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Home My WebLink About4305-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. 3.811. .... Date .............. l~a~... 2.~. .... ,19.7.0. THIS CEETIFIES that the building located at .l~Ollzlg$. A..ve ............... Street Map No.. xx ........ Block No... ~ ..... Lot No...:~ ...]~a.~;:kt.u. ck .... N.e~[: ...... conforms substantially to the Application for Building Pemit heretofore filed in this office dated ......... 1,:a~ ... 23 ..., 196.9. pursuant to which Building Permit No..~3.0.~... dated .......... ~'&y... 23..., 19..69~ was issued, and confoms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Priv. ate. one. family. .dYelling ...................................... The certificate is issued to . .H.e .rb.e.r.t...A.o..F. ;[~.h.e.~, ....... . .0~%..e.r. ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~.p.r..$.1... ~..~., .~.~?.0....by..R.:..~ .~..a.. Building Inspecto~ FORM NO. ~ TOWN OF $OUTHOLD 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) N°. ~1305 Z ~, ......................... m~ ......... ~ ........ ,19..#. Permission is hereby granted to: .~..~..~....iI~.~. ........... ............ ~,~t.t,4t,~ ............................................. at premises located at ................ :....~. ..... ~ .................................................. .................................................. I~t~t,J,tlllllr .......... Jl~. ....................................... ~ .......................... pumuon~ ~o oppli,-afion doted ............................... ~ ......... ~ ....... , 19.~..., ond ~ppro¥~:l by the Building Inspector. Building Inspector Tow~O~F S~U~HOLD BUILDING DEPARTMEKT TOWN CLERK'S OFFIC:E ............. ~ed ~.~.~.... ~,~,, No....~.~ ........................................ , ........................................................................................... ..................................................... .................... APPLI~TI~ FOR BUILDING 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 shewin.g, location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detmled description of layout of property must be drawn on the diagram which Js port 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 Inspector will issue a Building Permit to the applicant. Such permit shall be'kept on the premises available for inspection t%roughoUt the progress of the work.. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shell have been granted by the Building Inspector. APPLICATION IS HEREBY 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,~b~ld~g code, housing co~e, and regulations. · ' ' (Signature of app)~ant, or name, if a corporation) (Addres~ of appt~e~nt) State whether applicant is owner, lessee~..agent, architect, engineer, ~ge,neral contractor, electrician, plumber or builder. .............. ~. . .~. .~. .~. . ~ ....... , ~ ~. . .~. . . .~.~. .,,~c. . . . .~.?. . . .~ . . ........................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate Officer) Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ............ ..~'....~'....~. ......... ~..~'K~'~. ........................ ~ ........... ' ~~' '~ State existing use and ~cu~'n~ of premiss and intended u~ d~'d ~cu~n~ of pr~ constmcti~: a. ~isting u~ and ~cu~ncy ................................ ~. ~ ............ b. ,~ndeu,eond~upa,~ ........ ~~ ........... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. D~molitian .................. Other Work (Describe) ........................................ , a t ~'~ ~-'~ ~--' Fe 4. t'mCos ....... ...................................... · ........................................................... .............................. (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, 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 ............................~-..~Nur~ber of Stories ......................./~'/ ~, ...... / 8. Dimensions of entire new construction: Front ....... ~1~.~. ................... Rear ...... ~[L~... ........... Depth ..... ~....~. ........ Height .................... Number of Stories ...... ~.. ............................................................................................................ 9. Size of lot: Front ..... .......... Rear ...... .~,~J.~...~. ................ Depth ....Z'.~.I~....'.. ............. < 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction vJoIGte any z0nj~g law, ordinance or regulation? ............................................. ; .............. 13. Name of Owner of premise~..~...J~..~...~.../..~....~...~...~ ......... Address ....~.~.../.../.~../...~...~...~....~....... Phone No ..................... Name of Architect ..................................................... Address ..: ......................................... Phone No ..................... Name of Contract~..d~.~...~......~.~...~.~'..~...~....Address ..~.~..~...~.../.~'...~...~....~....... Phone N .c~...~.~..-. ...................~//~/' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and whether interior or corner lot. block number or description according to deed, and show street names and indicate STATE OF NEW' YORK, COUNTY OF ................................ f "'""" ............ · .~I.~.~J~J./~-~........~Z...~..J~.~..~J:JJ~'..~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) ,, ................ named He ,s the ~.Z~..~....~...~....~.......~. above . ' . .............. ; .......................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform 'or have performed the said work and to rr~ke 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 manner set forth in the application, filed therewith. Sworn to before me this ..... ..... ....... ............. #OTARY PUBLIC, State of N~w Yor~ No, 52-B125850, Suffolk Co~ Term Expires March 30, 19 s-9 SUFFOLK CODNTY DEPARTMENT OF HEALTH Bldg. Permit TO WHOM IT MAY CONCERN: The sewage disposal facilities for a sSructure located at (Give~ deed · /~'r:~d::~',/ .:~z<7~.:. ~.'..,..~u,~.~o>.,~' <:~r.~:/'., ~/,~ have been inspected by this Department and found to be satisfactory. 1970 Distric~ E gineer ~