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Home My WebLink About4113-zTOWN OF $OUTItOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy TIIIS CERTIFIES that the building located at .20~..Ga~.clila~a. l,a ...... Street conforms substantially to the Application fo? Building Permit heretofore filed in this office dated .......l~ov ........ t", 19.6~' p~rsuant to whic~ Building Permit No. dated .........IIov...~ ....... , 19. (~, Was issued, and conforms to all of the require- merits of the applicable provisions of the taw. The occupancy for which this certificate is , .: (owner, lessee or ~enan;) of the aforesaid building. Suffolk County Department of Health Ap] irova~ .~111~ .]. ~.. · ~ ~9.. ~.Y..l~,~ .~.illa. FOR~I NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT; TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4113 Z Permission is hereby granted to: ~outhold ~.:~. ~, ' to ..... ~. ~.. ~ .. ~l~...~e.L[~g ............................................................................... at premises I~ated at ........... J~/~....:~..~:~ ..................................................................... pursuon~ to opplic,tion dotod } ......................... ~.0~ .......... 1 ......... ......, 19~..., ond ~pproved by the Building Inspector. : S-9 SCHD SUFFOLK COUNTY DEPARTMENT O~ HEALTH Date Bldg. P~rmit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities fora structure located (Give deed location)~ have been inspected by this department and found to be satisfactory. Distriot Engineer District Engineer FORI~ NO. I TOWN 01: SOUTHOLD , BUILDtNG DEPAI~TMENT TOWN CLERK'S OFFICE Approved ........................................ , 19 ........ Permit No. ; Application No ............................. APPLICATION FOR BUILDING P, ERMIT Date ............. ~.' ......... ../. ............. ,19...~...?,.... INSTRUCTIONS o. 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 buddings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn ,,bn 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 issu~ a Building Permit to the applicant. Such permil' 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 p¢rpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the i,'.ssuonce 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 o terotions, or {or remora or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, ¢l~ousing co~e, and regulations. (SignatUre of applic0nt, or nome, if a corporation) State whether applicant is owner, lessee, a~ent, architect, engineer, genera( contractor, electrician, plumber or builder. If applicant,,J~a~~corporate signa~Jre of duly authorized officer, (Name and title of corporate officer) 1. Location of land on which proposed work will be docge ~....~...~ LatoNa.: ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o, Existing use and occupancy b. Intended use and occupancy ~~ , . 3. Nature of work (check which applicable): New Building .... f,K'..... ....... Addition .................. Alteration Repair .................. Removal .................. DernolH'ian .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~..~.~...~...~....~. ..................................... Fee do be paid on filing this application) 5. tf 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 Sf same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number oF Stories ................................ 8. Dimensions of entire new construction: Front ..... ~.~.. ..................... Rear ...~....~...~"-- ................. Depth ...~....O. ................. Height .'...~...~....~. ........ Number of Stories ..... ~ ................................................................................................... 9. Size of lot: Front ..... ../...~f~. ........... Rear .......... /.....~...~ ............. Depth ...~?. .................. 10. Date of Purchase ........................................................ Na_,r~e of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ....,/~....~..~..~ .................................................................................... 12. Does proposed construction viol~~, ~,a ~.~,/te any~ zonin law, ordinance or regulation;~ ...~ .. 13. Name of Owner of premises ~~'"....~..Address ...'.!~' .......... Phone No ................. '.'. Name of Architect ................. ~ .......... ~ ........................ Address ........,,.~..........~'....... ............. Phone No ..................... Name of Contractc~...'...~.'..~.~'. ............ 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 number or description according to deed, an.d show, street names and indicate whether interior or come, :vL ~ ......... ~ ................ STATE OF NEW YORK, ~ ¢ c COUNTY OF ................................ ~' .... ....................... .~ ....... bein§ duly sworn, deposes and soys that he is the opplicanl (Nome of individual sionin§ oppllcatian) above homed. He 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 forth in the application filed therewith. Sworn to before me this -- ~ , // CommisSion Expires March 30,, 1~,~7