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Home My WebLink About3979-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z. 3860 ..... Date .......... ~].y.... ill. ...... , 19. ~O THIS CERTIFIES that the building located at ']~i~ 'Mt,~ 'Cl'eek' DF ...... Street Map No. ~X ......... Block No.. X~ ...... Lot No. 'T~ .... ~th~ll' ' ' lq;][;, ....... conforms substantially to the Application for Building Pemit heretofore fried in this office dated ........ &il~ ..... ~[ ...., 19 6~' pursuant to which Building Pemit No.. 397~Z. dated .......... Aug ..... 2--', 19 (~8', 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 .... Pl, ivat;e .oae..ff.a~l--12r. ~lw~l,~irig .................................... The certificate is issued to . IglLl-t~a. &. 6hol'~. Sh~l'at~ ...... 0wrlol's ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ju~y.. ?.~. · 19~0 ' · · 1~¥ 'R'.' 'Vil~l.a .... .......... House 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) N? 3979 Z Permission is hereby granted to: ........... ~ · .l~3A~e-.l~e ~'a~e~ .&.. ~.~'~ ............. .............. ..................................... ................ G~eer, poa~t .......................................... to .... Du$-td. · .ney. · erie - · i'aa~it,y .. dve~.tts~ ................................................................................ at premises located at ..... -N/~-....~J.e..,¥,.~.~.~--~.I'OI~..~)I*'~'~ ............................................................ .............................................. 'So~tho'l.d ............ lq'~'~'~ ......................................................................... pursua~¢ to application doted ......................... &ti~ ....... ~ .................. , 19.~., and approved by the Building Inspector. Fee $10~,O. CJ Building Inspector / SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~ Bldg. Permqt No. TO WHOM IT MAY CONCERN: at The sewage disposal fac~,lities for a structure located (Gi~ deed location) have been inspected by this department and found to be satisfactory. D~Striot Enginser ~....~ · Distric~ Engineer a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showin.~ location of lot and of buildings on premises, relationship to adjoining premises or pu. blic streets or areas, and giving o detailed ~description of layout of property must be drawn on the diagram which is part of th~s application. c. The work covered by this application may not be commenCed before issuance of Building ~ermit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the app cant. Such perm t 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. APPL CATION S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Bu Id ng Zone Ordinance of the Town of Southold, Suffolk County, New York, ondl 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 oil applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or nome, if:a corporation) ......... · ....O ee or.t ................................ (Address of applicant) State whether applicant is owner, less~, agent, architect, engi.n~r, gen~rol contractor, electrician, pluml:~r or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of cOrporate officer) i 1. Location of land on which proposed work will be done. Map No.: ........... ~ ...................... Lot N~ ................. ]I/S W. Creek Drive Sout old Street and Number .~ ................................... ~ ................................... ~ ........................................................................ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy .......... ~,~.IL1R~,~'...~)f! .~,1,~ . . . 3. Nature of work (check which applicable): New' Building .:....~"'~'~"~. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..~,~00~..~. ...................... ~ ............... Fee ....l~e00 ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ OM ......... 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 ................................ 8. Dimensions of entire new construction: Front ....... 68 ........................ Rear .......... 68 ............. Depth ....... 2~,,/~ .... Height .................... Number of Stories ........ ¢~.e ............................................................... ~ ....................................... 9. Size of lot: Front ..... '~00 ................ Rear .' ....... .~00 ..................... Depth .....~.~.O/....'L~9 ......... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ~ # 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~no. ............................................. 13. Name of Owner of premises .~/~...~,~,&~a ............ Address ........ G~'~t~t~.~ .............. Phone No ..................... Name of Architect ...................................................... Address ' Phone No. Name of Contractor .~.e...~d~l,~)D~ ............................. Address ....~&~¢;~bl~ .................. 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 blocl number or description according to deed, and show street names and indicate whether interior or corner lot. I STATE OF NEW,.,YQI~K . 1 ¢ ¢ COUNTY OF ...Jl...tl~.~.~,,,~ ............. .f"-'-'"'. ................................... · ~,t,,~,,~.~m..~-.~t~O~ ...................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .......................... (~/'~ ................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed tJi~) said work and to rnoke and f e this application; that all statements contained in this application are true to th~fb~st of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed~e~with. , Sworn to before me this ~,,,.-~J/ / .................. day of ................... .......... , / ' ·. Notary Public, ..'.~~iD.~:~L~.',~ ............................. FHE NEW YORK BOARD OF FIRE UNDERWRITERS BURIFALI OI= ELECTRIC~TYY .......... ~ .... Ho~e~ber ZS~ 19~'~ · -'t ~.I '- 6~lr 'L00a.mp. ~., ~ F.This eertlfic&te Q~W~omPl'lance at the date of of ~nusu~l"~ironments It is advisable ~e~t ancl/o~ ~epai~a w~de by a qu~ll£1ed pe~a.on. 11971 THE NEW YOR< BOARD OF FIRE UNDERWRITERS ..... ~o,.,~a~r 5, ~.976 ,;,~..,..,..,,,~,~.,,.,,.,,. 88.5377 N ~-:~ ~' ~X~ . - ........... ~' ~.~. ~,~ T--~.~'-~ ~' '~ ~'~,; :--r-~ :.~'~: :::'~" ~ ~'F-- *.- ~ '~-~ ~- ':=~: ~,e~,~,.,. o~%" :i.--/+. 57~!/Y/Pt. ~l=or lielCe~