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Home My WebLink About4551-z]POEM NO. 4 TOWN OF SOUTI'IOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z38~,~ ................ Date .......................... THIS CERTIFIES that the building located at ....]~l,/l~lgOC~..& .l~:l~]g~...]~g,..]~, ............. Street Map No.....Z3~X ...........Block No...~r~ ............ Lot No. ~ ......... .(~g,t~og',l~ ........ ~.~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office doted ............................... · O~ .............. .1~ ........ , 19..~9. pursuant to which Building Permit No....br.~'.]~.. dated .......................... .]~D.~. .......... ].~, ....... , 19....$.~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ................. ~.va.te..~)me f~mll~. ~e.ll...i~..l~ ......................................... The certificate is issued to .Roher. t..ZllAL1. ............... O~l~3el~. ..................................... : ............ (owner, lessee or te~t) of the aforesaid building. Health ~ept approval ~AIII, ,~0 1~71 House ~ 380 Pinewood 6?5 Dlek~ Pt TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4551 Z Permission is hereby granted to: ................. ~ .......... ~....~..-. ................ ~. .... pursuant to application dated ........ : ............... M~e ..........~l[ ........... , 19.~.., and approved by the Building Inspector. APPLICATION FOR ~USLDIHG PERMIT U'~ ....................... , INSTRUCTIONS ! o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Insl~ctor. ~ b. Plot plan showing lec~tJorl of lot o~ of buildil~$ (~ p remlses, relationship to odjoinJ~ premises or public str~t~ ol~ ar~s, and giving o detailecl description of layout of pro. fly must be drovm on tl~ di~rem which is I:~rt of this (~plico- 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. SuchO~) permit shall be kept on the premises available for inspection throughout the progress of th6 work. e. No buildi, ng shall be occupied or used in whole or in pa rt 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 C. oun~, New York, and .other .appli,c..a. ble Laws, .Ordin. anc.es, or Regulations for the construction of buildings additions, alterahons, or,tar ~movaJ or aemo,hon, as narem aescri~ea. The applicant agrees to comply with all applicable laws, ordinances aha regu ations. (Signature of applicant, or name, if a corporation) ....................... ............... Stctte whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. / If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) location of land on which proposed work will be done. Map No.: ..................................:~... Lot No.: ...................... Street and Number ....~.~..~.~.....~~.~..?..~./..R~...'--------------~.....-...~......~..~. State existing use ~nd occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ~ ~.....--' . .......................... 3..Natur~ of work (check which applicable): New Building .......~... ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost .........,,.~..0..~.~.~ ............................ :.. Fee ............ ~....~.,....~..... r- ' .. (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 m 6. if business, commercial or mixed occupancy, specify nature a.nd 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 ....... L ...... ~ .............. Number of Stories 8. Dimensions of entire new construction: Front ......... .~....~.....~......" Rear ....... .~....~....~ ......... Depth .~..~'~'...../.. Height ....... ~....~.. .............. Number of Stories ......... ~ ........ 9. Size of lot: Front ..... -/..¥~..~.....i ......... Rear ...~..~.....~....~ ......... Depth ........ ~...~....r. ..... 10. Date of Purchase ....~_~,~/~....-..~...~...~..~. .................... N~ame of F~orme4' Owns' ...'~7_~. ............. ~ . 11. Zone or use district in which premises are situated ..... ~.~.~... ~ ............. 12. Does proposed construction vij~e any zoning ]aw, ordinance or~:eau at nn:~ ~" i3; i~Name of Owner of pre'mises/.~.~.~..~. Address ~ ~.'~' Z'"";~"~ ........ i ........... Name of Arch itect ....~.~).....~....~,)~..~,~ ............Address ~~~...~i~iI Phone No ................... Name of Contractor ..~...~.~ Address Phone No. ~.~.~,,~'~' .~ PLOT DIAGRAM Loca~e clearly and distinctly ail 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. STATE OF NEW YORK, ~ ) S ................ ~...-7_....'~-.,~:e~,~ ......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing applicatiot~) above named. He is the .................................................... .(,~j~.....~. ............................................................................ (Contractor, agent, corporate off cer, etc.) of said owner Or owners, and is duly authorized to perform or have performed the sa d work and to make and filq this application; that all statements contained in this application' are true to the best of his knowledge and beliefs, and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this _,, ~-- ~-, ~, ' .......... ' ~' ............... "'"(~ ~l~;~!i0 Suffolk Count ' e~rn Expires M~rch S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. ~C~--~--~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located - ~ .~ ~,r (Give deed location) ./f " have been inspected by this department and found to be satisfactory. b-"nief of General Engineering Services AUG 3 0 1971