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Home My WebLink About4384-zFOBM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town (~lerk'$ Ol~ice Southold, N. Y. Cerlificate Of Occupancy No. Z38,~0 ...... Date ........... ~. ~ ........ , 19. THIS CERTIFIES that the building located at . .J~ .l~al,~d~.se. 1~. ~.. Street Map No. l ......... Block No..~ee ...... Lot No. ~e~ .... ~r~lO]~...]~.o.~., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ,~....¶.~, 19. ~ pursuant to which Building Permit No... dated ......... ,~... ~..., 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 .... P~.~at~ ~..fa~..dvell.~ .................................... The certificate is issued to .... Robel~t. L, .Stott ....... Ovne~ ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval,~c~.. ~--.~'~~ .'~l~a... Building Inspector FOg, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT ('rillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~l.il.l~a.tth & ama~ l~e ..&.~... ~obert Start to i~ttd -,er ~ ..t.~U,~.../~.Liae, ..................................................... at premises located at ................... .~.41~.......~.lJl~ll~llgl...~..~t*..~e...]~¢~l~l~ ......................... ..................................................... IteI~U~M, ...... J~.Z, ....................................................................... pursuant to application dated ................................. ~1L1,I ....... .~...., 19~.., and approved by the Building Inspector. Building Inspector ~FORM ,NO.~ I! ~ ~,- TOWN OF SOUTH ~ TOW~C~X'SO~',C~/V0 ~,~ r'.~ ~.'~ ~ /...~ o Examined ..... .~.., ~9 Application No...~.~.~./. ...... App~v~ ................ ~..., 19 .... Pemit No. ~ ~ ~. q ~ ' ~ ,~ ................. a.e Disapp~ved a/c ............... ...................... ~ ........ :..~ ................................................. .~..~~-~. ~~ ............. g..~ ..... ~. ff.U../ ......................... ~STRU~ONS a. This appli~t~on mus~ be ~mple~ely filled in by ~ype~er or in ~nk and submi~ in duplicate Buildin~ Insect. b. P~tp~an showing ~a~ion of ~ and ~ buildings on premis~, ~la~p ~ adjoining p~m!~ or public st~e~ ~ ~, ~d givin~ a ~1~ descri~n ~f layout of p~p~y m~s~ be d~wn on ~he ~a~m which ~s pa~ of ~ls applica~n. c. ~e w~k ~ve~ by ~is applicat~ may ~ b e commenced before issuance of ~din~ Peril ~. U~ ap~v~ ~f ~iS application, the Building In spear will ~sue a ~Buil~ P~it Su~ pe~it s~ ~ kept ~ ~e p~mi~s available fo r ins~ti~ ~u~hou~ the p~ ~f e. N~ building shaR be ~pied or us~ in whole o~ ~ ~ ~y pu~e wha~v~ unffi a ~ffica~e Oc~p~cy ~ ~ve ~n ~an~ by ~he Bufl~n~ ~CA~ON IS ~Y M~E ~o ~e Building Depar~m~t for ~he ~ssuan~ of a Buildin~ P~i~ p~uan~ to ~he Bufldin~ ~ne O~in~ce of ~he ~wn ol ~atho~d, S~lk ~n~,~New Y~k, ~d o~er a~H~ble ~ws, Or~nces or ~la~ns, fo~ the ~on ~ build ings, additi~s ~ alt~a~ions, ~ f~ ~v~ or dem~ (Sig~tum ~ applie~t, or ~e ff a ~ ' ) '('Address of appi ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or of owner ~'..'~'. .................... Name of premise~ -~, · .......... if applic~~ ~orize d officer. ..... ...... 1. Location of land on which prop<~ed work will b,e done. Ma. lx,No ........... .~...._ Lot NJ .............. 2. State existing use and ~ceupancy eg p~emises an d intended use and occupancy of proposed construction., a. Existing use and ,~c:?:; ...~,~[ .... b. Intended use and, p y ... ~',.~.~..~T..~. ....... ' · ' ...... o o 10. 11. 13. Nature of work (check Which applicable): New Building '~'x"' Addition ........ teration ....... Repair ......... Removal ........ Demolition ........ Other Work (Describe) . .'x,:' ................ Estimated Cost .... .~. ~,/..~-..~ .~...~.~... ii ...... Fee . ./..~..~...?~.. ................................... (to be paid on filing this application) If dwelling, number of dwelling units ../.~.... Number of dwelling units on each flo~r ~ ......... If garage, number of cars ...,~. ~-:~. ........................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use .............. Dimensions of existing structures, ff any: Front .............. Rear ............. Depth ............. Height ................ Number of stOries . i. i :'~: ..... i'iii .'i i~'i.. ~. i~. .............................. Dimensions of same structure wi'ch alterations or additions: Front .............. Rear ............... Depth ................ Height ........... ..... Number of Stories ..................... Dimensions ~)f entire new construction: Frout . ~. ~.... i ....... Rear ~.~. ......... Depth ~...~. ....... Height .~. ~...t .... Number of Stories .../(. ........................................................ Size of lot: Front . .,Z..~'..~'~.. .... Rear . ../..?'.~ .... Depth .t~.~..O. ........ Date of Purchase ............................... Name of Former Owner ............................. Zone or use district in which premises aide situated.. ~",~.~'.. .......................................... Does proposed eonstmction/y~ff~.a.i.e~n~ law, erdinan.,~ or .~_.~_~?. ~ ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property linos. Give sweet and biock num~or de_s~cri~pti~)n according to deed, and show street names and indicate whether interior or corner ~ct. -/~pts iff. ~ ~ STATE OF NEW YORK, )S.S. b~-(~. L,)4~ ........ y . .. ~ ...... being duly sworn, deposes and says that he is the appli- ....... i signi 'ng_~plic~ ~ cant above named. He is ~he .. 4~ .... ~ (Oontractor, agent, oorporate officer, etc.) of said owner or owners, and is duly. authorized to perform or have performed the said v~ork and to make and rite this application; that all statements oontained in th is application a~e true to the best of his knowledge and belief; .and that the w~rk will be p~ed in the mann er set fort~ in the application filed therewith. Sworn to before me this Not ary lsh~)~:: .... .'= .... Z..~..L ~:~nty~g~ (Signture of apphcant) ELIZABETH ANN NEVILLE ROTARY PUBLIC, State of N~w York No. 52.8125850, Suffolk Cou~L, Tei'm Expires Mai'ch 30, 19~_ S-9 SCHD TO WHOM IT MAY at SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Permit No. CONCERN: W ~e sewage disposal facilities for a structure (Give deed location) located have been inspected by this department and found to be satisfactory. ~letriet ~glneem District Engineer