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Home My WebLink About4057-zFORM NO. 4 TOWN OF SOUTHOLD BU'H,B]NG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .. J~hl~. ~ .......... Street Map No...x~. ......... Block No .... ~t~ ..... Lot No..~1~... ~h.~.]~. ~.~lt~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............8.qp.~....~0.., 19..~.. pursuant to which Building Permit No. ~.. & ~Z $/~0 dated 19..~ff. was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...~..~Y~ .~....~.~....f...~.. ~..4.~. ~ ..t~. ...................................... The certificate is issued to . .~.a..t.~...~...&..1~.. ~..e..~g ..... .0~.. ~.~ ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~.p.l' .~..?~..¶.~9...l~y..R.:'. .~.J,~,$... UNDERWRITERS CERTIFICATE No ..... I~ ............................... HOUSE NUMBER....~..~ ........ Street...1~.~ .~ ........................ Building Inspector / FO~ NO. ~ 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) NV 4057 Z Dote ......................... ~ ~,!B:~e ......... 2(~..., 19..~8. Permission is hereby granted to: ~. atriek ~r~i$ . ~outhold to ~..~..~l.¢ ..~..e.w...~... ~.~1~... ~eal:Lt~ ..................................................................................... at premises located at ....... ~.~.....]~I. IP~IBtJIJ~..~IKt~ ......................................................................... Southold pursua:nrc to application doted ........................ JJ~p.t, ......... 20 ............ , 19~.., and approved by the Building Inspector. Fee $..1.~.~ ........... Building Inspector FOB3~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TIlt I'OAAIZ Certificate Of Occupancy No...S. 34~$... Date ........ M~y..~, ............ , lg6~. THIS CERTIFIES that the building located at . ,l$~ml~l .ROml ......... Street Map No ............. Block No ........... Lot No ..... ~t~o3~l,. Illin. Yazk.. ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~eptlmbelr...20,., 19 .~8. pursuant to which Building Permit No~7. ~.. dated .... ~ept. m~... 20,.., 19.68., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. i~.$vate .mm .~,~L~y. d~ell~g ...................................... The certificate is issued to . .Pat.~ge~. & .M~t~ .¢aX;g~,g.... ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · .&l~. 7.,..~,~.~.,. 1~.~.~..V.$],.1.~. .... .~...~..~. ~.~f.~.../.~: ./...~.. :~ .... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH i%9 I~P~ -8 [IH I0:09 DF ~;,RI"MENT OF HEALTH RIVERHEAO Bldg. Permit No. ~O5~7~ TO b/ROM IT HAY CONCERN: The sewage disposal facilities for a structure located '(Give deed ~ocatton) have been inspected by this department and found to be satisfactory. ~1~ 1 196§ District Engineer District Engineer TOWN OF SOUTHOLD ~I/~. o BUILDING DEPARTMENT TOWN CLERK'S OFFICE 19 6~:""-SOUTHOLD, N.Y.:~, ........ App,cation Appraved ........................................ , ~ ........Permit Na ......... pi,approved a,c .............................................................................................. :...: - ............................................................................... ............................. APPLICATION FOR BUILDING PERMIT a. This application must be completely filled in by ~pewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing I~atlon of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of prope~must be drawn on the diagram which is pa~ 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 Insp~tor will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for in,action throughout the progress of the work. e. No building shall be ~cupied or used in whole or in pa~ ~or any pu~ose whatever until a Cedificete 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 applicant, State whv eethr applicant is owne'r, lesse;;ag~nt, architecfr"~"-~'el~gineer, ................... if o corporation) 03 ;.. ~..77 .~'...~.g,~ ......................... -4 applicant) ~. contractor, electrician, plumber or builder. C7 If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land be done. Map Nos .: .......................................... Lot No: .................... 2. State existing use and occupancy of premises and intended use end occupancy of .proposed construction: a. Existing use and occupancy .......................................................................................................................... ;;-. ..... 3. Nature of work (check which applicable): New Building..................~ Addition .................. AlteratiOn .................. Repair .................... ~,moval .................... Demolition .................... Other Work (Describe) ...................................... · ~'1 ~p . . 4. Eshmated Cost ......... Z~t~..~.. ........................................ 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 ....... /. .................................................................................................................................. 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 .............................. Numbe~ of Stories ........................................ 8. Dimensions of entire new construction: Front .......~..,"~. .............. Rear ....... .~..~. .............. Depth ........~..~. ............... Height ............................ Number of Stories ...... ~, ................... 9. Size of lot: Front ...... [..0.~..d~.... ..... Rear ....... -/.~.~ ............. Depth ......... ..~...c/..~ ............. 10. Date of Purchase ........................................................ Name of Former Owner .~.~...~..~...~P.L.~.~... .~...~.~.~..~... 11. Zone or use district in whiqh premises are situated....../~....~./J~..~ ./~..7~./~...~. ........................................................... 12. Does proposed const,¢uction vi~late any zoning law, ordinance or regulation? ......... ..~.....~. .................................... 13. Name of Owner of premises .?.~.~:~.~.~/'~.~4E...~..~.~.r.e. Address ....?~.~'4;~.,~'m'~.e.r~. Phone No. ~'.~.~..~..~.~.. Name of Architect ...................................................... Address ............................ ................ Phone No ..................... Name of Contractor ...... ~ ..............................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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. D~'cK e'~' STATE OF NEW ~)RK, ffff ,ff,~.'( ¢ ¢ COUNTY/._~~OF ~ ~~ ..~ ............................ being duly sworn, deposes and ,ys that he is the applicant ............ (Name of ~n~ivid~l ~plicatio~ above ~med. He is the ................ ~ ~~ ............ ~~ ..................................................................................... (Co~,qctnr, - ......... '" ' ~m, and is duly authorized to perform or have performed the said work and to make and file this applic~ionLthat 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 ~ me this ..... ........... ............ ............ ............................. // R~ng in Suffolk ~un~ No. 52-3041000 ~mission Expires March ~,