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Home My WebLink About4287-zFORM NO. 4 TOWN OF $OUTHOLD BUU,~INC. DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .1~...~.T~..~.../l~L~d... ............ Street Map No. p.e.c. ,. ~t.o.~$ Block No ........... Lot No. 9 ....... p.e.q..m~..e....Ii.o.Y... ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 14a3~ ..... ~..., 19.69 pursuant to which Building Permit No .... .~.~.8..~. dated ...... .~.~ .....9 ....... , 19.6.~., 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. riv~te, ona .family. ~L~e~Lfa~ag ...................................... The certificate is issued to . I~ge. C3.au~ell .... 0~mer..-..bu~.c~e~' .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~).c.t;.. ~.~. ~.9...by. ..R:..V.~. ~.~..a. .... ~Lndov variance approved by ;dous~g Bd appeal~ ao e ~ORM NO. :~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 257 Z Permission is hereby granted to: at premises located at ................. ~gll~.~..~.....~..~.~.~e..~l~lllll~ ...................................................... ................................................ II~m3r...ll..~ ........... I~leeea~ ....... II,~., ..................................... pursuant to application dated ........................ I~..,....9 ................... , 19.-69, and approved by the Building Inspector. Fee $..~..~0 ........... APPLICATI(~N' FOR BU~ILDING ate ................... 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, relatic~hip te adjoining premises or public streets or areas, and 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 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 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 on in part for any purpose whatever until a Certificate of Occupancy shall have been grar~ted by the Building Inspector. APPLICATION IS ~:K¥ 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 demo- lition, as herein described. The applicant agrees to corn ply with ali applicable laws, ordinances, building code, ...... ff. .... (Address of applicant) State whether applicant is owner, lessee, agent, arcliitec~, 'engineer, general contract°r, electrician, plumber or If applicant is a oorporate, signature of duly authorize d officer. (Name .and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ......... Lot No ............ Street and Number ?, ~.~...~ ~ ~...~..~ ~ .... t'~ .o.~ .0. .............. ~.e..C.~. ..~. )..Ct .................. I"1..~ .~,1 ' ~ ~'~cl~,, Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed ooustruction. Existing use and occupancy .................................................................... ..... I. £ L : ......... 3. Nature of work (check which applicable): New Building . .'~.~..~... Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. ]~stimated Oost ~* 1.07,o..cl 9. 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 ears ............... .~.~..~..~ ................................................... 6. If business, commercial or mixed occupancy, spec ify 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 ........ ~, ......... -5 .~..i~..~., 8. Dimensions of entire new construction: Front ...... i~-.~...~ .~: Rear .... .'1-,~. .....Depth .... Heigh'c . 1 ..~..~.~.'. Number of Stories ....... ~.~o. ~, ................................................ 9. Size of lot: Front .. J.~...~....~..'Il'.,. Rear .../~..o..~..~.~.. Depth . ~.~..o..~.~-. ,.. 10. Date of Purchase ......... ~.~ .(~..~ ................ Name of Former Owner ./~.E .~ ~-,..~..5..~../.7.~. .... 11. Zone or use district in which premises are situated ............................. ~ ................. 12. Does proposed construction viola'~e any zoning law, ordinance or regulation?~.........ff...O ............... ._ 13. Name of Owner of premises ).~. {,.Z...~.(,~?..~..%..~.. Address .N.....~ .Lc, .~ g .[.it..//..,~..~ Phone No. 7 ~.%.'..~.7. Name of Architect ........... ~ .~ .............. ddress ...................... Phone No ............ Name of Contractor ........ .co ~9-. ~. 1-., ......... Address ...................... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali ·set-back dimensions from property lines. Give street a~d block number or de scription acoording to deed, and show street names and indicate whether interior or coiner iot. ! STATE OF NEIV ~Y~OI~, ) S.S. cOUNTY OF ?.u..~?.o..l.~ ..... ) ...... .I.N..G.E...M:..C..L.A.U..S.E.N. .......................... being duly sworn, deposes and saya that he is the appli- (Name ,of individual signing application) cant above named. He is the ....... .C.o.n..t.r.a..c.t.o.r. ........................................................ (Oontractor, agent, corporate officer, etc.) of said owner .or owners, and is duly authorized to perform or have pertorrned the said work and to make 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 mann er set fort~ in the application filed therewith. Sworn to before me this Notary PRblic, .... S..u.f.f..o.1~ .... Oounty 19 69 ' ~ I~ - / (Signture of applicant) JOULE D. [[Ot.a~ Public, State of New Yodf No. 52-8F30350 ~[ified in Suffolk Coun~ ~m~ssion Exoires March 30, SUFFOLK COUNTY DEPARTHENT OF-HEALTH ,ld,. Fer.it No. TO WHOM IT MAY CONCERN: at ~.~ive deed location) have been inspected by this department and found to be satisfactory. ~CT 2 8 1§6~ Dlst: ici Engineer District Engineer