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Home My WebLink About4450-zFORM NO. 4 TOWN OF SOUTHOLD BUILTIING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . IlI~t~. gel~/'. Cpeek..LI~i~ · Street Map No.C.o.~.e.~..C~e.e..~ l~c No ........... Lot No.. 11 ...... II~... ii.Y,, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~ept .... ~ ...., 19~. pursuant to which Building Permit No..~1~.. dated ......... .~ep.% .... J~.., 19~1., 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 . l~i'e~t,e .el~ .t'm~.~y. 4~elliil~ ...................................... The certificate is issued to .... llel~m~ .A~ ....... ~ ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ .$ ~. '1~9' · 'bF ~ .Vl~. & ....... ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N, ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 450 Z Permission is hereby granted to: ~kt.~.J..g~s.~z,..¢o.~.9....~..D~a~l. .......... ~..T ~d~.....ll~.....l.1~. ...................................... to ................. ~.ld,..n~w...oae ..g. atat 3,~..tt~,e3,~ ~,1~ ................................................................... at premises located at ..................... T-o,t...I~....1.S.....COZ'.e.~...Cz'.,.,Sa..,,,.,~..,~S ................................. ........................................... ¥~t~....gea, e~..~eek,.Dm, ............ 8ena~daeZ41 ........................................ pursuor~t to application dated ................................. ,qe.~ .......... ~...., 19...~, and approved by the Building Inspector. i ~ Building Insp~tor { 'TOWN OF SOUTHOLD % ~4P ' '~/'~ ~ b".~r-- ~'. '/~ IUI~ING DEPARTMENT TOWNsouTHOLD,CLERK'SN.OFFICEy. ~ ...... ..... ' ppr ed ....... ...................................... (Buddi~ Inspecto~ · PPLI~TION FOR BUILDING PE~IT ~.~ ~ ,~.4.~ .... ....... INSTRUCTIONS 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 on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property 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 fo? 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 ~Build!ng Zone. Or.dinance of the Town of Southold, Suffolk Count,/, New York, and other appli.c, able Laws, Ordinances or Kegu~ations, for the construction of buildings, additions or alterations or for removal or demohtion, as herein described The applicant agrees to comply with all applicable laws, ordinances, b. uild~n~ code land regulations. ...... .~-~~;.;...~.~..m....e~. ..... (5ignafure of applicant, os ame, if a corporation) (Address of applicant) ~' State whether applicant is owner, lessee, ageot, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~..~.~'~.L.~)-- ......... ~.~....~...L...~.Q~../~..t~.. ...................................................................... If appli~m~ a~rporate, sigrje~re of dully authclrized officer. ........ ......... ..__ o .. (Nam~ and title of corporate officer) 1. Location of land on which proposed work will be done. Map No..' ..~.~ ...~..~.. ..................... Lot No:: .../.~ ................. Street and Number ............................. ~..~.~,~,..~. ....... [.~.~..~,~.~..~,.,...:.::~.~l~.j~..~........' .................................. /~/-- ~ ~ -- , ,""Municipality 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 .................... ..~,~..~...~.. ~ ................................ .................................... 3. Nature of work (check which applicable): New Building ~ Addition Alteration Repair .................. Removal .................. Demolition .................. Ot_~Z. Work (Describe) ........................................ 4, Estimated Cost ................................... ~.. .~......~......Fee ............ ~ ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~ ........ Number of dwelling unJts on each floor ............................ If garage, number of cars .......... ~ ................................................................................................................ 6. If business, commercial or mixed ~cupancy, sp~ify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front .~ ......... .... Rear ....~ .................. Depth ~ ........ Height ~ ........... Nu~er of Stori~ ........ ~ .................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ ~pth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~.~ ............... Rear ....~ ............. D~th .~ ............. Height ...~ ........... Number of Stories ........ .~ ............................................................................................................ 9. Size of lot: Front ........L~ ........... Rear ........ ~ ................ Depth ...~.~ ................ 10. Date of Purchase ........................................................ Name of Former ~ner ........................................................ 11. Zone or use district in which premis~ are situated ..................................................................................................... 12. Does pr~osed construction violate any zoning law, ordinance or regulation.;> .; .......... ~.~..~......~ ........................... 13. Name of ~ner of premises .~.~....~...~~r~s ~..~~. ~[~ .................. ~om~ of Archit~t ..................................................... A~ross ............................................ ~hon~ ~o ..................... PLOT DIAG~ r~~ Locate cleerly ~nd distinctly ell buildings, whether existing or proposed, end indicate ~11 set-~k dimensions from pmpe~ lines· Give street ~nd bilk number or description occording to deed, and sh~ street nemes end indicate whether interior or comer lot. COUNW OF .... ...... . .... ; ......................... ~.~.......(~~..~......being duly sworn, deposes and says that he is the applicant (Name ot"ind~'dual.,,.~j~plicat~ · ,~ ~ ~, · above named He ,s the ~ ~ · · ......... ...... .......................................................................................... : .... (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 application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to beG me this __~ _ ~ Ge/ ~.~...~~ _ ................... t. Notary Public,~~4.L,/,,~.a~/~:}i~L.[nty"'//--~ _.~J~ :~)' ............................. , ' ~ Tlm~ ~.pir~% MIrCh ~, t11~? ' S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~t/~/~ Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. DEC1 ~0 II SL.Ji:'I~"OLK ~UNTY. N .Y~. It \ L ~,~I~UN~LL.. C. ONST. CO~P. e- iYo~ p'~pe