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Home My WebLink About4389-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..S. 3.7.6~ .... Date .... ~ZV~.....2.7., ....... , 19.7. O. THIS CERTIFIES that the building located at . Numa~t ~o. ]to~[ ....... Street Map No. I[~m~&u. ~. Block No ........... Lot No. 177. & .178...Cu~Cllog~e, .[[,.~f,. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~IF.... 1.6. t ..... , 1969.. pursuant to which Building Permit No...43.8..~.. dated ..... .J/W.1F.....1.6.,. ...... , 19.6.9.., 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 .. prlvat~, on~. f~tlF. ~elLtnq ..................................... The certificate is issued to .... lifo. ~t, on l~.aulkn~ ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~..26,..I~7Q~..~t~..V. llll ....... ....... Building Inspector | TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4389 Z Permission is hereby granted to: ...e.~..~.,.......~.....l~..t~.~m~.... to ........... ~..~...~t~...~...,t..~T.... ~,~ ........................................................................ at premises located at ............... ~ll:~...~L&..~Ta..~-.l~..Jl~llt~.~J~.-Jl'~ ........................ .................................... ~laJama..~t..&..~taa~t~ ..it~mJt ......... l~l,t, ell, el~ .......................... pursuant to application dated ................................ ~:Jl~ ....... ~J6......, 19...~11~ and approved by the Building Inspector. BUILDING DEPARTMENT/'~/~'_-'"~"e't ~4~*, TO~ CLERK'S OFFICE, ~ ~ ~ ~ ~ ~.~~ .~ $OUTHOLD, N.'Y. ~~ Approved ........................................ , ly ........ rerm~t ~o. ~;~ ........................... ~ /~ Disapproved o/c ......................................................................... ................................................ ........................ APPLI~TION FOR BUILDING PER~IT ............ I o. Thi~ oppl!c~tlon mu*t be completely filled in by t~writ~r or in ink ond ~ubmi~ed in Inspector. b. plot pl,n ~howin0 I~,tlon o{ ~ot ~nd of buildino~ on pr~mi~*, relationship to od~oinin0 pr~mi~ ~reas, ond ~ivin0 ~ d,toiled ~ription of Ioyout of pmp~mu~t be drown ~ th~ dio~mm which c. lh~ work covered by lhi~ *pplic~ti~ mog not be commenced befor~ issuanc~ o{ Buildinfl ~rmit. d. ~pon opprowl of thi~ opplicotion, th~ Buildin~ In*pector will i**u* a Buildi~ ~rmit to th~ ~pplic~nt. Such permit sholl be kept on th~ premis~ avoilobl~ {or jn~ection throu0hout th~ pr~r~s o{ th* work. e. ~o buildin~ ~hall be ~cupied or u~ed in whol~ or in pa~ for any pu~o~ whot~wr until ~ sh*ll h~w been 0ranted by th~ Buildin0 In~p~tor. APPLICATIO~ IS H[R[BY ~ADfi to th~ Buildin~ D*portment {or th~ is~uonc* o{ ~ guildino ~rmit pumu~nt to th~ Buildino Zon~ Ordinonc~ o{ th~ Town o{ Southold, Suffolk Count, ~w York, ~nd other opplicobl~ ~w~ O~inanc*s or Rooul*tions, for th~ construction of buildings, ~diti~ or ~lter~tion~, or {or removol or d~moliti~, ~* h~min d~crib~. Th* opplic~nt ~r~ to comply with ~11 ~plicob[~ I~w~, ord~nonc~, buildin~ c~ ~nd r~~ ........................... ....... ....... (A~r~ o{ ~pplic~nt) State whether applicant is owner, lessee, agent, architect, engineer, g~er~ral contractor, electrician, plumber or builder. Name of owner of premises .............. .~. ....... ~ ......... ~.....~ .............................................................. applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ........... ...'~..~,~.~..°a~.......~.~.. ....... Lot No: ../.~..?././7.11~. Street and Number ...~...O~..~.~...o~..~ ..~.4. .................{~..C~...~.o..el 0.0. ............. i ..... /~/- ~ ~0~ ~ '- Municipality ' ' '::,T ...................... 2. Store existing use arid occupancy of premises and intended use ond occupancy of proposed construction: Existing use and occupancy ........................................ ~....._.._..~_...7_. ................................................................... Intended use and OCCU anc -'~ ~' p y ....................................... ........................................................ ..... 3. Nature of work (check which applicable): New Building ................. Addition .................. Altera~on .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) .............~....i .................... (to be paid on filing this application) 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 .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ............ ~.~.. ......... Rear ............................ Depth ............................ Height .......... .2...~. ............ Number of Stories ......... ~..~... ........... 9. Size of lot: Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~ ......................................... Name of Architect ...................................................... Address ............................................ Phone No ..................... 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 numbers or description according to deed, and show stroet names and indicate whether interior or corner lot. . STATE OF NEW YORK, '/. ......... ................... ~d...~..'~ ......... ...~..L..v~...-~.. ............................... being duly ~orn, deposes and ~ys that he is the applic~t (Name of ,n~vidual signi,..~p~lica~ion) above ~med. He is the ................................... ~ ............ ~~ .......................................................................... (Contractor, agent, co~omte officer, ~c.) of said owner or ~nem and is duJy authorized to perform or have pe~ormed the said work and to ma~ and file this application; that all statements contain~ in this application a.re tree to the ~st of .his ~ledge and ~lief; ~nd that the work will be pe~o~ed in the manner set fo~h in the application filed therewith. Sworn to before me this ..... o, ............. ................ ............. / ~m ~pi~s March-30, $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. ~(_~9 5-- TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located ~ (Give deed location) - have been inspected by this department and f~und to be satisfac~tory. ,Didst ~'~ c'~ ~lginen? District Engineer