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Home My WebLink About2769-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .~ .~.. $.~.0~. ]~P: ............. Street Map No. ~.a.~.8,. p.t;,. ~ No ........... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Feb .... 8 ...., 19.~. pursuant to which Building Permit No. 2.769Z., dated ........ ~D ..... ~ ..... , 19. ~, 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~.l~g~..0~. Saml~ .~e. lli~g ....................................... The certificate is issued to .All~e. ~aga~ ........ ~e~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Sep.~.. $ 2...~ 969 ................. UNDERWRITERS CERTIFICATE No .................................................. HOUSt~ N UM BI~R. 3~Q ........ Street..AbO~. ~g ...................................... Buildin~ lnspec[or FORM NO. 2 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) N? 2769 z Permission is hereby granted to: R~I 4~'m~.. &.. A~.e~,.m...ge~e,~ .............................. · .. ,3@9.... C~ the~a.l,..~,ve ................................ ...... ]~e~p~.te~dt ....~, ~;, ................................... to ... hu~ct..n~...one.. £am:~ ;1,~... d~e~ ~n& ................................................................................... at premises Iocoted at ~t...~gt..~ee.t~on.....~.~:...~ended..~4ap..~laas~u..p.~.~.op ......... ................................ ~/.~....Abe~r~..Lar..N~s sem...P~ ....................................................................... ........................................................ Cutcho~,u~r.....hT,.~, ................................................................... pursuant to application dated .............................. J~-...~O .............. 19.~.., and approved by the Building Inspector Fee $."1 0...{~, .......... Building Inspecto[ TOW1V OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ottice Southold, IV. Y. Certificate Of Occupancy THIS CERTIFIES that ,the building located at .. ~.~... &,D,O~'~..I:alae ....... Street Map No. lls~&u. P~ .plUck No ........... Lot No...99 ..... (l~tehop. · N,~, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Feb. · .~8.., 19 .~. pursuant to which Building Permit No...~. 7.6.9.Z.. dated ........ ~eb ..... 8' · ., 19.6~, 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 ... ~Tivate. O~te. family, dwell~n6 .................................... The certificate is issued to . .Al:2~ne. G~gan .......... 0vl~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. {{al)g...].i~. ]~.9.. b~..Ii:..~.~..].~.a... Building S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The~ sewage disposal facilit~f for a st{ructure located have been inspected by this department and found to be satisfactory. District Engineer FORM NO. ! TOWN OF SOUTHOLD · BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ~, · . . ~ APPLICATION FOR BUILDING PERMIT . Date ................ INSTRUCTIONS , o. , This. application must be'"co~pletely 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 punic streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part af this location. c. The work cov. ered 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ................... State whether applicant is owner, lessee, qgent, 'architect, engineer, general contractor, electrician, plumber or builder. ..... ........................................ ;; ................................................................................................................... o, ....... ............................................... If applicant is a corporate, signature of duly authorized officer. ....... ....................................................... (Name and title of corporate officer) be.done. ,No: ... ~ Lot No: ............ 1. ,ocot,on of land on wh,ch proposed, work w', Street and Number ...~..~.~.~.~., ..... ........................................................................................ Mu,nicipality prer~ises and ~se add occupancy of proposed construction: 2. State existing use and occupancy of intended use and occupancy .......... 4 .~.~..l[~'~..~..~... ..... ~. ......................... b. Intended use and .¢~. ~, .~ 3. Notureiof work (check which applicable): New Building ....... ...f,.......Addition .................... Alteration .................... Repair .................... Re,,~ooval .................... Demolition .................... G]her Wor~ (Describe) .................... Estimated Cost ....... ~-"'~"~';4s~ ..... ...... ...... ?~":~(to be p~[~on ....................................................... ~iling this application) 5. If dweJ~l ng, number of dwelling units ..........~.....Num~er of dwelling units on each floor../,~..~.~ If garage, number of cars ....... ~.~ ............................................................................................................... 6. If bu4iness, commercial or mixed occupancy, specify nature a~d extent of each ty~e of use .............................. 7. Dimen~sions of existing structures, if any: Front..,~ ..... Rear ............................ Depth ............................ Heigh~ ............................ Number of Stories ............................................................................................................ Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ DepthJ .............................. Height .............................. Number of Stories ................................ 8. Dime6sions of entire new construction: Front ...... .~,~ .......... Rear ...... ~ ........... Depth ,)ize ~f Jot: Front ......... /~.~ ........ ~ear ...J~ ............... Depth ..~.~...: ....... Date of Purchase ~ ~ Name ~f Former Own 11. Zonejor use district in which premises are situated..~,~:..~.~t'~,~.., 12. Does[proposed construction violate any zoning law, ~rdinance or regulation? ....... ~'. .................................~J~ Nam~ of Architect ............ ~.~.~(.~ ...... Address .,~,..r~~ne Nam]e of Cant ractor......~...e... J~. ~.~.....Address .......... ~~ .......... Phone NO./~.'~'~ ] ~ PLOT DIAGRAM Locat~ clearly and distinctly ah buildings, whether existing or proposed, and indicate all set-back dimensigns fro property tiqes. Give street and block numbers or description according to deed, and show street names and whether interior or corner lot. . o l*P uv7 3. o"F 99 ' STATE QF NEW YORK, OF ........ .-~,.....l~ng duly sworn, deposes and says thc~e~jr~e oppli of individual s~gning rion) ~-- ~ ....~_ ~ above the ........................................................ ~6. ....................................................... ill ..... I (Contractor, agent, coqSorote officer, etc.) of said owners, end is duly authorized to perform or have performed the said work q~d to make andi~file this that all statements contained in this application ore true to the best at--knowledge and b~llief; and that, rk will b,¢ performed in the manner set forth in the application fHj~d ,,th,grewith. Sworn tab fore me this ~x~u~.$ ..~__~,,~bu j ~'" · ' - ¢~72~'1.2~r~,~7' ~. co..w U~k',,~o,,O~z".~l,f~ // - ,/)' ill Notary Pubhc, . ........................ ..._._ .