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Home My WebLink About4592-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z 1+028 . Date Oct THIS CERTIFIES that the building located at , Mai!!er Ct Map No.Smithfield ~ck No. · Lot No.. 20 . So~thold 22 ,19,~'0 Street N,Y, conforms substantially to the Application for Building Permit heretofore filed in this office dated Dae 18 , 19 69 pursuant to which Building Permit No. dated Dee 1S , 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, ate o~ne famil~ dwelling ............ The certificate is issued to ~,~W.Smith & 8oils .Inn. · Owael' .. builder (owner, lessee or tenant) of the aforesaid building. NOTE~ a~pl-oved by ~d Appeals Suffolk County Department of Health Approval 0(~t 22 1970 by R, Villa House ~ 262 [_[ Building Inspector FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMEN'r TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~592 Z Permission is hereby granted to: .......... .~ ~,~i~ ..~...S ~ ..X ne ..................... ................. ~te~e~a ........................................... to' . ......... ~utlsL.~zeret. u~e..~:t~., d~],:M.~g. ......................................................................... at premises located at ................... ~O~llL.~O.....~h~{-~;B~[~L.~.JIL~I~ ................................................. ............................................. ~e~..8o'~ .............. ~:m.t~o.~& ......... ~,~.,. ................................ ~ursuc~ to c~plicafion dcrted ~ . Dt~,.~. ..... .~.~ .............. ,~ 19 ..... 6~and opproved by the Building Inspector,, ~ee ~....!,~ ........ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structu.re located ~f (Give deed loca%ion~ have been inspected by this department and found to be satisfactory. OCT 2 2 1970 Dlstrlot Engineer District Engineer Disapproved a/c .................................................. .. APPLICATIO~N 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 o~ buildings o n premises, relationship to adjoining premises or public st~reets or areas, ~nd 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 n~t be commenced before issuance of Building Permit. d. Upon approval of this application, the Building In spector 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 shall be occupied or used in whole o~ in part for any purpose whatever until a Certificate of Occupancy shall have been granied by the Building Inspector. APPLICATION IS HE~:~tY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of So,,thold, Suffolk OImnty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable~ laws, ordinances, building code, (Signature of app ica , , ' fpo ~i"' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or Name of owner of premises ~: ~ ..................................... If applicant is a~.~orporate, signature.~f duly au~horize d c~ficer. (Name and title of corporate officer) ~o~~~'LOt No. ~-~ ....... 1. Location of land on which proposed work will b ~ done. M.al~No .................. Street an~L~m~ber' o~ ~_~ ..... ~' ' w" ' ' ~i'p'~l~[~7'/' ............ .'" a. Existing use and occupancy .~.~ .............................................. b. Intended use .and occupancy .... ~~ ............................................... 3. Nature of work (check whi h applicable): New Building .. ddition ........ Alteration Repair ......... Removal ..... ~ Demoliti.0n ........ Other Work (Describe) ...................... 4. Estimated Cost . .0.~..(~ .................. Fee . ./t~...Pff...-. ................................. (to be paid on filing this application) 5. If ,dwelling, number of dwelling units . .~.. ..... Nnmber of dwelling units on each floor .............. If garage, number of cars ..... ,/.~-.ff~-9~. .......................................................... 6. If business, commercial ar 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 . .~. ~ .... Height ............ Number of Stories ............................................................. 9. Size of lot: Front .. .... Rear ............... Depth~.~...LT. ...... 10. Date of Purchase ............................... Name ~£ Former Owner ............................. 11. Zone or use district in which premises are situated..~,~ i .~ ............................................. 13. Name of Owner.of premises,~z~' .~.,(~(...~ess .~ .... Phone No ............ Name of Architect ................... ' ......... -~ddress ...................... Phone No ............ Name of Contractor.-- ~ Address Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, a~d indicate all set-back dimensions from property lines. Give s~eet and block number corner ]ot. . deed, and show street names and STATE OF NEW YORK,- . COUNTY OF ............. ~ signing being duly dbposes and says that he is the sworn, appli- applicat'~n) cant above named. He is the ....... .~.~.... '(C~ontractor, agent, oorporate officer, etc.) of said owner ~r ~wners, and is duly autlKn~zed~o perform or have performed the said work and to make and file this application; that all statements oontained in this application axe true to the best of his knowledge and belief; .and that the work will be perfo~ned in the mann er set fortl~ in the application filed therewith. Sworn to before me this ..... (~...~.... day of .~.~... 10~. N~tary Public, ~ .............. .nt (Signture of applicant) ELIZABETH AI'~ I~VILLE NOTARY PUBLIC, Stet~ cf ~[ew York No. 52-8125859, Su[folk County .Term Expires March 30, 19~.~