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Home My WebLink About4141-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnie Of Occupancy No. ~..35J-.~ .... Date .......... July. .... fl, ....... , 196.9.. THIS CERTIFIES that the building located at .~I/a, .Ot~:h~t~. g. eet. .... Street Map No ............. Block No ........... Lot No. I~.~Y~. ~.tl~O~-k .................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Decent~er .... 2 o.., 19.68. pursuant to which Building Permit No..4JL4~.. ~.. dated .... ;r~ecembe:c .... 2,..., 19.6[i~, 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~.iva~e .one, .fa~uily. i~.ellln~. .................................... The certificate is issued to ..... Daniel .Fo~ga:c.l:y .................................. (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Jul.y..2,. Jk969,. ~O~:,~..t;. V.it. 1. '4 .... TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) to ..~-~.~.W..~ .~:~; ~..~ ' ~ ' ~ Building Inspector. Fee ....................... Building Inspector $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. TO WHOM IT MAY CONCERN: at have been for a structure located The, sewage disposal facilities (Give deed location) inspected by this ~partment and found to be satisfactory. 1969 District Engineer District Engineer TOWN OF SOUI'HOLD BUILDING DI~PARTM~NT ToWN .CLF~IroS OFFICI~ SOUTHOLD, N. Y. Disapproved a/c ' ' ............ .... ~' (B ding Inspector) ~ L"~' '(Ill' ' ~ ' .................. APPLICATION FOR BUILDING P'F. RMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink .and .submitted in duplicate to the Building Inspector. b. P}ot plan showing location of l~t and ~ buildings o n premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of lay out of property must 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 applicati.~n, the Building In specter 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 o~ in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS Iik~l~ay MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~athold, Suffolk Oounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction cd build ings, additions or altm-ations, or for rentoval or demo- lition, as herein des(nibed. The applicant agrees to corn ply with all applicable laws, ordinances, building eode, housing cede, and regulations. (Signature ~f applicant, or name if a corporation) (Address~oi[ applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contraclx~r, electrician, plumber or builder ............... · ......... Name ,of ,owner of premise~ If applicant is a corporate, signature of duly authorize d .officer. (Name and title of corporate officer) 1. laoeation.of land on which l;rgposedwork will bedone. MapNo ~ ~ LotNo~...Xf~ Street and Number .... ..~//& ..... ~e~. o..~},_... ~'. iii. :. ii ~.'.,~.[ff..~. 3.. '/~~i Munimpality /~ 2. State existing use and ~ccupancy of pr~mises and intended use and occupancy of proposed construction. a. Existing use and oeeupaney .................................... ,_, ..... _. ........................ ntendedu and eupancy ' ............... ........ ............ 3. Nature of work (check which applicable): New Building ....~.... Addition ........ Alteration ........ Repair ......... Royal ....,.... Demolition ...~.,O_th?~W°rk (Describe).~..~ ....... 4. timated out ez (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 ..... ..~..O.... Rear .....~...O.. ..... Depth . i~-O .' Height Number of Stories ~ Dimensions ,of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of St~'ies ..................... 8. Dimensions of entire new construction: Front ................. Rear .............. Depth ............ Height ............ Number of Stories ............................................................. 9. Size of ~ot: Front . .~t..0~.. ....... Rear . d' O-O Depth / ~ O ~ 10. Date of Purchase ............................... N~meqof Fmu'ner Q.~ner ............................. 11. Zone or use district in which premises are mtuated. ~ ...... .~..~ ...................................... 13. NameofOwner.ofpremisesb.~'.....gl..~.?..]F'..O.~...~,-..-r'~... ~tr..i-.q~,,ddress~/..g...~lV/'~J',~-k~r~e'-~--~-~ PhoneNo ............ Name of Architect ........................ ~ .....~ddress ........... l..~' ........ Phone No ............ Name of Contractor .... ..~~ ......... Address ...................... Pkone No ............ PLOT DIAGRAM: Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street a-9. d block number or de seription according to deed, and show street names and indicate whether interior or comer lot. COUNTY OF'X.'~ff.~J~FL"~...~ . N · ......... ~..-~.....~.. ~ .......... being duly sworn, deposes and says that he m the appli- of"m ivid al signing ap t n) cant above named. He is the . .' ...... ~-~v,~.t. _:-.~..~. ................................................. (Oontractor, agent, em-porate officer, etc.) of said owner or owners, and is duly authorized tn 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 th.at the work will be perf~ned in the manner set fortl~ in the application filed therewith. Sworn to before me this Notary Pu bli c, ~~J-'~l~,~_~ '~a ~ ~'~T '~-~' ........ ~a¥ ?u~uc, state ot"~/'~ ~,ommission