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Home My WebLink About4307-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, ri. Y. Certificate Of Occupancy No.. ~i .366.3... Date .. ~l. ov~ml~x .... 12, ......... , 1969.. THIS CERTIFIES that the building located at Ox~h~l:d. s,tzeet .......... Street Map No. ~IXXXXXXX.. Block No. ~ .Lot No. O~.ient.,..New..Yoxlc ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... I~ay... 2.6, ....... , 19.6.~9. pursuant to which Building Permit No. 43.(17. Z.. dated .... May.... 2.6, ........ , 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 l~r£vate, one. family..d~ell.lng ....................................... The certificate is issued to ..... Donald. B. oerum ................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval September. 18o. 1.969,. Rober.t .Villa Building Inspector House ~ 1000 Orchard Street 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) N? 307 Z Permission is hereby granted to: pursuan,t to application dated ............. F~. .... ~.i.. , 19.~.~:.., and approved by the Building Inspector. Fee $...].?.~...0~.. ......... SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: at The sewage disposal (Give deed location) facilities for a structure located have been inspected by this department and found to be satisfactory. District Engineer Examined ... Approved .................... ,19 .... Permit No. Disapproved a/c .................................................... Application No. APPLICATIO~ FOR BoIL.DING PERMIT INSTRUcriONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Pl. ot plan showing location of lot andoi buildings on premises, relationship to adjoining premises or public streets or areas, and giving a deiailed 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 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 fo r inspection throughout the progress of the work. e. No buildipg shall be occupied or used in whole ov in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspecti~r. APPLICATION IS I-IJ~.~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 Oounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction o/build ings, additions ~or alterations, or for removal or lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, and regulations. (Signat~e of .applic.an, .ac name ' a corpo o (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .~..~ If applicant is a corporate, signature of duly authorize d ~fficer. (Name and title of corporate officer) 1. Location of land on which prOp~e~ work will b e done. Map No ............... .. Lot No .............. Street and Number ..... . ./~.~..~..'~. .................. . ./~.~....':~....~./. ....... ff l / ooo 2. State existing use and oceupancy of pr~emi7 an d intended use and occupancy of proposed ::.t .ru. Tt. iyy.. a. Existing use and occupancy ..,,-..-...-. .............................................. b. Intended use and occupancy .......... ~ ........................................................ 3. Nature of work (check which applicable): New Building . ~ Addition Alteration Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. F-~timated Cost . .~..~t..~.~.~..0.O. .............. Fee ................................................. (to be paid on filing this applicotion) 5. If dwelling, number of dwelling units ..../ ...... Number of dwelling units on each floor ./ ............. If garage, number ,of cars .... ~- .................................................................... 6. I_f business, commercial or mixed occupancy, spec ify nature and extent of each type of use .............. 7. Dimensions of existing structures, ff any: Front .............. Rear ............. Depth ............. Height ................ Number of stories ........................................................ Dimensions of same structure wi'ch alterations ox additions: F~ont .............. Rear ............... Depth ................ Height ................ Number of Stories ..................... 8. Dimensions ,of entire new construction: Front ... ~.z/.; ......... kear ...~..~'. ~ ....... Depth ~..?'..~. ..... Height ~ / / Number of Stories . ./..~.. Size of Lot: Front .... ./..~.v. ~. j .... ' l~ear j...?.q.~...~. ......Depth :~6o ~ Date of Purchase ......................... ...... Name of Former Owner . ./...~..,...~..~ _ Zone ax use district in which premises are situated...~...~A'A~... .......................................... I)~es proposed construction violate any ~yning law, ordinance or regulation? ...~7~,~v.. ................... Name of Owner ~)f premises . ~ .~. ~... Address . .t~.~.. Name of Architect ~.--~.~..'Y~. Address ii~iiiiii Phone No ............ Phone No.~'.. Name of Contractor Address ......... rhone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give s~eet and block number or de scripti,0n according to deed, and show ~reet names and indicate whether interior or corner lot. STATE OF NEW YORK, )S.S. COUNTY OF S..~.~.d~. .... ) ............ .~'.4~..~.....~..,¢.g. ff.~.¢../1~. .................. being duly sworn, deposes and says that he is the appli- (Name of individual signing applicati, on) cant above named. He is the ................... .~'..~.~..7..~.4.6' .7.~.ff. ........................................ (Oontractor, agent, corporate officer, etc.) of. said owner ~r owners, and is. duly authorized tq,perforra Or have performed the said work and to make and file this application; that all statemerrts contained in this application axe true to the best of his knowledge and belief; .and that the work will be perfe~rned in the mann er set fort~ in the application filed therewith. Sworn to before me this NOTARY PUBLIC, State 0[ New York No, 52-7267800 Suffolk County ·'erm Expir~ March 30, 19~