HomeMy WebLinkAbout3798-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at ............................ Street
Map No ............. Block No ........... Lot No ..................................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .......... {..~....~-i.,~.',.~., 197.~!. pursuant to which Building Permit No..3..v.~.~'..2~
dated ....................... I '~ /xa a ~, 19.7~( ., was issued, and conforms to all of the require-
merits of the applicable provisions of the law. The occupancy for which this certificate is
issued is /~ 0 ~ k' F ~ ~'t ~ t '~' .]5 ka~ ~' /- L~ ~ ~.~ 6~
The certificate is issued to k~ A ~ ~ i ~ ~ ~ ~ I~ I. I ~ lq &9~ ~ t~ Ik
(owner, lessee or ten.t)
of the aforesaid building.
Suffolk County Department of Health Approval lq- D ~ ~/u ~, ~ * 9 I 9 (~ ~ 5'/ '~> V~k L ~
UNDERWRITERS CERTIFICATE No .............................................
HOUSE NUMBER ~ ~ -~ Street
Building Inspector
- · FORM NO, 2
TOWN O~ SOUTHOLD
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? 3798 Z
Permission is hereby granted to:
at prem,ses located at .~..,ll.,:.{~ee~,.le~es.{..~ies~ .......................................................
......................... ~.....~ee~a~,.-t~ ....... ~t~t ...........................................................................
pursuan~ to appl!?ation dated .............................. [~1~"'7~ ............... , ]9.:~., and approved by the
Building Inspector.
tee $..iO~ ..........
NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Tem~or~
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at ..l~..~.~t~f.~A~....~..~.~.~. .................................... Street
Green Aere~
Map No ....................... Block No ....................... Lot No...~2 ......... .(~r~eD~t~.....~.~.~.t. .........................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.................................. ~1~.~.. ......... .~.~ .......... , 19....~...~, pursuant to which Building permit No. ,~.~.~ ....
dated ............................ ]~1~. ....... ~,~ ...... , 19....~.8, was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ........
......... ~'.~,~.t~...~..~:J~....~.:L~ .....................................................................................
The certificate is issued to ..}/.~.~,.~...~..~.....G.?...~..~...]:.~...~.b. ......................... .~...~..~..e.~ ..........................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Date June 175 1968
Bldg, Permit No.
TO WHOM IT MAY CONCERN:
The sewage disposal facilities for
at Greenway West 1735' to main Road, Orient
a structure
located
(Give deed location)
Green Acres at Orient~ Lot 12
have been inspected by this department and found to be satisfactory.
Distriot Engineer
District Engineer
Builder-Owner - Martin Oramlich
BUILDING DEPARTMENT ~/~/~
TOWN C~RK'S OFFICE -
............................... , i~. ~ll~tion ~ ...........................
Disapproved ~ ..... ~ ........
APPLICATION' FOR BUILMNG PERMIT
Dato.... ................ ....... .............. . ......
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 showin~ 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 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 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 sh~ll 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, housing code, and regulations.
(Signature of applicant, or name, if a corporation)
Gte enw.a. . West Orient
(Address of applicant) ~3
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,~
...................................................... (~X~ ~....-.... ]~.~ ~l.~.e.~ ....................................................................................................... '~
Name of owner of nrem se~Mar~;:j-~ Gra~lieh
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
M--,.- Green Acres - 12
1. location of land on which propceed work will be done. ---ul~ ,~u.: ........................................ Lot No.: ........................
Street and Number .... .~i~.~.~I~....W..~.~..~ ....... ..0.~.~...~ ...........................................................................................
~ (-- ~> ~ Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .~..~.c&~.t 1...a.Ll.d .
b. Intended use and occupancy oD.e fsJ~'i]_~, cl. we'lliz~g
3. Nature of work (check which applicable): New Building .~,~E,,~ ....... Addition .................. Alteration ..................
Repair .................. Removal .................. Demolitian .................. Other Work (Describe) ........................................
4. Estimated Cost ..!..1..0...q.0.....~.. ...................................... Fee ...1..~).~.~).0. ...........................................................................
(to be paid on filing this application)
.5. If dwelling, number of dwelling units ...o..~....e. ................... Number of dwelling units on each floor ............................
If garage, number of ca:rs ........................................................................... :: ................................................................
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 c~lterations or additions:. Front .................................... Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ...... ~8. ........................ Rear ..,,~.8 ..................... Depth ....~,~ ...............
Height .................... Number of Stories ....... o.-~e. .......................................................................................................
9. Size of lot: Front ............................ Rear .................................... Depth ................................
10. Date of Purchose ........................................................ Name of Former Owner ........................................................
1 1. Zone or use district in which premises are situated ....~.t.~....~.~.~ ..............................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ...... D,(~ .................................................
13. Name of Owner of premises ..~........G.?...~..~...~.~..~...~. ............. Address ....0.~.~f~.~ ........................... Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ............. .s....8~...e. .............................. 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 number or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NL:V~YO~K, ! S S
COUNTY OF ..?...~.~..~i.O..'..J-~.. ............. ~' ' ·
............................ ~,~'.~.i~"t..~s~]_i.~.h ................................ being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ................ f)~J:~e~....-...]~Ll, cle~z' .....................................................................................................
(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
Noto Public, Coun
L MAR~ON A. E~GE;~T
~.NOTARY PUBLIC, S'.at3 of New ~3rk
~o. 52-3233120 Suffolk Count~
Term Expires March 30, 19_~