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Home My WebLink About4352-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z .3612 .... Date .... O°tober .... 23, ......... , 196.~. THIS CERTIFIES that the building located at ~mll:h .Roa~ndian. ~o~' Street Map No. Indian. Neck, Block No ........... Lot No. 2&l;~rt. o£. 4..~e~o~lc,. ~, Y .... Park conforms substantially to the Application for Building Permit heretofore filed in this office dated .... J. une...20, ....... , 19.69. pursuant to which Building Permit No. 4352Z... dated .... J. une...24, ........ , 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 ... privata .o~e..family. d~elli~g ..................................... The certificate is issued to . .G. eor~.e .Mot. an ......................................... (owner, lessea,or-tenant) of the aforesaid building. Suffolk County Department of Health Approval House % 105 Smith Road " "5000 Indian Neck Road · .O~tO~er. 2.0,. 1969,. Rober.t .Villa FOF~ NO, 2 TOWN O~ SOU?HOLD 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? 435g Z Permission is hereby granted to: Ghet, O~lo~sk~t A/C 6ee~'ge I~l, alt at premises located at ............................................................ ..~. ,t ~ ~ .~....~.~1~ ~e..~..~. ~8~ ...................................................... . . ......................................... ~.a.~..~.e.~..~..~..,s.~.t...h...~. ......... ~......~.e......~.:~.: ........... pursuan¢ to application dated .......... .~.I.,$~.....~. ....... :..., 19.....~.~., and approved by the Building Inspector. Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. ~tj~O ~-~ TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure lpcated (Give deed location) ~' have been inspected by this department and found to be satisfactory. TOWN CLERK'S OFFICE Examined .......... , 19..~,...~.. ,A4splicotion N~ ....... '...-~...........'--'. ....... Approved ........................................ , 19 ........ Permit No. Z~/ ~> ~' ~_ ~--/~ ~ ~ Disapproved a/c ........ ~ .............. APPLI~TION FOR BUILDING PERMIT Date ~:~ ~...~u · 19 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, relationship to adjoining promises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this applica- tion. 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 applioant. 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 or in pa rt for any purpose whateve? until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of. a Build,!ng. ,Pe.rmit purs.?nt to the Bu Id ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app.caom LAWS, L~rmnances or Regulations for the construction o.f buildings: additions, alt.e, ratlons, or for rem.oval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature o~ applicant, or name, if o coq>oration) Ga, ddress~f applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................................................................................... If applicant is ~ c-6i~orat~, signature of duly authorized officer. ,~' .................. i~ame and title of corporate '~"~ri ................... ..~.... ~ ...~.....~.... 1. Location of land on which proposed work will be done. Map No.: .... ..~...'~-. Lot No.: ..... Street and Number ..~....~..~.~..~~-~"~'1'~'"~'~"~....~..:.~· 2. State existing use and occupancy of premises and 'intended use anEl"occupancy of proposed construction. o. Existing use and occupancy ..... ~~.~...'~.. ................................. ~....-~.. .............................. b. Intended use and occupancy ......~.......~.....Q~.....~/:x~.~....~......~.. 3. Nature of work (check which applicable): New~B'~ldir~j ~........~... ...... Addition .................. Alteration .................. Repair .................. Removal .................. Derno.ition .......... ,.~ ..... Other Work (Describe) .................. 4. Estimated Cost ........,,~.~..~...~ ....... :~....~.~.~,.,.,:.. 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~f,,, nature and extent 6f each type of use .................................... 7. Dimensions of existing structures, Jf any: Front ............................ Rear ............................ Depth .............................. Height ............................ Number of Stories ................................................................................................................ Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ................................ Height ................................ Number of Stories ......................... i.~.... 8. Dimensions of entire new construction: Front ........ .~....C) ............. Rear ....... .'~....~.. .............. Depth ...~....~. .................... Height ....... ~..~...~ ............ Number of Stories". ...... 9. Size of lot: Front ..... ~....~...0. ............ Rear ........ /...,,,Y....~ .............. Depth ....~....~.....,~,..../.....O...~ ' 10. Dote of Purchase .., ...... /...~....(a..~...-..........~......~...-.. ..... N~e.~Owne_r 11. Zone or use.distrlct in which premises are situated ....... ~..~ ................................................................ 12. Does proposed construction ~,~late an~, zoning ]aw, ordinance or regulat on? ...... ~....~. ...................................... 13. -Name of Owner of premises~.~.. Address....~~. Phone No ................... Name of Architect ...................... ~ ................... ~ ....... Address ...~".~.../'~..~'..:..-~'Phone~"~"'~ No ................ Nome of Contractor .~.~....~,~.~..'..... Address ~..~~,.t~.~.:~... Phone No. PLOT DIAGRAM Locx~te clearly.ond dist!nctly oil buildings, whether existing or proposed, ?~d indicate QIJ set-back dimensions from Pr~per?y .lines. Give St're~t and block numbers or description 4~Cco~ding tO' de~d,~ and 'shOW Street names ond indicate whether inferior or corner lot. STATE COUNTY OF S.S. ...being duly sworn, deposes and says that he is the applicant iName of signing application) above named. He is the .................................................... ' ............................. 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 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: ._ ............