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Home My WebLink About4546-zFORM NO. 4 TOWN OF SOUTHOLD BUHDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 7. 5807 THIS CERTIFIES that the building located at .~/endy. D~.~.ve..(.I?V~ ,~)... Street Map No. R.O.3'~...t~.. O~l°ck No ........... Lot No. '1 ..... Lau2..e'l .....E o~'.. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Nov.,... 6 .... , 19..69 pursuant to which Building Permit No.. ~.~b~6~. dated ......... ~o.v. .....7. .... , 19.69., 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~..i.v.a..t.e..o..n.e..f.a..m.i.ly...d.~.e.l. 1. i.n.g ..................................... The certificate is issued to . ~er~ar~ .~.e. lbeck ....... 0tenet. ....................... (owner, lessee or tenant) of the aforesaid building, Suffolk County Department of Health Approval East...1.1%..1.97.0...by. t~, .V:~l.la .... HouSe ~ 16~ Building Inspector FORM NO. :8 TOWN OF SOUTHOLD EUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4545 Z Permission is hereby granted to: pursuant to application dated ......................... ~ ......... ~ ............... , 19.~1~., and approved by the Building Inspector. APPLICATION FOR BUILDING PERMIT .................... ......... .......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot p!.an sl~wing location of lot ,*nd of buildings on premises, relationship to adjoining premises or pub c streets or areas, and giving a detailed description of layout of Property must be drawn on the diagram which is port of thie application. c. ' The work covered by this appljoation may not be commenced before issuance of Building Permit. d. Upon' approval of this application, the Building Inspector will issue a Bud ng 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 aP ih 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 Count, New York, and other applicable Laws, OrdinanCes or Regulations, for the construction of buildings, additions or alterations, or for removal or demo t on, as herein described. The app cant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. i¥';"~;~';~i~'~' ........ ...... ~^ddre~ :;F~;';ii~;:;:~i ~ .................... State whether applicant is owner, lessee, agent, architect, engineer, general controctor, electrician, plurnber or builder. Nome of ~ner of prem s~ ......................................................................................................... ;..~ ..................................... If ~licant is a co~orote, signa~re of duly au~orized officer. (Name and title of co~rote officer) 1. L~ation of land on which pm~ed work w ~ done. Map No.: ..... ~ Lot Nh. MunicJ~li~ 2. State existing use and ~cu~ncy of pmmJ~s and intended use and ~cu~ncy of pr~ con~mcti~: a. ~isting use and ~cu~nw .................................................................................................. b. In~nd~ use and ~cupanw ............................................. ~ .................................. ~...., .............................. 3. Nature of work (check which applicable): New Building: .................. Addition .................. Alteration .................. ' Repair ................. .,~l~emoval~... ,--- ,, .,--, .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ......... .~....~....,..~....0...~..C.~..~ ....... ........... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelhng, number of dwelling . .......... Number of dwelbng umts 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 ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front . ..~.. ........... ~. ........... Rear .....?.P.-...~.. ......... Depth ......~...~.. ........... Height ....£..~... ...... Number of Stories ~ ..........~ ................................................................................................ 9. Size of lot: Front .../...¥'.~.~....~.. ..... Rear ..... .L.'~...~'..~...~..~'... ...... Depth .../....~......~.'...~..'~.. ...... 10. Date of Purchase ...... ~/:..~....,~.....~..~..~..-- .................... Name of Former Owner ...... ..~..:.......Z~..?..¥....J'..~.....~.. ............... 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 premises ..../~.....~....'~....t....-~....~...../..~..~....~. ~ress ....... ..~.../.~.~.¢.[...'~...~ ............ Phone No ...... ..-=..: .......... Nome of Architect ../.~...~....~..TT..~.../.../.~..~.....~...~....~..Z~..Address .....~..,/.~...~..~ ..... Phone No..~...-?:~..T....~?/ Name of Contractor ............../~,',~..~ ~....~../~ ............... Address ..Z~...~.~:...~.~....~y~l~Unone~' -- No..~..?....~...~....?.ff.9. / PLOT DIAGRAM LoCate clearly and distinctly all buildings, whether existing or proposed, and indicate all setJcmck dimensions from property lines. Give street and block number and nd or description according to deed, and show street names i icate whether interior or corner lot. , I STATE OF NEW YQRK, )-ce COUNTY OF ....... ..\.. .................... .f '~"~' ............................... ..3,. ............................................................. being duly sworn, deposes and says that he is the applicant (Name of ir~dividual signing application) above named. He is' '~t~e ......................................................................................................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owner~ 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. Swam to before me this ............... ............. Notary Public, .:...2.,~..~..../....~..~. County ............. ~~f "~'~;i~"~¥i ............................. MARION A. EEGEN~ NOTARY pUBLIC, State of New yor~, NO. 52-3233120 Suffolk C;oun~..~ Term .Expires t~£ch 30~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Gi~e deed locatio~ - z \ have been inspected by this department and found to be satisfactory. District Engineer 1971] District Engineer I