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Home My WebLink About2917-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ..-1~ .Roa~..BI,lisa%.1~ .- Street conforms substantially to the Application for Building Permit heretofore filgd in this office dated ......... llc¢~i.. · t .... , 19 65' purauant to which Building Permit No.. 29'~.. dated ........ l¢oV.~ ....~ ...... , 1~.., Was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . ~.oseph .& l~l~;alae4;h.Zsv:t~s ......... 0~tnel~s ......... (owner, lessee or t~nant) of the aforesaid building. Suffolk County Department of Health Approval -. ' ' Building Inspecto~, ~ FOPvM 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) 2917 z Permission is hereby granted to: ......... pursuant to application dated .................... ',,,~-,.~..,'~.i ....... / .................. 19.,,~..~,,~ and opproved bY fhe Building Inspector · /0 ~'¢- Fee $ ........................ Building Inspector SCHO SUFFOLK COUNTY DEPARTMENT OF HEAL'~H ~ldg. ~e(./mm~, ~ I'.. TO WHOM IT MAY CONCERN: ~The sewage disposal facilities for a structur~ located r - ~tve ~ed-'locatton). be satisfactory. District ~ngineer _ _. Dis t r~_c t Eng,inee r BUILDING DEPARTMENT TOWN CLERK'S OFFICE~/~ $OUTHOLDo N. Y. Disapproved a/c .............................................................................................. · ~lding/J~nSPector) APPLICATION FOR BUILDING PERMIT Date .~.~.I(.C~.~./~ ........ /, .................... , 19.~.~.. .... 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 ureas, and givin~ o~leroiled description of layout of property must be drown on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon op~provol of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept oh t~e~remises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until o Certificate of Occupancy shall have been granted bY the Building Inspector. APPLICATIOhJ IS H.EREBY MADE to the Building Department for the issuance of a Bui d ng Permit pursuant to the ~Build!n.g. Zone. Or..dinance. of t..he To, w? .o.f..Southol. d/..Suffolk C. oun~, New York, and other applicable Laws, Ordinances or Kegu~ar~ons, tar me construction at Du,amgs, aaa~t~ons or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinanceF, buildinil code and regulations. ......................... ......... ....... , (Address of opl~icant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electric/an, plumber or builder. .............. .............................................................. . .................... Name of owner of premises .....~.,S.~...~."/~'.....~.....~.~.~..~,~.~'.~.~..... Z~...~. ,/ .~'.~' ...... 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. Map No.: ........................................ Lot No.: ........................ Street and Number ....~.~.~.~-..T.......,~.~.~../..._~ .......................... ,d~.E~lZ..t'/.dJ,.,l~.)..,..:~..,.7., .................... 2. State existPng use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ........... .3.~./~,/~.,~..J~ ........... H~2. ll~.~ ................................................................... 3. Nature of work (check which applicable): New Building .i....~.... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....~...%.~0.~) ...................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling uni;~s ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........ ~,~.~......~.0.~.~'.....~..../...~.,d.J~ ..................................................................................... 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 ..../.~.{~..~..E~.~..... Rear ..... /.~.1~...~..A'.~...~. .......... Depth ...~..~.~..~..~..~.;E'.. ...... r40. Date of Purchase: ...~'~x~..~......~.8/.~..,~..../...~..~..'~.'- -- .......... Name of Former Owner ~..{~..~.~. ....... ~)~.~Z~..7,~. ............... 11. Zone or use district Jn which premises are situated ........... 4 ...... ~).~ ./.~..I.~.~. ......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...~.~. .................................................. 13. Name of Owner of premises ~j~£.e/~..~J~.k'..L~.~.....Address ~.~..Te...,~.$~£.r.~...,.~'~... Phone No.~;.~.~..-.~gd.~ Name of Architect ..~.'.~.,..~./J~.~.~.~.~,,~ ............. Address ....,~.~ff..;EP.~.A/~...~.:..~,..... Phone No. Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from prop~n',/ lines. Give street and block number or description according to deed, and show street names and indicate whefl~er., i?er or or corner at STATE OF NEW YORK, ~. c c COUNTY GF ....... n ....................... ~ .... .......... '..~.~.~ ......................................... being duly sworn, deposes and says that he is th ,pplicant ( /(Nar~(~ °f i~dVidual signing applicati°n) above ~-ned. He is fh'e ......................................................................................................................................................... (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 and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .... ..... dayof... ........ J...,_l/ Notary Public,/JLl~n~..~.:...'.~~m~. County / / ~ (Sifn~ure of applicant) Ho 52-3233120 Suffolk County \ fern Expires M.a[ch 30, "'