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Home My WebLink About4402-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..~.57~8 ..... Date .......... ~-,,.. 6. .......... ,19.~. THIS CERTIFIES that the building located at · Street Map No.. ~ ........ Block No. ~ ........ Lot No..1~ .... Il..eW..S .~f. f.0~k. . ]! :! .* ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ,lil~..y.. 3.~.. , 19.69 pursuant to which Building Permit No.. dated ......... ~/t~'''- 3t , 19.69, was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . l~iva, te. ona .rally. twelLing ...................................... The certificate is issued to . Eli~lo.~th. Campbell ..... (l~m~l'. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ,T.&~,. ~.. ] ~.~1.. by .R,¥;I,:].II~ ....... ........ Building Inspector louse fP 1~0~1¥1 NO, ~ TOWN O~ 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) Permission is hereby granted to: to ..... J~tt 3.~..ne~...cme ...t aad.3,~.. ~tv~.3.ta& .............................................................................. at premises located at ................. ~j~..~r~l)~lZ'~:t~9..,~:~/&(J..~..~..~lLr~...~ ................................ ........................................ .W.~w...~1~.l~o~r, ........... .tl.~:.~ ....................................................................... pursuant to application dated ............................... aT.13~ ....... ~ ....... , 19..J~, and approved by the Building Inspector. Foe .......... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH D.te TO WHOM IT MAY CONCERN: at The sewage disposal facilitiea for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. DJ striot Engineer District Engineer TOWN CLEItK'~ OFFICE Examined .~ .................... , , Application No ............................. ~/~ Approved .~... ................................. ~"~ ~. ~-, , ,19 ........ Permit No.....~.. ......................... ~7~ ~,-,~'/~ . O ~ ....................... ................................. APPLICATION FOR BUILDING PEP, MIT ~1 ............. .......... Z/.. ............ , Date / INSTRU~IONS ~ a. This application must be completely fill~ in ~ ~wrlter or in Ink and ,ubml~ In d~llca~ ~ ~e Bulldl~ ~ Ink,tar. b. PI~ plan shying I~otion of I~ a~ of buildings on pmmls~, relationship to adjoinl~ p~l~ orp~.~ or areas, and givi~ a detailed de~rJption of I~ of p~must ~ drown ~ the diagram ~lch I~ ~ ~ t~ ~. c. ~e work ¢~ered by this applicati~ may ~ ~ comme~ed ~fom I~e of Bulldl~ Pe~. d. Up~ approval of ~is application, the Building Ink,tar will Issue a Building pe~t to ~e ~lleant. ~h permit shall be kept ~the premiss available for in~tion th~gh~t the p~mss of t~r~ e. No ~ilding shall be ~cupi~ or us~ in whole or in ~ ~ for any pu~o~ what,er until o ~ifl~ of ~n~ shall ha~ been granted by t~ Building Ins~tor. 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 cbnstruction 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. .... (S,gnature of appli~j6t, or name, If'~'~r~;i~i". ....... ............. ¢.~".~.,r.~m~6 .....~ ............................. ..~.1...~ ............... (Address of applicant) ~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .~../~.i.~....~..~..~...~...~........~..~:......~.~.~..~...~..././.. ...................................................................... If applicant is a corporate, signature of duly authorized officer. (Nanm and title of corporate officer) I. L.o~otion of Iond on which proposed work will be done. Map No: ............................................ ~ No ..................... Street and Number '"~"~'"~'0'"'~'; 'JC"~"'"'"~"~'~"(-~'"'i~i~''~''~''''~''''''''~'''''~'''~'~''6' '/'~" --M pality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................... b. Intended use and occupancy ............... ~..E.~.....~.~. ......................................... i ....................... J A iti .................................... 3. Nature of work (check which applicable): New Building .................. dd on Alteration Repair [ ................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost .......c~...~ff....~.......ff~... ................................. 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 ..... /.....~.,~..~......~.~....4~r..~.~.~.~ ........................................................................................ 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 ~.3/~" Rear ...~.~........~. ...........Depth .~....Z:. Height ............................ Number of Stories ....~. ..................... 9. Size of lot: Front ..,~/.~..~. ................. Rear .~.~..g....( .............. Depth ../..~..~..:..~...~. ............ 10. Date of Purchase ....3'./,h.g/.,&~..~. ................................ Name of Former Owner .~.../~./~../~...r.~.~......../.~...e...%..K:.q..g. 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation.;> ...................................................... 13. Name of Owner of premises~./.~Z.~.b~T../t...C:..(?~/ze.~.~..~./..(Address ............................................ Phone No ........... , ......... Name of Architect ...................................................... Address ............................ ................ Phone No ..................... Name of Contractor .~..r..~..~..~'...'~........~..;.~..~....~..J. ....... Address ,t~.,~..~...,.; ."~...~.E../.~.. .............. phone No. ~..~.~...~.~..-~..¢~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property fines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. I STATE OF NEyC'~g~,~/gr t ~ ~ COUN'rY OF ~~ ....... ' .... ........................ g,,,,~,,;,,~~ .................... being duly sworn, deposes and says that he is the appllcont ................................................................................ :.... (Contractor, agent, corporate officer, etc.) 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 a,pplication a.re true to the best of .his knowledge and belief; and that the work will be per, formed in the manner set torth in the application filed therewith. Sworn to before me this ( ) O ............... .................... . Notary Public,~~...~:....~ pul]ti, ''~''' ,~,te oi~ :::"i,. '('~i~nt) ............... ' " '"'"'"'"" 'TRRY rio. o~ Term ~pire~ Marc. ,