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Home My WebLink About7073-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. Z6077 ....... Date ................A~..27...., lg~.. THIS CERTIFIES that the building located at . S:i. gsb.y .Road ............. Street Map No. Matt, .Pie, .P//~pk No ...........Lot No .....~? ...... ~M~;'c~-.'C~Cl~. ~;~/; .... conforms substantially to the Application for Building Permit heretofore fried in this office ~ Aug ~ ~ lg.~. pursuant to Which Building Permit No...70~$Z dated ........~n. · -20 ..... ,10~22Z dated .Au-g 'l~'r J969&.Feb .~ 19.7-~., 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 .. P.~.Iv,~..fie. ena .far:~l¥. ~x.mllfng ..................................... The certificate is issued to .. p~.~. ~. Zu~u~o ..... ~ne~, ................... : ........ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N ,it, ............................... UNDERWRITER~ CERTIFICATE Nd... ~..R, ..................................... HOUSE NUMBER .... 2.~7~ ..... Street ..... 3~sby. ~oad ........................ Building Inspector FOBM NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7073 Z Date ................................~ ............. 19 Permission is hereby granted to: '~-~'~- ~,',<2 . ......... ~.~-~.........~..~, ..................................... '...~ ........................................................... at premises located at ~.....'~....7..~t.:.....~.~~...~..: ......................................... ............................................................... .~..~.~....///.../..~...~. ~.. .............. ....~.: ................................. pursuant to applicat,on dated .... (,//~.,/~.....~'.~. ......................... , 19./~..'...., and approved by the Building Inspector. Fee $ ... ~xamined ........~..~........, 19..~.. ' / 'Application No: ..70.~' .......... Di~ppmved o/c ................................. ~ ........................ .~ ....................... /_ ~ ~. ~ ..... _ .7.=. .......... · X ' ~ t~~ t~ ~ ...... ................... . ...... IN~R~I~S ~ a. This a~licati~ m~t ~ completely fill~ in by ~ewriter ~ in ink a~ s~mi~ in tripli~te ~ t~ Buildi~ In~or, with 3 ~ of pl~s, aocum~ pl~ plan ~ ~ale. F~ ~co~i~ to ~ule. b. PI~ plan Sh~in~ I~ation of lot and of buildings on premises, relationship to adjoining premiss or public stree~ o~ areas, and g~vi~ a ~d~ d~ripti~ of I~ut ofp~ must be drown on the diagram which is ~ of this a~licatl~. c. ~e work cover~ by ~is a~licati~ may n~ ~ comme~ before i~uance of Buildi~ Pe~it. ~ ~ . ~... u~n.aPP~al Of this apPlif~t~ ~e Building I?p~[or will issue a Building Permit to the applicant. Such permit~. snan ~ Rept on me premiss ~ai~ame tar in~ti~ m~gn~t ~e ~rk. e. No building s~ll ~ ~cupi~ or u~ in whole or in pan for any pu~e whoever until a Ce~ificate of ~cu~ shall h~e ~en granted ~ the Building Ink,tar. APPLICATION IS HEREBY ~DE to the Building D~a~ment for the issuance of a Building Pe~it pu~ant ~ the Building Z~e Ordinance of ~e T~n of ~ut~ld, Suffolk Count, New Yo~, and other appl~le ~, O~l~ at R~ulations, for the constru~i~ of buildings, a~iti~s or altemti~s, or for m~al or ~ohti~, as heroin de~ri~. ~e appli~nt agr~s to c~ply with all a~licable I~s, o~ina~es, building ~, h~i~ ~e, a~ ~lati~, a~ ~ admit authoriz~ in~to~ ~ premises ~ in buildi~ ~r ~e~ i~ti~. ....... (Addre~ of a~licont) State whether applicant is owner, lessee, agent, a~hit~t, engineer, general c~tmctor, electrician, plum~r or builder. Name of owner of prem scs. . ;.5/'. ....... : L.A..... :..U...~..?. ........................................................................ If applicant is a corporate, signature of duly 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..;~ ; - . ........................... ]. Location of land on which prOPesed work will be done. Mop No.: ..~.~l. ..................... Lot No. '~'"'7 ........... Street and Number ~ .~...[ ~..~.~..~...g'....../~.~.,~, .l~..F~::.'~.L'Z:..~,.~d.;.ya ............................................ ~. ~Tm~'~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ...,~,,.~)~JC~,,~.~,....~.~.~.~.,~,~C.,~,, ...................................................................... Intended use and occupancy ........................... (~.... ~ ............ ~ . ., ........ ~ ~, ~3, ,Nature of work (check which applicable): New Building .................. Ad~, ition .................. Alteration ........... ;.,,;, Repair .......... ~ ....... RemoVal .................Demolition ....... ~ ......... Other Work ................................................ .....: ' ~ (Description) Estimated Cost ...~.~/~- ................ ~ .............................. F~/.....~.... ........................ ' ....... ~ ......................................... 4, '~-~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Nu~r'~ of dwelling units on each floor ............................ If garage, number of cars ........................................................... ;~, .............................................................................. 6. If business, commercial or mixed occupancy, spe6ify 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 ............................ Dep~:h ................................Height.................... r ....... <;~ 'ir~,-'~N~n'ber of Storie~,,,...; ............... ~J~li~ ~r~'"'"': ,:~' -~t~ iii · - · .' · ~ ~' ~L ~ ' Rear':'~ ~I~'' " ~"'-'~h~' ' '~ ' 8. D,menslo~, ~e~t~tire new construct,on: Front ...... ::.er,..~,ff~::. ........ f,~ ..... ....;:~...~. ........ ..~,,...~a~. ..... Height ..~.,...~.~.e. ...... Number_of Stories ..................""'-""T. ................................................................ ;,: ............................. ....~ O Re r ~.. ../~.. 9. Size of lot: Front ...~:.....:~.~... ..................................... 9 ........................................ De~pth ............................... 10 Date of Purchase .~Z~..I. 3....~.~.~..~... ........... Name, of Former Owner ~,.~,~..A~,..~.~ .... 11. Zone or use district(i~ which premises are situated ......... ~. .................................................................... ~..,'., ,..:..~ .... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: .~,/~. 13.14. Will Iotber~, .r~Jq ('~ ¢')~ ,,~ft['~7~regradad ............................ Will ex~ess fill be removed from premises: ( ) Yes ( ) N:0 Name of Architect .............................................................. Address ........ ~ ....... Phone No ........... i~..-~..,.., ~ont~;;~ort ............................................................ Address .......... : ............. .; .................... Name of PLOT DIAGRAM Locate clearly and distinctly all II~ildings, whether existing or proposed, and ir~licate all set-beck dimensions-from property lines. Give ~tz~t andl block number or description according to deed, and show street names and indicate whether Interi~ o? comer lot. STATE OF NEW,YORK, [ c c COUNTY OF ..: ............................. ~'~'~ ........................................................................ ..-~..~,.-~,~n~.....~-~eing~49,~wo, rn, deposes-and says thet he isthe applicant (Name of, individual signing-,contracf) .... , 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 best of his knowledge ami, belief; and that the,work will be performed in the manner set forth in the application filed there~91th. ' - ~_' ~i, Swam to before me this ........................ day of ............................................ , 19 ........ Notary Public, .................................................... County ~ (Signature of applicant)