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Home My WebLink About4563-zFORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No, ~'3920 ...... Date .......... ~,ag ..... 6 ........ , 19.. ?0 THIS CERTIFIES that the building located at .1~,. SI&. Dl't. vl ............. Street Map No. 0-,by. ~.. Block No ........... Lot No...81~ ..... 0~$eat~ .~.~. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... l~lV'" '2b~ ......, 19.. 69pursuant to which Building Permit No... dated .......... lte.V. .... 21~. , 1969, was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. 'P~i~mte' ~ae' f~,-ily 'dwe'~Ting ..................................... The certificate is issued to . lx'eae. ~!. &. Pea'er' P~II~ ..... ~el'l ............ (ovrner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ' 'Jllly'' '~ .... ~0 "by' Iieul. , 11~ ....... /.~ i3,.t-...~..~ ..... Building Inspector TOWN OF SOUTHOLD 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? 4563 Z Permission is hereby granted to: .......... ~eay..3lee~mt....&,,l....;Z~eae...Vez,4 & I~tez, Ilmlabaa at premises located at .............. O~,GGt,..3;)~r...t.]:;~..~ .............. ~t..~l, ....................................... ................................. lemtll..&el~..~)~e ........... et,,e~ ......... .11.¥2~ ............................................. pursua~* to application dated .......................... ~ie4~ ....... ~' .............. , 19~..~4~, and approved by the Building lnsl~:tor. Fee $.~O,~X~ .......... Building IR-spector ( FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sonthold, N. Y. Certificate Of Occupancy No. Z3920 ....... Date ........... Au~ .... 6 ...... , 19..70 THIS CERTIFIES that the building located at ,. 1~.. flea. Did, ire .......... Street Map No0~b~' .Sea .... Block No ........... Lot No...~ ..... Ol~leltt...EoY, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... EOV'-' 2b¢, 19.. 69 pursuant to which Building Permit No.. dated ........... NO~ ... 2~+.. , 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 .... l~lvate, orlo. faraily, dwet.lir~§ .................................... The certificate is issued to .Jane .ktaI~cl .&, Ret~l'..t~,ola~aart .... 0wntal~ ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval J~kly .ak...i970., .by. t/.. 7illa ..... BUILDING DEPARTMENT,./ / ~,~ ~ TOWN CLE~,K'S OFFICE '/Y//~ ~ o.';( $O~THOLD, N.Y. ~.~,~ ,~. ;,V~ ~ Application No. ,.~,.~.,.~.-~-. ...........~ Approved ........................................ , 19....~.... Permit No ........................... ~ ~,~ d.',~,/C~ ~' Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PERMIT Rte ...................... ........... 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 port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. permit d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such 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 r~ulations. (Sigrl~ure of~app, licont, or name, f a C°rporat~on) ' .................... .......................... (Address of applicad~) State whether applicant is owner, lessee, agent, architect, engi~neer, general contractor, electrician, plumber or builder. Name of owner of Premises ..J..~..~.......~.........~4c'~....~ ........................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) .'4~'~'--~ '" --" '7 1. Location of land on w.hich proposed work_will be don~,. Map No.: ...~....~....~...~. .............. ::.... Lot No.: ....?..~.. ............. Number ..... K.~ .......................................................~ ....... ..'~......~.../. ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ..... ~.: ............................................................................................................... Intended use and occupancy ....~..* .............................................................................................................. \ 3. Nature of work (check which applicable): New Building................./'~ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ~ ................. Number of dwelling units on each flor ...: ........................ If garage, number of ~rs ............................................................................................................................................. 6. If business, commercial or mixed ~cupancy, speci~ nature and extent of each ty~ of use ............................ 7. Di~nsions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ............................................................. ... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ ~pth ................................ Height ............................ Number of Stories ................................ Height ....~.~.~ ....... Nu~er of Stories ....... .~ ........ . .................... 10. Date of Purchase ...~..~.~.~.~. ........................ Name of Former ~ner 1 I. Zone or use district in which premises are situeted ...~ .... '"'"~ .......... ~2. Does proposed construction violate any zon n aw ord hence or renu at on> 13. Name of ~ner of premise~~~.Address ~~...~ Phone Name of r ...................................... P~ne No?~.~.~.~.. PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposal, and indicate all set~k dimensions from prope~ lines. Give street and bilk number or descripti~ according to deed, and show street names and indicate whether interior or corner lot. T STATE OF N~ YORK, ~ S S ................ ~ ........................................................... De~ duly sworn, d~oses and says t~t he is the applicant (Name of individual signing application) above named. He is the ................................................. ~/~.~ ........... (Con~ractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner ~t forth in the application, filed therewith. Sworn to before me this Notaw Pubhc, ~ NOTARY PUBLIO, Slate 0f New Yo~ (Signature of ap Jlcant) ~o. 52-2262800 Suffolk Cou~t~ Te~ Expi~ March 30, S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH J§L 2~ 197~ Date Permit No. _~z~.~ Z Bldg. TO WHOM IT MAY CONCERN: The sewage disposa? facilitte~s~ for a struct re located (Give deed location) have been inspected by this department and found to be satisfactory.