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Home My WebLink About4554-zFOB, M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy No. Z .3~ .... Date ........... .~..e.. !.? ....... , 19.~... THIS CERTIFIES that the building located atC~dal'. ~c .East. D~ ......... Street Map No. Ce~. B~.,. ~ock No ........... Lot No.1~ .&..1.~ ..... confo~s subst~tially to the Application for B~ld~g Permit heretofore ffl~ in this office dated .......... IOV .... ~3..., 19.~ p~su~t to which Building Pe~t No..~ .Z dat~ ........... ~... t.~ .., 19. ~, was issued, ~d conforms to ~1 of the requ~ ments of ~e applicable pro~sions of the law. The occupancy for wMch this certificate issued ~ . privale, one. f~ll7. !~l~ ...................................... The certificate ~ issued to . 8., .~. & G,. ~o ..... ~r~. ............... (owner, lessee or ten~t) of ~e ~ores&d b~dMg. S~olk Co~ty Dep~ment of He~ Approv~ J~ .. 9.~..197fl .. ~7..B.. ~ ...... ~e~iter, ~ N ~9~1 ........... ....... FOR¢'H 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) N? 4554 Z Permission is hereby granted to: ........ · em~..~e~....~OJ. ~.& 11~ ~ ........... .t4t39.....v....ll~J..l~ .............................. to ........ ~ · ~jl/l .. j~jll~ · .tJl~J~.J{JjlJ .................................................................................... at premises located at ............ ~i~J~jlJ~..~J~J.~/L..jJ~....~Ji~-.~l~.J~llJl~-.~) ............... ....................................... lil)l ..(bm4~.. tli~am~t~..a~ ..~m~ ........... .Je~r,e.~ .......... '. ....................... t~llding Inspector. J:ee $.;~j~l~ll~ ...... .;. pursuance to application dated ........................... ~ ......... ,j~, .......... , 19~...jJ~ and approved by the S-9 SCHD RECEIVED I97t]MI~Y 19 I~MII:2~, ~EPARTI~ENT OF HEALTH RI~ER}EAD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. District ~n~!neer ~ ,, District Engineer 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 plan showing location of lot and of buildings on premises, relationship to adjoining pram sas or public streets or ~t areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. C d. Upon approval of this app. lication, the Building Inspector will issue a Building Permit to the applicant. Such permit ~ shal! be kept on the premises avadable for inspection throughout the progress of the work .~, e; No building shall be. occupied or used in whole or in part for any purpose whatever until a Certificate of Qc~,upancy shall have been granted by the Building Inspector. - APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Bud .ng Perm t pursuant to the Building Zone Ordinance of the Town of Southold, .Suffolk County, New York, and other appl cab e Laws, O. rdinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as hereto described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ~/ ~,{/~,_ .~_.~ ~.~.~.~... l~.~....~.....~.~....~z ........ ~..,.Z.~e.a~.~..a ~ ..... . (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ~u.~.2.z~.'~.-.~...-.. ................................................... ~ ........................................ Name of owner of premises .~...-.....~.....~..'~....~.....~'....C~.. ......... ~... ....... ...~.........~:...~..--.~...~.._/.~./~...../~.....~. ........................................... If applicant is a corporate, signature of duly authorized officer. ~' ~/2 ~' / .~ .~. (Name and title of corporate officer) ,, ~. ~.~,.?,, ~ /~ 1. Location of land on which proposed work will be done. ~ap No.: ..../....4/. .......................:....~ot No.: ./...~..~....~../...'~..~. ---,~,5 ..... ~ ........................................ ~.;,;,i.~..;.~.i;;~ ..................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ................................................................................................................................... Intended use and occupancy ..... /........./-~...~...C~.:. ...... ~......~...R-.~.././..~.~.'.~,.:. ........................................................ 3. Nature of work (check which applicable): New Building ' ..... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 6b F 4. Estimated Cost (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 ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~.....'~.. ................ Rear ....... . .~.....'~... .......... Depth ....?w....~.. ........... Height ....~..0. .......Nu,,m~_ er of Stories ........... /. ........ ~,'~ ..................................................................................... 9. Size of lot: Front ...... ~...~...~.. Rear ............ ~.....~... ........ ~ ..... Depth ........~...~....O. ................ 10. Date of Purchase ........... ~...~.~...~.. ............................ Name of Former Owner ..~..,~..//..~/.~....~(£...../.~....~..(..~...,~'.~./.~ 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 .~..;.~....~......~...~...0. ......... Address ../..~..~?..~'.~.~...°.~..../i~.~.~...~../~..~:.¥Phone No. ~.~.~..'.~.~: Name of Architect ......,~.~..L..~.z~...~...: ........................... Address ..~..ll..~...~'...~.../).../~.~....f'~....~. ....... Phone No. 7...Z;.?..T...Z...~.,~.P i: Name of Contractor ..i~.&A,'/..~.~.(.~'......~./.~ ./~......Address .....~.../~..~....~..~.~.~-...-~.~.. ........ Phone No. ?....Z..?..?.~.~..~ ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from Pw~OePt~er? inlit~iS~r GoirVceo~ereltot.and block numberlj~e~iptio~i~(~,~eed~ a:: ~w s;e~tI/~?es~dl i{/r~ic~-- 51 - r .......................................... bein, duiv wom, d~po~s and soys tl~t he is the applicant · (Nome of individual signing application) above named. He is the .......... ..~....O...¥..~.'~..~..~...F..~.~. ........................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rtmke 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 ,~ ~ ~'~ .............. Nato, ¢oun ....................................... NOTARY PUBLIC, State ~f New York No. 52-8t25850, Sulfol~ Cou~t,y Term I~xpires March 30, 19 TME -I RE. NO. ,i c~. 'q c~ --I