The URL can be used to link to this page

Home My WebLink About2741-zFORM ~0. 4 TOWN OF SOUTHOLD RUILDING DEPARTMENT TOW~ CLERK'S OFFICE SOUTHOLD. N. Y. CERTIFICATE OF rlCCUPANCY No. Z. 29?9. .... Date ............... ;~anuary .... .1.1. 19.67. THIS CERTIFIES that the building located at . N/end. P. vt..Road~, .ofl, N../.8. ~tr~ham Ave Map ~ ~,~t~t.'h.i.!~l Block No .... XX ....... Lot No. xxx .... i4attitumk~..i~,~, ....... conforms substantially to the Applicati,o~ for Building Permit heretofore filed in this office dated ......... }i~,~f....-~,0 ...... 19.~ pursuant to which Building Permit No. dated ......... l¢~y'"~1 ....... , 19..~ was issued, and conforms to all of the require- ments ,of the .applicable provisions of the law. The .occupancy f~or which this certificate is issued is ... 0~e..f:a~.ity. ~.~u't~. C~3~t~ge ......................................... The certificate is issued t,o ...~azl:~a..Ttl~hi~.l.. ~.~[t~a_.~. c~..Cottage .............. (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Appzoval ....~.8~.~. 3..~.~.~.. ,~Y..~,..¥;~lla ...... FOI~M 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) pursuant to' applica~tion dated Building Inspector Fee $,..l(~e.(~,,,,.i.. Permission is hereby granted to: ............... .c=~t~ .......................................... to ...3~:L%~...m~..l~ ...~o.t,~a~e. ............. : ....................... ~ ......................................................... at premises located at ....... .~/J~....~l~.il~l~.e..~Bt~l...(~,,~,,~4~.). .................................... : ......... : ........ · , ...l~..~. ....... .~..~. ....... 19.6~,.., and; approved by the ...... : ................... ~ii~ii;~b'"i;;~;~'~;;; ..................... il'" S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da~e JUN Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (GiZve deed location) have been inspected by this department and found to be satisfactory. Dimtriot Engineer District Engineer FORiVI N'O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,ned ......... ....... , Approved ........................................ , 19 ........ Permit No ........... Application No ................. [ .......... Disapproved o/~~.~-~ ........ ................................. ................................. APPLICATION FOR BUILDING PEItMIT 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, end giving a detailed description of layout of propertymust 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 Certificate of Occupancy shall have been 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, Suffolk County, New York, and other applicable Laws, Ordinances or p,egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) (Addre's's of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. /,,~ Name of owner of premises ............. ~....~m~...~ ............................................................................................ If c~QDlicant is a corp, orate~,_.~ignature of duly ,authorized officer. (Name and title of corporate officer) Location of land on which proposed, work will be done. Map No: ............................................ Lot No: .................... Street and Number~...~..~...~..(~...~.', ........... ~..~..~.,.......~..L...~..'. .......... ~ ............................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a a cc p y ........................... .~ ........... ,[~ ................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................... Removal., ................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ....................... .~. ................................ Fee ...................... .4 ................................................................. (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 3 ~ / ............................ Depth '"~? ~ Height ........ /.~.: ........... Number of Stories ......... /. ................ 9. Size of lot: Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............ ~....~...~/~ 12. Does proposed construction )~late/a~n~_.~.i,n~g law, ordinan_s~,or regulation.;) ........... ~ .................................... 13. Name of Owner of premises ~..~~ .......... Address~..~../../..~,~..,..~..,~.. ...... I~on/-~e I~ .~.~..~..~...: .... Name of Architect ..~T/ ........ ,r~ ..... ~.....~-,~ .......... Address .............. ,~ ...... v... .............. ~ I~oneJqo.~ ........... .~. ..... Name of Contractor ~.~..:.u~.....Addres~..,~..:~~ .~.~.'.~..~Phone 'i~o...~...~...~..51.~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property Fines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. I STATE OF NEW YORK, ~. ,. ~ COUN~L-Y OF ................................ ~ ~'~' ....... .~,~i.~.:..~ .................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 Jn this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..... ................ ..................... , · ................................................... Nota~ Publi~ Z.J~.....~.:~..~~.~~st~e,.0?~.'~, ~r~ (Signature of applicant) ............ ' ( ~ [e~m