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Home My WebLink About3230-zFOI?JVI NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. CE:RTIFIBATE: OF OCCUPANCY THIS CERTIFIES that the building located at E//I .Rambler. Rd ............ Street Te~'ry ~aters Map No ............. Block No ............. Lot No. '2] ..... 2~o~Cho'ld ................ conforms substantially to the Applicati,on for Building Permit heretofore filed in this office dated .......... .8.e.p..~ ..... .3'.bf..., 19..~.({. pursuant to which Building Permit No..32.~0. Z dated ........... ~.Sp..~ .... 2.0..., 19.(~(~., was issued, and conforms to all of the require- merits .of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P~v~2e- · -one · f~if:y' uhce211llg ...................................... The certificate is issued to ~t:PI~ S(~il~p~.~. .~.. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~;~.. ~/....~]~ ................... TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~HOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ O N- 3230 Z Permission is hereby granted to: at premises located at ;J.Jj~..Jj~j ....... ~JJ~...Tji~ ...................................................................... ...................................... ~e,t~...;llx~mt~ ....... .~'~,~,341,t.:1l,~,, ....... : ......................................... pursuant to application dated ......... : ................ ~J41]Jtj....,;j~.', ........... , 19.t~.., and approved by the Building in{pector. ' Building Inspector / S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) / have been inspected by this department and found to be satisfactory. District Engineer FOII. M NO. 1 Examined ......................................... 19 ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................ 19 ........ ermit No ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th~s cpphcat~on must be completely filled m 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, relattonship to adjoining premises or public streets o areas, and gw~ng a detoded description of layout of propertymust be drawn on the d~agram which is part of this application c. The work covered by this application may not be commenced before ~ssuance of Building Permit=. d Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the apphcant. Sucl 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 m part for any purpose whatever until a Certificate of Occupanc,. shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to th.- Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulahons, for the construction of buildings, additions or alterahons, or for removal or demolition, as herein described The apphcant agrees to comply with all apphcable laws, ordinances, building code and regulations. ......... ........ (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................................................................................................................................................................... Name of owner of premises ..~.~.~...4/r.. ....... .,~'..(~./...~...~'.~...~..../. .............................................................................. If applicant ~s 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: ~/~..~..L~.~'.~.~.~ .......... Lot No: Street and Number ........... ,.~..~..~'..~.~./..~. ................................................................................................................... Mumcipality 2. State ex~stJng use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ................................................................................................................................ b Intended 3 Nature of work (check which applicable): New Budding ..... ,2~ ......Addition ................ Alteration ................ Repair .................... Removal .................... Demolmon .................... Other Work (Describe) .................................... 4 Eshmated Cost .,~..~...~..~....~..~ .................................... Fee ........................................................................................ (to be pa~d on flhng th~s apphcation) 5. If dwelhng, number of dwelling units ......... ~. ............... Number of dwelling umts 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. D,mensions of existing structures, if any: Front ..... .'~...~ .......... Rear .... .~.....~.. ............ Depth ...~.~....~ ........... Height ........................... Number of Stones ............................................................................................................. D~mens~ons of same structure with alterations or aod t ans. Front ................................ Rear .............................. Depth ............................. Height .............................. Number of Stories ........................................ 8. D~mensions of entire new construction' Front .....~..:~.. ...............Rear ............................ Depth .......................... Height ....... ],~¢~....~ ........... Number of Stories ........ ./. ................. 9. S~ze of lot. Front ...X...O....o.. .............. Rear ..... .Z..~..~. ............ Depth .../...¢~..¢.~.:..'.~....Z. ...... 10 Date of Purchase ..~..~-~/¢L~.. ......,Z..~....-......~.~ ........ Name of Former Owner ./~.,~-.~..~..,~...~.....~.~../~.~./.' ]1 Zone or use d~stnct in which premises are s~tuated ...... ¢/~.~.~.., ........................................................................... 12 Does proposed construction wolate any zomng law, ordinance or regulation? ....... ~...~. ............. , ..................... 13. Name of Owner of premises/.'/~.~/~.~'. '~'~-" ~.. ~.~.)f:..! Address ~' ~.~.~'.~..~..~./~..../~....~.~...~~'.~'~.,~.:.~.~.£.;~ Name of Architect .~. ..... .~..~.4~..~....~... ........................ Address ...~..~mr./~'.~.~.~',~.4~ ...... l/..¢'. Phone No ................... Name of Contractor ~.~.~¢.¢...,~.~/~....~.~.xY.d....~....~'.~...~.Address .~..2.¢....°....~.N.~.!~ .~. ........... Phone No. PLOT DIAGRAM Locate clearly and distinctly all build[ngs, whether existing or proposed, and indicate all set-back dimensions fro, property hnes. Give street and black numbers or description according to deed, and show street names and indical whether interior or corner lot. STATE OF NEWaYO,~,~, ~ ! ~ S S COUNTY OF ~-~.}i.'~ ...... ............. ~ ....,_~,7 ~ ~....~..~~. .......... being duly sworn, deposes and says thQt he s the app ca ..... (Name of indivi~/ual s~gnmg appl~a~/on}~ above named. He is the .......... ~>. ..... ~ ..................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and f th~s application; that all statements contained m th~s application are true to the best of his knowledge and beli~ and that the work w~ll be performed in the manner set forth ~n the application filed therewith. Sworn to before me th,s (2 .......... ...... . day Notary Pubhc~~~_ '_ ~Count¥~'"~'"~rT""~'~i'~'~~'~'n~t')'''~~ ........................