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Home My WebLink About4401-zFOBM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. ~ .38.(18... Date ........... h&y. .... 2~ ...... , 19.7.0 THIS CERTIFIES that the building located at . C~ly..Lane ............... Street Map No..l)eer..Park Block No ........... Lot No. ? ...... 14attl.tuek .... NoY., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Ju~-y. · .~ .... , 19.69. pursuant to which Building Permit No.. dated ......... July ..... 31'' 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 ... P.~ivate · one .£a~.~.y · d~ellSng ..................................... The certificate is issued to . .14z',&, .Ere-.Robert-Jones .......... l~mer~ ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ..~Y..~[. $9.7.0.. bY. .I~,..g.~,ll~ ...... ..... B~iifiin~' i~~t or ......... Bouse ~f 220 FORM NO. ~- TOWN OF SOUTNOLD 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? ~401 Z D~, ..................... &O~. ......... M .......... , !9...~9 Permission is hereby granted to: ~a~ea~..,~ea ...: ~,~,....liebe~.t..,lo~ea .A ~lfe .............. ~a~.~i.~.~ ............................................ at premises located at ..........,~,~.t~..~.....~.~.~..~.&~g ........................................................................... ................................................. C~d~..~ .............. ~a.t,t~L. tue~ ................................................... pursuan¢ to application dated ......................... e~L,l~: ......... ~,~ ........... , 19.6~.., and approved by the Building Inspector. .......... ................................. ................ Building Inspector Approved ........................................ ,19 ........ Permit No. ..~...O...(.. ~ ~1~,,~. C Disapproved a/c .............................................................................................. TOWN OF SOUTHOLD . · ~ /~/~.'~'~ '~" : . - ~ BUILDING DEPARTMENT ~/1~/7 0 ~,.~ ~ (~ ~ ~, - m SOUTHOLD, N. Y. ~/7/7o W~ ~ ~ ~~'~~ Application No ................. J ........... (Building Inspector) APPLIGATION FOR BUILDING PERMIT Dote ~ INSTRUCTIONS · a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Budding Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of proper'n/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 for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever 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 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ~~ C~ ......... '('~i~ature of~l~lJcont, or nome, if o corpora ionl. .......... . ........................ (Address of applica~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... .~....z~....~$ .................. ~ ...................................................................................... If 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: ....~...e...?..~../~....~...f=...!?. ............ Lot No: Street and Number .....~...!...~...D...~......~....~.~..L.T"~.. .............. ~.~.....'~.....~.~......~..?(...~.~---=.. ................................... i ................. ~ ~-o Municipality 2. State existing use and occupancy of pre~mises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~.....:...Z........ .......................................................................................................... b. Intended use and occupancy ....................... ~ ........................................................................ 3. Nature of work (check which applicable): New Building l/ Addition Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ~...~,~.~ ..,$~., .......................... Fee (to be paid on filing this application) 5. ~f dwelling, number of dwelling units ............ / .............. Number of dwelling units on each floor ............................ If garage, number of cars ..../.=.~../~..~....~..,~.~.,n,,l'..~..../~.~..4f.~..~..e..~.:. ....................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ..........................Rear ............ ~....~ ......... Depth .....~. ...................... Height ......... ~ ..... Number of Stories ............................................................................................................... Dimensions of same structure with alterations or additions: Front .....: .......................... Rear ..... .-. ......................... Depth ~ ~ Height ............. :. ............... Number of Stories 8. Dimensions of entire new construction: Front ..... ~.~.,..I..~..x~ ...... Rear ...~.L~.....~.. .......... Depth Height ............................ Number of Stories ....~. ...................... 9. Size of lot: Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase . ..~. ......................................... Name of Former Owner ...... ......~. .......................................... 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...................................................... ,9~vMt$ I,~- ~ ~ ............................................ 13. Name of Owner of premises ........ .~.e ...... [....~.......~......Address ,~'~-'77"~9-~'~,/c~ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~.[.¥..~...~.....~...:..._~......x{...~.~ ............ 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 street names and indicate whether interior or corner lot. / STATE OF NEWt"I~O.J~, ~) .................................//'~'~~ ................... being duly sworn, deposes and says that he is the applicont (Name of individual si n~g above named. He s the ~....~.~....~ ........................................................................................ (Contractor, agent, co~orate officer, ~c.) of said owner or owners, and is du.ly authorized to perform or have peHormed the ~id work and to make and file this application; that all statements contain~ in this application are tree to the be~ of his kn~ledge and belief; and that the work will be perform~ in the manner set fo~h in the application filed therewith. Sworn to before me this ................... ......... - ....................................... Notaw Pub 'c~L~...~.,.....~~. Cg~ ,,~n ~tete at Ne~ ~ (5i~ure of applicant) S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date C~O-~ 5 /~90 Bldg. Permit No.~/ "~/~0/ TO WHOM IT MAY CONCERN: The ,sewage dispo, sal facilities for (Give deed&cation) at a structure located have been inspected by this department and found to be satisfactory. District Ei~ineer District Engineer