The URL can be used to link to this page

Home My WebLink About4041-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z 351L .... Date ......... ,tune ..... 23¥ ..... , 19.62 THIS CERTIFIES that the building located at . I~,/S. Cox. Lane ........... Street Map No ............. Block No ........... Lot No.. Cutcho~ue,. l~e~. Ifolrk ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... kpt, eml~z.. 1.3,., 19 f~8. pursuant to which Building Pemit No. 4/141. Z.. dated .... 8aptesal~z:.. 1.3,.., 19.68., 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 ..... husinaas, building .............................................. The certificate is issued to .... C, eoxge, i~hlexl ..................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 3~n~. 20,. L969,. l~oh~r.t .Vffia... ....... l li g'inspector '] ..... ~l~g Pe~t NO. SUF~OLX COUNTY ~PARTME~T OF HEALTH Riverhead, New York TYPE OR PRINT LEGIBLY IN INK ' · · ' ~ealth Department l~n No: App!!oation for Approval of Commercial Sewage Disposal S~tem TO: The Suffolk County Department of Health Date ~ Application for approval of commercial sewage disposal system is hereby requested. (Name a~d side of street, and name and distance to nearest intersecting street ~amlet Village T~wn I hereby certify that this commercial sewage disposal system has been con- etructed in accordance with plans approved by the Suffolk County Department of Health on (date) and with all the requAre~ents of the latest b~11etina on sewage disposal of the Suffolk County Department of Health. Applicant's Signature Title Address ~A--*alt~,~.--~-~-~i~~--Tel.NO. Heady for inspection FOR USE OF ~.ALTH DEPARTMENT ONLY L,~apected by~ Installation satisfactory - Yes Based on the information stated hereon by the applicant and other information mode available, it is the opinion of this Department that this system with proper · aintenance can be expected to function satisfactorily and is not likely to cause a nuisance, provided designed sewage flow is not exceeded. Structural features are not included. ~~ ~. ~ 6/ 8 Examined .....,~....._[i...T........!....~.~IL,~ ............ , .... Approved ........................................ , 19 ........ Permit No .................... ~....~ TOWN OF $OUTHOLD ~/. / _ , BUiLDiNG DEPARTMENiY/~:¥~,~- ~-.,.~, '-~-z~.~- ~/,--.~,'/~' ''~ ~ TOWN CLERK'S OFFICE ~ ~ '~""~ ~ ~ ~ ~ SOUTHOLD, N. Y. ~6Pplicati~ No..~..~..J. .......... 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 detailed 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 ......... '('"'~'"'"ure of appji ............. i" ....... ...................... ........ ............. r~ame or owner o p .................... =.~...~...;~<~ ................. , ............... ,..~ ..................................................................... if applicant is o corporate, si§nature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ............................................ Lot No' . ...... Street and Number ...,~...5....~. ....... .~.O...0..(..~.....1~'.. ................ ~..~.. ...... ~ .......~,~ .... ~ Municipality ..................... ~ ..... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................. b. Intended use and occupancy ................... ~...~"....,....~.....~ ............................................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost .......... .~..O..,..O...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 .......................................................................................................... ~ ........ ~/p~. ........ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of exJstlng 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 .......... ~.O.. ............ Rear ....... [~.~.. .............. Depth ........~...~.. .............. Height ............ ~ ........... Number of Stories ......... ./. ................. · 9. S ze of lot: Front ........~.~.. ........... Pear ......... .~..:~.~. ............ Depth .......... /.~..5,..~.. ........... ~ 10. Date of Purchase .......... ..~'../../..5'..~..~.. ............................ Name of Former Owner ...... ~......~ ............. 1 1. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...................................................... of Owner of premises ....~......~..*~ ............. AddresS ...~..~..~...~-:F~.~.:.Le.?.....~..~....C.u...~one_ __ -- No..~..~.?.....~..~.../..O. 13. Name · No. Name of Architect ................. .~.....~..( .................. Address Name of Contractor ~ .C..o. ....... d~..~.~ ~.~.. --" .................... ~aaresS ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions fram property lines. Give street and block numbers or deSCription according to deed, and show street names and indicate whether interior or corner lot. 7¥ 75' STATE OF NEW YORK, ~ ~ ~ COUNTY OF ............................... ^[/'~' ......................... ~ ...... "~ ll/¢~ ................................. being duly sworn, deposes and says that he is the applicant (Name of ir,~vidual Signing application) /~,~_ ~ ]~,~'~,~-~-- above named. He is the ......................~ ..................................... . .~......~...~..~ ..................................................................... (Contractor, agent, corporate officer, et;c.) of said owner or a~wners, and is du'ly authorized to perform or have performed the said work and to make and f · this application; tlnat all statements contained in this application a.re true to the best of his kr~wledge and belief; and that the work. will be performed in the manner set forth ~in the application filed therewith. Sworn to befc~e me this f) , ! .......... · ~./~... day of ..~...., 19..~.~'/ /~,, -' ~ ~ , ~,~r~F~.~.~......-?~...~ ........ ~ .................... ~ .... Notary Public~.f~.~..~~, ~te of New York (S~nature of applicant) /'! '1~o. 52-323~120 Suffolk Countg. (./ Term Expires March 30, Ii , ;~.~ 'l° ,ti ! II