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Home My WebLink About4361-zFO~M NO. 4 TOWN OF SOUTHOLD BUll,DING DEPARTMENT Town Clerk's Office $outhold, BI. Y. Certificate Of Occupancy Date ..............Del...~ ......, 19.'~. THIS CERTIFIES that the building located at .t~/8. ]~a~l. St~#t .........Street Map No... Xx ....... Block No..X~ ...... Lot No,~ .... 01'~I~%.. ~.~]~p ............ conforms substar~tial~y, to Bthe Application for Building Permit heretofore fried in th~t~i~ ec~ . . . . aated ....... -.l..,~,:~ '4 .... , 19../.. pursuant to which Building Pernnt No ...... '~). ~..A. 7.. dated .........~. f.~l...~. ...... , 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 ~,,~..~,. f~,~..~,,.~ .... ..,~...~ .~..~..x. ............... The certificate is issued to .F~. }d~..&. W;Lfi.. ~{l~r! ....................... ' (owner, lessee or tenant ) of the af?resaid building. Suffolk County Department of Health Approval Dlt... 19...¶ ~.~... bY. .1~..~.~& ..... UBIDERWRITERS CERTIFICATE No. i~..~{J)~ .................................... HOUSE NUIvlBER 6~ ...... Street ...~.~.~. 8tl'ett / FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4361 Z Permission is hereby granted to: at premises located at ........................ JJ~.......~"l~..~J~ ............................................................ ................................................... ~...ll,~,, ................................................................................ pursuar~t to application dated ................................ ~l~....'~ ........... , 19.~,., and approved by the Building Inspector. Fee $..~J,.(~ .......... Building Inspector $-9 SCHD SUFFOLK COUNTY DEPANTHENT OF HEALTH _~ ~ Date 2~. ! 9 KI74 ldg. Permit TO WHON IT HAY CONCERN: The sewage disposal facilities for a structure located / (Cive/deed location) have been inspected by this department and found to be satisfactory. TOWN ,C~-~R~'S OFFICE sOUTHOLD, N.Y. ~-/? o 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 o n premises, relatkmship to adjoining premises or public streets or areas, .and giving a detailed description of layout of property must be drawn an the diagram which is part of this application. c. The work covered by this application may not b e 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 o~ in part krc any purpose whatever tmttl a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS lieaek'~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 Regulations, for the construction of buildings, additions or alterations, or for renloval or demo- lition, as hewein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of app cant, or name ff a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ......~A,k~M,~4~ ................................................................. Name of owner of premises ii'".~.'~i~.~....~.. ....................................... If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) done. ~ap No ............................ 1. Location of land ~n which proposed wor~ ~will be Lot No .... Street and Number~ / _.....~..~.~.~ ~.-~ ....... .. {0.4~M~.i i~. · .~.. · .~ 2. State existing use and occupancy of premises an d intended use and occupancy of proposed construction. Existing use and occupancy .................................................................... Intended use .and Occupancy ..... ~. ~ .............................. 3. Nature of work (check which applicable): New Building~ Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated O~st . ~.',[,..~.:l.~--'-- ~.~.~ ............ Fee..~..~ ....................................... (to be pa'id on filing this application) 5. If ,dwelling, number of dwelling units ...(. ...... Number of dwelling units on each floor .............. H garage, number of cars ...~ ...................................... . ................................. 6. If business, commercial or mixed occupancy, spec ify nature and extent of each type of use..~.~,~m. 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 ................ /~h~Inber of St~a'ies ..................... o~/ Z 8. Dimensions of entire new construction: Front ....~..~. .......... Rear . .~ ..~ ......... Depth ............ Height ..... ~ ...... Number of Storie~ ............................................................. Size of lot: Front..~.!i ~ Rear . ./. d'.~. ..... Depth...~.q'.*.~~ ~~ Date of Purchase. ~ .~ ........... Na~of ~xorme~.Owner · · Zone or use district in which premises are situated...~t...0M,~... .................................... 10. 1L 12. 13. Does proposed constructioz v_lgJate any .z~nin, g.3aw, ordinance ,o~,r~gulation~ ,..%~O- .................. Name Of Architect ~_~.~.~.,~ "~ '~ -~ --~' A~ddress (~I~M~, ~ Phone Name of Contractor ~.~..~M/g~ddress ~S~., .~.~, Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set, back dimensions from property lines. Give street and block number or de scription according to deed, and show 'street names and indicate whether interior or corner lot. STATE OF NEW YORK, )S.S. COUNTY OF .............. ) .................................................... being duly sworn, depose~ and say~ that he is the appli- (Name of individual signing application) cant .above named. He is the ........................................................................... (Oontraclor, agent, corporate officer, etc.) of said owner or owners, and is. duly authorized to perform or have pertormed lhe said work and to make and file this application; that all statements 0ontained.in this application are true to the best of his knowledge and belief; and that the work will be pertm~ed in the mann er set fortht in the application filed therewith. Sworn to before me this Notary Publi/¢~.L~0~/~(4~ (30unty ; "'" MILDRED