .................. Alteration ~' .~ Repair .................. RemOVal .................. Demolition .................... Other Work ................................................ . ..... //~ ~ (Description) 4. Estimated Cost ........................................................... Fee d'...~.. .................................................................... (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, 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 ..................... .~.......~... Rear ........... ~ ........ Depth ...~ ............ Height .................... Number of Stories ..................................... ~ ....................................................... 9. Size of lot: Front ...................... ~,~... ........................... Rear .......................................... Depth ................................ 10. Date of Purchase ........ ~....~.....: ...... ~. ............................. u~Lm~e o,,~ormej~Owner ........................................................ 11. Zone or use~!strict in which premises are situated ..... Ar.% ...... ~.~ ......................~-~ ...................................... 12. Does proposed Construction violate any zoning law, ordinance or regulation: ...... /...v......~. ................. ~ ..................... ... 13. Will lot be regraded ....... Will e_xc~ss~fill be removed froq:lr,. ,, ,,PrJelrnj~es: ( ) Yes (b<~. No Name of Owner of premise~ ...... ...~..~ ....... ~ Address ..~ ...... Phone No ...................... .' 14. Name of. Architect ........................................... ; .................. Address ................................ Phone No ....................... Nome of Contractor ............. ~.~.~.~.....'.. ................ Address ................................ Phone No ....................... 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 indi, whether interior or corner lot. te STATE OF NEW~I~)J . }S.S lng duly swo~n, deposes ahd says that he is the applicant .... i' ;; TZ/in ividuo signing contrac above named. ~"7'~')~- ~ ~ 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; 4'hat all statements contained in this application are true to the best of his knowledge and belief; and thor the work will l~e performed in the manner set forth in the application filed therewith. Sworn to before me'this _., ~ ~.~ ................. ......... .............. ...... Notary Public, . ................................................... County "'~' ..... (S'gnature of applicant)