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Home My WebLink About2848-zPORM I~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD. N. Y. CERTIFICATE OF OCCUPANCY No..~[. 2~30... Date ............ &ttS~St; ..... ~ .... 19~. THIS CERTIFIES that the building located at ..... ~/'~-S..~[~tek~l'~ .lal3~i ..... Street Map No. 3t3[ ......... Block No... ~ ....... Lot No.. 3t31~ ..... ~O1~01~t. ~*~., ...... conforms substantially 1~o the Applicati.on for Building Permit heretofore fried in this office dated ......... &ttg~8~;...1 .... , 196~. pursuant to which Building Permit No. ~8 .Z. dated ............. ~tgt~;. ~0, 196.~., was issued, and conforms to all of the require- ments ,of the applicable provisi.ons of the law. The .o.ccupancy for which this certificate is issued is ...Private. nne..f~l~..d~el~ ........................................ The certificate is issued to .,Toa$l~h.l~,aga~13 ...... ~ ........................... (owner, lessee or tenant) of the afore.said building. ,Suffolk County Department of Health Approval Jt[llS. ~'3,'-1966 .b~' .R.¥~.l. la ......... Building Inspecto[ FO~M 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? 2848 z Date ......................... ~,.1~'1~ .... 2~). ......... , 19...D5. Permission is hereby granted to: .. Ose ~-.....l~Ll.m~... _~k~.C..... J~ eel)h ..l~.sia ....... Lull.ton.. ~,m .............................................. .............. ~i~..Gr~er....L,l, ......................... to ...... BmtXd..ne~..one..~amL~....d~in~ ................................................................................ et premises located at ,...W/.~.....~.~C~f~.~..,~II, ..................................................................................... ..................................................... 8 ~u~,~oZd~.,... $I, Y., ......................................................................... pursuant to application dated ................................. A.I~.~,~.t;.....~, ...... 19...~5.., and approved by the Building Inspector Fee $..iO.~ ......... Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH Date TO WHOM I~ MAY COMCE~: The sewage disposal facilities for a structure located at (Give deed locatton~ ' ' ~ have been inspected by this Department and found to be satisfactory. Dist~i,t Engine~ ...... Dietric~ Eng~ee~ ....... FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C~LERK'$ OFFICE SOUTHOLD, N. Y. ........ Approved ........................................ , 19....~.:.. Permit No. Disapproved a/c ...................................... ~?;;:~ ....................................... %=:: ...................... APPLICATION FOR BUILDING PERMIT Date .................................................... 19..~C~...~... 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 of property 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 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, buildin, g code and regulations. ..... ....................... :... ( 'g ture of appl~ant, or name, if a corporation) ~ / (Address of applicaJ3~) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Nome of owner of premises .......................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done~ ,~4ap No.' "4'""~ .............................. Lot No.: ........................ Street and NumberL~/~~.~.~.?...(~...~...~.~/.~??..~.~...~.~.~.~/~..~..~.....~/~---~.~x ,~z~ ~' ,// '~, ,~ ~ ................................... Munici~lity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................. Intendeduseandoccupancy ~ Z~~ ~~ I ~'Addition 3. Natu,]re of work (check which applicable): New.Building ........................ Alteration .............. Rep4ir .................. Removal .................. Demolition .................. Other Work (Describe) .................................... E ti a e ct 0~'/~/-5'~' ~' 4. s m t d Co ................... ¢ ......... ' .............................. Fee ....................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ./.. ................ Number of dwelling units on each floor ......................... If gqrage, number of cars ............. ./.. ......................................................................................................................... 6. If b.,iusiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................ 7. Dimknsions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number f Stories .............................................................................................................. DJmbnsions of same structure with alterations or additions: Front ....................................Rear ......................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~....~:../. ............... Rear ........ ~.....~..../. ........ Depth .....c~....?...-..~....~.. Height ...... .~...( ....... Number of Stories ................ ./. .............................................................................................. 9. Sizelof lot: Front ...... /'..~... ...... ,......./Rear ......... ./...d..~.. ................... Depth ......... 10. Dat~ of Purchase .........../.¢V..~...~.. ...................... Name of Former Owner ..~...~.....?...~~.~... 11. Ton? or use district in which premises are situated ................................................................................................. Doe§ proposed construction vig~ate any zoning law, ordinance or regulation? ......... ~..~...~ ....................................... 12. , ~. , ~ f ' ~...~.. Addres ~t_ ¢ 13. Name of Owner o premlses~ .~ s ................................. ~hone No ................. Nar~e of Architect ...................................................... Address ............................. ,,, ........... Phone No ................. Nar~e of Contractor ...~..~.4/~'~ .................. Address .~..~~ '..~.~..'~., .~....~-/-:~.. hone No ................. i PLOT DIAGRAM L.ocat4 clearly and distinctly all buildings, whether existing or proposed, and indicate ail set-back dimensions property lihes. Give street and block number or description according to deed, and show street names and india whether inferior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applic¢ IName of individual signing application) above nan~ed. He is the ! j (Contractor, agent, corporate officer, etc.) of said ow'Lner or owners, and is duly authorized to perform or have performed the said work and to ma:ke and this application; that all statements contained in this application are true to the best of his knowledge and belief; that the wgrk will be performed in the manner set forth in the application filed therewith. Sworn~tob~foremethJs _ ~. /'~-~ ............. .......... ....... ] No, 52-0618100 Suffl;ik Ity LO