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Home My WebLink About4047-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No...Z..3.48.8. ... Date ............ 14~.... IS, ..... , 1969.. THIS CERTIFIES that the building located at RoIoinaon. Lane ........... Street Map No. Peconic Block No.. ~ .Lot No. paz:t. 3..& .4,..l~ecor~lc,. ~,¥,.. 'l~i~' ~1~' ' ' conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ $ .ep.t..e~lg~.. ;K..1-6, 19.6.8. pursuant to which Building Permit No. 40~7. Z.. dated ........ 8. eP~....e~:Le...r..!.6~, 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.r..l.v.a.t.e...on.e...~..a~.i..1y...d~..e.l.l,l.r~9 ...................................... The certificate is issued to . Charl~*a. Slama ....................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . I4a¥. 13 o. 1.~69,. Rober. t .Villa... FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~0~? Z Permission is hereby granted to: .~..$i~er~..~.~....~t~.~:l~J~ ......... ................. .g.~t~l~ ......................................... to ~.~...~...o~..~..~w~z~ ................................................................................... at premises located at .....~..~.~.t~l~. ........... .~..~t,..:Le~. ....... ~ellJll~li..J~..J~ ....................... ................................. ~ .~.......~.~..~.....~.~.~.~ .......... I1.~., ............................................... pursuar~t to application dated ........................ J~.~ ....... .J.~ ............... , 19..~J~, and approved by the Building Inspector. Fee *.!~.:.~ ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permi o. ?%9 TO WHOM IT MAY CONCERN: at The sew. age disposal facilities for a structure located (Give deed location) ~U have been inspected by this department and found to be satisfactory. 1969 District ~lnee~ District Engineer BUILDING DEPARTMENT TOWN CLERK'S OFFIG~/~ SOUTHOLD, N. 19 ........ PermitNo. tZ0('t/7 ~ ~ ~ ~ ........................................ , .............................. ~-'az~ ~ .~v.~,,~ ,~/~,~ ~ APPLICATION FOR BUILDINO PERMI~/~ ~ ~ ~ ~ ~ ~,_~ . .~ 4,1~~ ~-I~ ~ .~ . ................. ................................... , ........ a. This application must be c~pletely fill~ in by ~ewriter or in ink a~submiffed in d~licate to the Building Insp~tor. b. Plot plan showing I~ation of I~ and of buildings on p~mises, relationship to adjoining premiss or public struts or areas, and giving e detailed description of layout of prope~must be drawn on the diagrum which is ~ of this application. c. The work covered by this applicati~ may not be commenced before i~uance of Building Permit. d. Upon approval of this application, the Building Insp~tor will issue a Building Permit to the applicant. Such permit shall be kept on the presses available for insp~tion thr~ghout the pr~ress of the wor~ e. No building shall be ~cupied or us~ in whole or in pe~ for any pu~ose whatever until e Ce~ificate of ~cupancy shall have been granted by the Building Insp~tor. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with oll applicable lows, ordinances, building code and regulations. ..................... (^d~lress of' pp i'~ "'ii' ................ ~t .... State whether applicant is owner, lessee, agent, arc%acer, general contractor, electrician, plumber or builder. If applicant is o corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ...................... ~..~.. ..... Lot N,,: ..~...E4..~....~.. · Street and Number .~. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Ex st n~ use and occu-anc' ~~ P Y .......................... zz;...~..~...~'..'.~ .............................................................. ... .......... 3. Nature of work (check which applicable): New Building / Addition Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ................. ..~..O....~:.....c~.. .................. Fee f O (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... ~.. ............. Number of c~wellJng units on each floor ...~.....~,. ............... If garage, number of cars ..................................... ~.. ............................ i ..................................................................... 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 ............ ~/.2...~/. ...... Rear ..i....Z?.57~..~.. ....... Depth ............................ Height ............. .~. ............ Number of Stories ............................ 9. Size of lot: Front 5'c) Rear ............ ./..~.~.~.. ........ Depth ........ .~.......Z .......1- 10. Date of Purchase ........................................................ Name of Former Owner ............. £/~. ...................................... 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...:....~..~ 13. Name of Owner of prem,ses ..... h....~ .............. ~ ........... Address .......... ~/~G.~ .................... I.~.. J~o · No ................... · ~ c ~s v S,~.c..~... ................... ~hone a ..... Name of Arch,tect .....-~..' .............. .~.......~. ...................... Address ...~....¢. ..... N ................ , n .................... Name of Contractor ....................... ............... Address ....... .~..~zl.~.~..~li. ................. I~o e 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 numbers or description according to deed, and show street names and indicate whether interior or corner Jot. ~--e z., ',,a' ~Pa t.,- 5'~'1+- duly sworn, deposes and says that he is the applicant above named. 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 · .. 1,6.. day.of ...... .................. c_:,- , 7 .... ~ '"~ .74~,~ ~.-~b~;~&S.....,, ........... ~ .......... ~ ............................