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Home My WebLink About3009-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 . .Albo .Drtxte .............. Street Map No. X-~ ......... Block No~,~.. ....... Lot No. ~X~ .--Laurel..N,~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... }~ ..... ~ .... , 19. ~6. pursuant to which Building Permit No. dated ........... gg~.... 3 .... , 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 . P~4va~. one..~am&.l.7, aw~ 1t~ng ....................................... The certificate is issued to .Ra3r~ond. K~ogman ....... .~,~a~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ,.. ~%-. 2~, ~9,69, - h~ .R.,, .~11~ -. FOI~I 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? 3009 Z Permission is hereby granted to: to ..... B.u~l~..n~.~...~...fa~J,l~..d~e~ng ............................... ; ........ ~ ......................................... ~ ;~4; -~u,,~,nu~ ~ ,,ns~ec.o. ~ SUFFOLK COU~f~ DEPARTMENT OF HEALTH Date Fldg. Pe~it No. ,~ 0 0 ~ '~- TO WHOM IT MAY CONCERN: The sewage di__sposal facilit~s for a structure located at (~i~'e deed location) have been inspected by this Department and found to be satisfactory. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT ............................. . ..... 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 detoi~ed description of layout of propertymust 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, building code and regulations. (Signature of applib,,a'nt, or name, if a corporation) / ' (Address of apl~cant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, 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 work will be done. Map No: ............................................Lot No: ~.Z.~....~..z~ Street and Number 4~...~..'~O ~'~/~' .,.~.~....~...~...~...~....O.~... ................... '~/ -- ~7/.~0 Municipality 2, Stote existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended useandoccupancy ......... ..~..~../..~...~....~.....~.. ........... ~.~.,,/...~....~.],~.,,~.,.~ ............................................ 5. If d~ If gc 6. If b, 7. Dim~ Heig Dim~ Dep 8. Dim Hei,c 9. Size I0. Dot~ 11. Zen 12. Doe: 13. Nan Nan Nan property whether int , J Nob re of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repc ~r .................... Removal .................... Demolition .................... Other Work (Describe) .................... ' ................. Estin~oted Cost Z 6o0 ~ .~...~...~I.-L Fee ............................................................................. (to be paid on filin~ this application) ,el[lng, number of dwelling units ...... ~. ................ Number of dwelling units on each floor ............................ rage, number of cars .......................................................................................................................................... ~siness, commercial or mixed occupancy, ~pecify nature and extent of each type of use ................................ ~sions of existing structures, if any: Front .......................... Rear .......................... Depth ............... ' ............. ~t ............................ Number of Stories ........................... :.:..... ................................................................ ~ ............ nsions of same structure with alterations or additions: Front ................................Rear ............................... .............................. Height .............................. Number of Stories ........................................ ,sions of entire new constructiop: Front ..... ~.~ .............. Rear ...... Z~ ............. Depth ........................... ~t ............................ Number of Stories ........... ~ ............ ~ ' of Purchase ........................................................ Nome of Former Owner ....................................................... or use district in which premises are situated .................................................................................... : ............. proposed construction violate any zoning law, ordinance or regulation? ......................................... , ............. of Owner of premise~/~..~.~ress ~~~. Phone No. o~ Architect ............................................ , ......... Address ............................................. Phone No ........; ............. of Contra .............................................. Address .............. Phone No ............ PLOT DIAG~M clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from es. Give street and block numbers or description according to deed, and show street names end lindicote STATE OF, NEW ]/'ORJf,,,. ¢ ~_~ ] S S COUNTY~.~, ~~¢~;~F ..~...~..~,Jk '' above nan ,d. He is the ................................. (,.,¢r~¢~,~.~_~,.. ......................................................................... i ............. / (Contractor, agent, corporate officer, etc.) ' of said owner or owners, and is duly authorized to perform or have performed the said work end to make land file this opplic=tion; that all statements contained in this application are true to the best of his knowledge and belief; and that ~e work will be performed in the manner set forth in the application filed therewith. Sworn to ~,~,~me th~s , .............. ¢. ~ ....... day of ..~ ............... , 19.~...~..,~ _~~2 //')., n. ....... ...... .............. Notary PL )IFc, .~.~..'..~..f~%../.¢..~...~~., ,~'~t?.t .~ef~($~rnat~ of applicant)