HomeMy WebLinkAbout3211-zF~M NO. 4
TO~FN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southolcl, N. Y.
Certificate Of Occupancy
;]~... THIS CERTIFIES that the building located at . llp~.t,l~. ~:-e-.~. ~,,t,v.q ......... Street
/
Map No..~ ......... Block No .... :~/....Lot No..~.~;..... ~-p.tli;l.~o.l.~ ................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......Sep~o..~.~ ..... , 19.~6. pursv_!~t to which Building Permit No. 3~.1..1~.~. .
dated ......Sep.~, .6e ........ , 19.66., 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 .. ?~a'm~.~..~. ~.~,~*~U-~..ch:.e~J, in.g ......................................
The certificate is issued to . .:.:.~',;:~ .!:c!., ?.o.b.t. :a.: ......................................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ...Dcl;P.d. 3oI~1;.. alit. ~-9~3 .by. R,. ¥tlla
UNDERWRITERS CERTIFICATE No.P..0..1)~. ?.-1~ .........................................
Building Inspector
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)
3211 z
Date ............................ ~t~;e~l:~..... 6..., 19..66
Permission is hereby granted to:
~114~,,..Tol~a.. &.. ~C't~_~;I.e t,t~e...Z~a~ .............
.................. lta~ ..... N'~.~.~. .........................
to ...~.. ~r.. ez~e.. ~'em~t~..~~ .................................................................................
ct premises located at ~-~..~]~.o~r:~lt,..~.--~l~ ...........................................................................
.............................................. ~m~.....~ ...........................................................................
pursuant to application dated ................................ ~[~1~ ....... ~ .......... 19~.., and approved by the
Building Inspector
Fee $.]J.~(~J ...........
BGi~aing ~hspec~ort
SUFFOLK COUNTY
DEPARTMENT OF HEALTH
SUFFOLK COUNTY CENTER
RIVERHEAD, NEW YORK 11901
September 20, 1973
Town of Southold
Office of Building Inspector
Town Clerk's Office
Southold, N.Y. 11971
ATTENTI(~: Howard Terry
Re:
Edward Tobia
n/s North Sea Drive
Southold, N.Y.
Dear Mr. Terry:
We have checked our files and cannot locate this Job. Since it
dates back to 1967, chances are we hav~ discarded the papers.
The water sample checks out satisfactorily; therefore, we have
no objections if you issue spproval for a certificate of occupancy.
Very truly you~.s, ,/1
Robert A. Villa, P.E.
Chief
General Engineering Services
" " ...3.,.~. !.. 1 Z
Approved ........................................ , 19 ........ Permit No .......... ,.,,
TOWN OF SOUT.OL. r/~ ,v~." ~,~- ~,,~.,,,~
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Application No..~.~..(..~.....~ ........
Disapproved a/c ..............................................................................................
APPLICATION FOR BUILDING PERMIT ~
Date ................................... Z..., 19. k.~
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 deta,iled description of layout of propertymust be drawn on the diagram which is part of this application.
c. The work covere~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 o 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~uilding code and~egulations.
~ ~ .~-' ~ (s,~.~,~o~op~,,~.o;'~;'~';",'~';~;;;;;~;~ .........
................ ....... .........................
, ,, '~ ~ (Address of applicant) 7/~
State whether apglic~t is owner, lessee, agent, architect, engineer, gene~ contractor, el~trician, plumber or builder.
.................. ............................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1.
Location of land on which proposed wor~. will be done. Map No: ............................................ Lot No: ....................
n r ' ~:~/ ' ~
Street ad .umbe ...~..... ,~. ,.,~.... ......... ~ ...............~. ......~ .................................................
~/ - ~ I ~ Municipali~
State existing use and ~cupancy of premises and intended use and ~cupancy of pr~osed construction:
a. Existing use and ~cupancy .......... ~.~ ................. ~ ....... ~ ...................................................
~. ,~,~d~d ~d occ~a~ ....__......__~ ...................................
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ..................
Repair .................... Rqmoval .................... Demolition ......... ~..-,rv~ ~ Work (Describe) ................. ~ ....................
4. Estimated Cost ..,....~.....,,~..,...~...O..~. ............................. Fee ................................................................................
(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 ........................................
......~..~.......~.. /./.-~Z/ ../;F; /0
/
Height ....................... __/i .... Number of Stories ......
9. Size of lot: Front ...~.Z~.~....;. ......... Rear ........ /./2~.....'.. ..... Depth ..... .~...~ .............
,0. Date of Purchase ..... ........... :- Nome of Trmer Owner .....
12. Does proposed construction ~alate any zoning law, ordinance or regulation? ..... ,,, .................... ., ..............
13. Name of Owner of p/r~/mises/':...~...~..~..'....../.....~.....~'..../...'~......Address .~...~...~..~...'.4~...'~...~'..~.....'...~....~..'..../- "~"~'~"~ ~?'~ 'J'~' Phone
Name of Architec~'~..'.~...~:..~~ ......... Address ..~..'.~....~....: ............. ................ Phone No .....................
Name of Contractor ...~..~....~...:.....~..~....4~..../..'.~... .................. Address ..~.~....~...~?..-~.....~....~...~.. ...... Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block numbers or description according to deed,' and show street names and indicate
whether interior or corner lot.
2o0
STATE OF NEW YORK, S.S.
COUNTY OF ................................
........ ' ......... being duly sworn, deposes and says that he is the applicant
(Name of individual signi~ng application) ,,:
...... ~ x-~,~'~~' ~ ~ ~
above ~med. ~e 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 and belief;
and that the work will be performed in the manner set fo~h in the application filed therewith.
Sworn to before me this~~~ ~~~~ ~ ~ [
............... / ......... ~,of .. .... ,19 ......
........ '"'"'"'"'"'"'"'""'"'"'""~ - ~ -~':,~'~LD,~ ~
Nota~ Public, ..t./..Z.~,'.~:~.~~.~unt~ 'i~'i"Z~ - (S'g atu e of app 'ca )
~ ~A~ PUBLIC, State oi Ne~rk
~ No. 52-061~]00 S~foTk Coun~
ommission ~p~es March 5~,