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Home My WebLink About4562-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z1+26,~ ,. Date Jl~llO THIS CERTIFIES that the building located at l~llnneweta Rd Map NolfaSS, P~ .PrCl~lock No. Lot No. 219 & pt 220 11 ,1971 Street Cutchogue ~ conforms substantially to the Application for Building Permit heretofore filed in this office dated l~eV .21~ , 19 t59 pursuant to which Building Permit No. dated ItchY, ~ , 19 ~9, was issued, ~d conforms to all of the require- ments of ~e applicable provisions of the law. The occupancy for which this certificate is issued is Priva~ .ene .f~ily d~e~l~g ............... The certificate ~ issued to A~lp~ Ru~t ...... ~er .... (owner, lessee or ten~t) of ~e aforesaid building. Suffolk County Departmem of HeMth Approval Ja~e ~0~ .1971 by. R, Villa House.~80 ~eweta ~ ~ ~ 200 ~yberry R~ ~ ( ~' B~lding Inspector l~'OgZif NO. ~: TO~N 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) Ne 4562 Z Permission is hereby granted to: at premises located at .............. ~.~9.....]Jallll&l~i..~.~l~..~l~ll~.; ................................ ...................................... ~m,t,...tme.....ta.~:.~s~....e~,e~a~,. ........................... pursuant to application dated ................... ~i~l~ .....i.~ .................. , 19.:.~ and approved by the Building Inspector. S-9 SCHD Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. ~ti~$_~ af ~Genera~ EnEineerinE Services ,-! BUILDING DEPARTMENT TOWH CLERK'S OFFICE .......... ~ A~on Examined ....~..~......~.. ............. , 19~ Approved u~, 19..?..... Permit No...~.~....~.. ~ ~ ~Z ~'~ .......................................................................... ........ APPLICATIOH FOR BUILDING PE~IT ~/~.~ .......................... ...... INSTRU~IONS a. This application must be completely fill~ in by ~ewriter or in ink and submi~ in ~plic~e to the Building In~ector. b. ~lot plon ~win~ I~ation o{ lot a~ o{ buildiag~ on premi~, relationship to odjoiniag pmmi~ or public st~et~ ar~, ~nd oivin~ ~ ~oiled ~ripfion of I~t o{ prop*~ must be druwn on tbe die, mm ~hich i~ ~ o{ lhi~ ~pplic~ti~. c. ~ work c~red b~ thi~ ~pplication m~y not be commenced before i~u~ o{ 8uildin~ ~rmit d. ~p~ ~pr~ol o{ t~i, application, ~ Buildin~ In~p,ctor will i~u~ ~ Buildin~ P~rmit to th* applicant. S~h ~rmi~ *h~ll ~ k~pt on tbe pmmise~ ~v~iloblo {or inspection thmaghout th~ p~r~ o{ th~ work. ~. ~o buildin0 ~11 ~ occupi~ or used in whol~ or in port for ony pu~os* whot~v*r until o ~holl h~ been omnt~ b~ th~ Buildin~ In~p~tor. APPLIC_~TION IS H.EREBY 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) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................... (~ar~t= ~ ~;~: .............................................................................................................. Name of owner of premises ...A..~.9.~.~,..~.1~ ....................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~)3,~*}~, 1. Location of lan~d on which proposed work will be done. Map No.: ..N...a..?..s..a...~....?..°..l..~.t.....?...~..°..T~_ot No.: .....2..1...9....~..~. ...... Street and N~mber ......... .~I3.I~I~tgI'~,[B,..][QS~, ....... ~AS~.a~l,..~.~e......C..~.t..9..~..o..s.~...e. .................... ~'/'- ~-0D ~T DE'~F~'¥ ~'o4D Municipallh/ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy vacant lot b. Intended use and occupancy ....... ~..D..e.....f..a...~..l..1. Y.....d..l~.e.1...1..l..n..~ ............................................................................ 3 ~N re of work (check which applicable): New,Bui!ding',~ ....... Addition ' Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........2. Zt.....0..O..0...--,+ .......... ,.. ................. Fee ........ .1...0.....0...0. ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... '"~O~i~B.....'..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 ........ .br.[[ ............... Depth ..... 3.1 ............... Height .................... Number of Stories ...... t.4 ........................................................................................................... Size of Jot: Front ....... ~0Q..~ ......... Rear ........ ~,00....~'. ............... Depth ................ .1~0..,~,+... Date of Purchase ........................................................ Name of Former Owner ........................................................ "A" ~ist Zone or use district in which premises ore situated Does proposed construction violate any zoning law, ordinance or regulation? ..,I~. .................................................... Name of Owner of premises ...~..t....~..~.S.& .......... : .......... Address .......C...~..t...c..h.,o.~..e. ................ Phone No. Name of Architect ........................ : ............................. Address ............................................ Phone No ..................... Name of Contractor ....... ~......?..e..e.?...~..o...s..~...~. ................ Address ....... .........[v"a't~l~ituclr...... ......... ....... Phone No ..................... 10. 11. 12. 13. P~OT 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. See filed plan STATE OF COUNTY OF ...~...~.~....~.~...'~.. ............. $~'~' ................................. ~.O..S...e.~..~..e..e..~.~O.s..~.. ~. ......................... being dumy sworn, d~oses ond soys thor he is the oppmicont (Name of individual signing application) above named. He is the .............. CD=~D~ ................................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~:ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and tha~ the work will ba performed in the manner set fo~h in the application filed therewith. Swam to before me this .................. P m, ub Nota~ 'c, ~ . Coun~ ~ (Signature of applicant) NOTAR u~, NEVILL Y P~IC, S ~o. ~.e~° t~.~{ ~,~ ~o~ -I