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Home My WebLink About4289-zFORM NO. 4 TOWN OF SOUTHOLD BUHDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . Z~. · Gl,&tlneel~ .Road.. Street Map No...xX ........ Block No.. ~ ...... Lot No.. XX... ~. 8mffolk..M,~ · .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........14~, ..... 9' ', 19 ~. pursuant to which Building Permit No...~2~. ~ dated ........Ma~, .... ~;~ ..... , 19.~., 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 ..... ~i~te · o~e. fmail~, dwell~ .................................. The certificate is issued to ...~e..C. ].~.~.$~ ..... . .O~..e.r...-..1~$...1.d.e.x-. ................. (owner, lessee or tenant) o! the aforesaid building. Suffolk County Department of Health Approval . .O~t~ .28~..1~9...b~'. ~,. ¥~]~ .... Buildmg Inspector I 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) 4289 · Z Permission is hereby granted to: .......... 3,!~.0.....IL... ~l~.lre.~.e...~'~.t~ ..................... ............ ~,lAe~ ............ 1~,,1[., ............................... to ................. ~d.~l..Mw..aee...e~l~...~am3~.~lag ............................................................ ~ ...... at premises located at .................. Z/I~.....(}I~I~r~iII~....]IA~ ........................................................... .................................................. le~..ailfeMe ......... ll.m.1'.,. ................................................................ pursuant to application doted .......................... ~ ..........~. .............. , 19..~, and approved by the Building Inspector. SOo-r~OLD, N. Y, Approved .......... / ......... ,19.. !. Permit No .......... TOWN OF SOUTHOLD BUILDING. DEPART~T/ Application N0 ..... Disapproved a/c . ./ .............................. INSTRUt21'IONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plotplan showinglocation of lot andof buildingson premises, relationship to adjoining premises or public streets or area~ and giving a detailed description of lay out of property must be drawn on the diagram which is part of this application. c. The work covered by this application may myt be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector 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 gra~ted by the Building Inspector. APPLICATION IS l-m~'~Y 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 Regulat/ons, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with ail applicable laws, ordinances, building code, housing code, and regulations. ...... ..... ('Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................................................................ -,,- ...... '~. ......................... · .... Name ,of owner of premises ............... .~ .~.. ~....'i~...~ ............ (J ..................... I2 applicant is a corporate, signature o£ duly authorize d c~icer. (Name .and title of corporate officer) 1. Location of land on which propased work will b e done· Map No ........ : ......_.. Lot No. ~ ............ Street and Number-~°~° .~~....~....~...O~..; ..... .-~-.~ ~ ......... Municipalit~ ~ 2. State existing use and occupancy of premises an d iniended use and occupancy of proposed construction. use .and occupancy Existing use and occupancy .................................................................... ...... ........... ........ 3. Nature of work (check which applicable): New Building '~.~-~.. A~dition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost .... ~$ ..................... ~ o 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 ........... .~..,~...O. ...................................................... 6. If business, commercial or mixed occupancy, spec ify nature and extent of each type of use .............. 7. Dimensions of ex~ structures, if any: Frc~at .............. Rear ............. Depth ............. Height .... ~--~ ...... Number of Stories .......... Dimensions of same structure with alterations or .additions: Front .............. Rear ............... Depth ................ Height ................ Number of S~ies ..................... 8. Dimensions of ~ntire new construction: .F..r~n. ~ ..... ~..~.~.. .............. Rear ~_ Del~thl,~,,~ ''~'~T'' '~'~' ' Height ...t.'~- ..... Number of Stories .......... 0...~. '~.-~. I 9. Size of lot: Front ........ I. 9. 9 .... Rear ..... 3..~ 9. .... Depth ......... 10. Date of Purchase ..... .\..~..(o..~ ................. Name of Former Owner . ./-.%.c.a..~..~f..~..5../~..I .... 11. Zone ar use district in which premises are situated .................................................... 12. Does proposed construction violate any z~ning law, ordinance qr regula.tion~ ..,..., .................. 13. Name of Owner'~it~remises. ~ .~..~. ~-..~X ~ ~/- - · A, ddress #. :. ~. ~.c..~...[-3,. (~.~-[./~ Phone No. ~ ~ .~..7 ~. t~.) Name of Archit~ . ......... ~A~ .~..~, .......... Address ........ .?.~. ?. ~ .~.... Phone No ............ Name of Contractor .......... ~..~..~...~ ........ Address ...................... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setrback dimensions from property lines. Give street and block number or description acoording to deed, and show street names and indicate whether interior or corner lot. STATE OF N~ y~)P~, )S.S. COUNTY OF ?.u..~?.o..~?. .... ) ........ I..n.g.e...H.:..C.1..a.u.s.e.n. ......................... being duly sworn, deposes and says that he is the appli- (Name of individual signing application) cant above named. He is the Contractor (Oontraetor, agent, corporate officer, etc.) of said owner.ar owners, and is duly authorized to 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 performed in the mann er set forth/in the application filed therewith. Sworn to before me this N~tary Public ..... Suifolk ....... County (Signture of applicant) 52.~'/~0~ ~ullified in $1dtOl# ~/ _r~ S-9 SCHD Date Bldg. OF HEALTH 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. Dlstric~ Engineer D/strict Engineer