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Home My WebLink About4277-zFO~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy NO.Z . .~..~..~..~.. Date ................ . .'~..~.. d ./{~.'., 19T ./. THIS CERTIFIES that the building located at . .~/..~...~..V? ?.~.. p.~. i..~ ~..~f. Street Map No... ~... ~... Block No.. ~.. ~. .... Lot No...~..~. ..... .'~'. 0. ?..~..D..3..L..~....../~.,~', conforms substantially to the Application for Building Permit heretofore filed in this office dated i ~'~i .... ' 19'~'?' pursuant t° which Building Permit N°'tJ"~'?'?"~- dated ..... ~'~ , 19 .... ~ , was issued, and conforms to all of the require- ments of the applicablg provisions of the law. The occupancy for ,which this certificate is issued is .~../'~. ~.....~.......~.~ .... ~.] ................ The certificate is issued to ...~. ~...~...~..... ~..'.~f./ ~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~. ~..~...¢.. !.?.?.~ ..... ..~.. ................ Building I~pector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 277 Z Permission is hereby granted to: at premises located at ....................... .~...~.......~.~l~...~..~..s~.. ........................................... p~rsu~ to ~ppli¢~tio~ doted .......................... ~t~*,~ ......... ~ ....... , 1~...~., ~nd opproved by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Date Bldg. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a str~uc~ted (Give deed location) j J have been inspected by this department and found to be satisfactory. Chief of General Fm~Ineerin~_ Sarvl~,a~ District Engineer AU$ 2 6 1971 Examined ........... ~ .~....0~ ..'~..., 19./~.71. m.. pp~v~ .................... ,19 .... Pe~t No ..... Disapp~v~ a/c ....... · .............................. '~/~'~ - '~ ~ ~ ~0 ~PLICA~ ~R INSTRU~:r~ONS :~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building InspeC0or. b. Plot plan showing location of lot and of buildings o n premises, relatim%ship to adjoining premises or public streets or areas, and giving a de~ailed description of layout of property must be drawn on the dia/~mn which ii part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit, d. Upon approval of this application, the Building In specter will issue a Building Permit to the applicant. Such permit sb,ll 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 f~r any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspeclme. APPLICATION IS 1-iv~mY MADE to the Building Department for the issuance of a Building Permit pursuant ~0 the Building Zone Ordinance of the Town of Southold, Suffolk Oounty, New York, and other applicable Laws, Ordinances or 1%egulations, for the construction of buildings, additions or alterations, Or for removal or demo- lition, as herein described. The applicant agrees to corn ply with aH applicable laws, ordinances, building code, housing code, and regulations. ~ (Signature p~.applicant, or name if a corporation) ........ (Addres/{}of applicant) I . State whether applicant is owner, levee, agent, architect, engineer, general contractor, electrician, plumber or builder .......... .~,~.....~.(~C~..,. --~-x ,,~ .... ~ ..... f~' ....... ~' · · ',A Name of owner of premises...]c~,4.~.~._/.2.~,~-~..~f~'~~-- .......................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which propceed work will b e done. M.ap No ................. Lot No .............. Street and Number ..~..p.~k/~. p~,~. .... ~~-'~' ................. ;~f-- 375' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy .... ~..~ ............................................... 3. Nature of work (check which applicable): New Building . X AdditionI Alteration Repair ......... Re.m~'al ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ........ ..~..~. ~'./~ .../fff~......~ ......... Fee ................................................. (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, spec fly nature a~d extent of each type of use .............. 7. Dimensions of existing structures, ff any: Front ..., .......... Rear ............ : D~pth ... ~ ...... 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 .~.~-.0 .......... ~ Rearf ----~'~ri'c)' ~ .~_~ .... Depth .~..of~.. Height..Z.~.~. · · Number of Stories...~t~,/.A, .,f,.t.~ .~..(,.~ ............ ~ ......... 9. Size of lot: Fro~nt ../.~L'g. ..... .. Rear' '..:/..~[/...'. ..... Depth ...3..~.~. .... 10. Date ofPurchase . .... .~t.,.,~,.,./..~.~.O~' ...... Name of Former_Owner .../.~~ 11. Zone or use district in ~mises are situated..~ ............................ ------x~.,-~ 12. Does proposed construction viola~ any zoning law, ordinance or regulation? ... ~. ~...- ............... 13. Name of Owner,of premises .~'t~J~Address .~ ................... p' hone No ............ Name of A~chitect . ~~_..~./~ ,~..~ddre~ lJ~.,~ Phone No. Name .of Contractor~J~ ..~f-~(.. .... Address .~... Phone N0~.~..-./[~.95 PLOT DIAGRAM · Locate clearly and distinctly all buildings, whether e~s?n~,.g~o~proposed, and indicate all set-back dimensions from property lines. Give street and block num.~ or de slh'iption according to deed, and. show street names and indicate whether interior or corner iot.~ ~-----.~-~_~-- STATE OF ~ YORK, )S.S. COUNTYf~/~"OF ............ ~. ) ~--(Name of individual signing application) ~ ,.~ cant above named. He is the ................. /.~ .. ! ........................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements aontalned in this application are true to the best of his knowiedge and belief; .and that the work will be performed in the mann er set fortl~ in the application filed therewith. Sworn to before me this .... .~.f(b ...... day of ....~)(~ ....... 19~. 0 ' Notary Public, i ................... ICounty~--~4~co]~/' .......... ' ~i~ur~'"~o ~ii~)' ............... ~ ~-"~ / - - ~ NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk County ]'~erm Expires March 30, 19~