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Home My WebLink About4456-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z. 38gl ...... Date ........... Ju~e... 29 ...... ,1970.. THIS CERTIFIES that the building located at .. 'N]$ ~ew' l~tift'oXk 'Ave' ' · Street Map No..x-r ......... Block No...~ ...... Lot No.. ~e .... Ma~;t~tll~k.... N,~-, ..... conforms substantially to the Application for Building Permit heretofore filed in this office ........ Sept; ...... 9-, 19'14 pursuant to which Building Permit No. 1~6~. dated dated ........ Sept ..... 9 ...., 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 .ems- -f-am.i.l.y. ~i~llimg ...................................... The certificate is issued to ...&ll~l, ey..~.-AbSt~ ..... 0w~e.~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 'June 'L~' 3970' ' 'by' R': '¥$~'~a ..... / · Building I~/~ector House ~ 209~ FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI"HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 455 Z pursuant to application dc~ed .................................. ~... ..... , 19.. and approved by the Building Inspector. Fee $...../...:...;,. ......... Building Inspector APPLICATION FOR BUILDING PERMII' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and Submitted in duplicate to the Building ~ Inspector. b. PI.at .pi.an sho. winfl I .oc.ation. o.f lot .a.nd of buildings on prem.ises, relationship to adjoining premises or public streets or ~ areas, aha gtvfng o aesallea ocscr~ptfon at layout o? property muSt be drawn on the diagram which is port of this application. ~ c. The work covered by this application may not be commenced before issuc~ce of Building Permit. r- 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 in~oection throughout the progress of the work. e. No building shall be occupied or used In whole or in part for any purpaee whatever until a Certificate of Occupancy ]~k 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 Buildin.g. Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regular,ohs, 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, buildi~ code, housing code, and regulations. (Signature of applicant, or name, if a'corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................. ............................................................... : ............................................. Name of OWner of premises ,~ //~) ~=>E ~// ~ ,Y~'~'/ 7'~._~ If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which prapaeed work will be done. Map No.: ................................. /...... Lot No.: MunJcll~311ty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exst use- . a. ng aha occupancy. . .................................................................................................................... b. Intended ~ ond ,occ~na~"y ....... : ~ ....................... ~,,,oo, ....... ; ................................. ,," ......... 3. Nature of work (check which applicable): New Buildi0g :~., .............. Addition .................. Alteration .................. Repair .................. Removal .................. Dem61i~'ior.~...."; .......... O~9/' Work (Describe) ........................................ 4. Estimated Cost ............ ./..~...//.....'~....~....~.. ........... ...,,:.' ....... ~ee :t...:./.,..~-...~ .................................................................... ~ (to be paid on filing this application) 5. If dwelling number of dwelling units ............................ Number of dwelling,,qnits on each floor ............................ 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 ..........~....?'......~j.~ Rear : ........ ~....'.r./.~. ............ Depth ...~: ....... Height ........ ~ ....... Number of Stories ...................... .~....i .................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............. ............... Number of Stories ................................ 8. Dimensions of entire new construction: Front .,,.,...~..,~Z... .................Rear .......... ~.'~...~.. ......... Depth ..~ .~.. ............. Height ...... ./...~.. ...... Number of Stories ~..: ......................................... 9. Size of lot: Front ........./..l~.~. .......... Rear ........... /...?....5. .............. Depth ....... ./...~...d/....~...~ 10. Date of Purchase ............. .~../...o....~....~-~...... ........ Nc. ne of Former Owner ........................................................ 11. · Zone or use district in which premises are situated ............................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ../~'....o. .......................................... 13. Name of Owner of premises .~.., ............................ Name of Architect .......... /.~.~.;..~...'~'..../..~..~....~. ............... Address ............................... : ............ Phone No ..................... Name of Contractor ..........i ......................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ~xi?ing or p,.mposed, ,an~. indi,cat, e all set-back dimens!o~.~,.fro.m property lines. G ve street and block number or descnphon accormng to aeecl, and snow street names and ~na~care whether interior or corner lot. STATE OF NE~Y~,~ COUNTY OF~.~ ...... ~4..~~'~' .................. ~.:.~~... ............................ being duly swam, deposes and- soys that he is the applicant (Name of individual signing ~pplication) . above named. He is 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 rna~e 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 f~il,ed therewith. Sworn to before me this ................ ....................... Notary Public~..~l~/~~~ (S,gnature of appliced~ $-9 $CHD SUFFOLK COUNTY DEPAHTHENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: have been inspected by this The sewage disposal facilities for a structure located (~ive deed loca~on) department and~ound to be satisfac, tory. J ~ N 2 ~ Ig.70 District Engineer, District Engineer