The URL can be used to link to this page

Home My WebLink About4461-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Occupnncy of the aforesaid building. Suffolk County Department of Health Approval No.I[~)0 ....... Date ........... ~ ..... 25 ..... , 19~0.. THIS CERTIFIES that the building located at . ~ate~l~ D~NI ........ Street Map No... ZX ....... Block No.xx ........ Lot No. ~ .... 811~attmld .... ~I,Y., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Sep$ .. 16., 19 .~0. pursuant to which Building Permit No. .1~1~1~. dated ........... 8ep~ .... ~, 19.~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for'which this certificate is (owner, lessee or tenant) ~e P 1380 FORM NO. I 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? 4461 Z Permission is hereby granted to: ..... at premises located at ................... Ws~.~-'~J. eX..D~.~..~'-~ ..................................................................... pursu~ to application ~ed ................................... ~ ....... ~&.., 19..~, and appr~ by the Building lns~ctor. ! ~ Building Inspector BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~'~' Examined .............. .~/ .................... , .......... Approved ........................................ , 19 ........ Permit No......~. ..................... Disapproved a/c .............................................................................................. / ................... ......................... APPLICATION FOR BUILDING PERMIT ,9 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in dup cate to the Building Inspector. . b. Plot plan showing, location of lot and of buddings on premises, relationship to adjoining premises or pub c 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 Perm t to the applicant. Such permit shall be kept on the premises available for ir'~,pection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any puq~ose 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 Bud ng Perm t pureuant to the ~Build!n.g' Zon~, Orfl. inance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordnances or Kegufarions, tar the construction of buildings, additions or alterations, or for removal or demolition, as here n described. The applicant agrees to comply with all applicable laws, ordinances, budding code, hailing code, and r~egulations. ~(Sigr~ture-~'~pp~if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ¢4. Name of owner of premises .......................................................... ..~..<.:...,~ ............ ; ............................................................. If applicant is a coq>orate, signature of duly authorized officer. (Nome and title of corporate officer) !. Location of land on which proposed work will be done. Map No.: ...................................... ;. Lot No.: ........................ Street and Number ~ ' /~"~ - /980 J~/~"I-E~ ~'JEh/ ~)-I~) I//.~ _ .~'OLiTHOL~ ..................................................................................... ................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ~'~ C~A ~ .T.. b. Intended use and occupancy i~)N~' F:~4 I,.L...~. D~4/L'--Z,LI~ 3. Nature of work (check which applicable): New Building ? ................. Addition .................. Alteration .................. Repair .................. Rerr~val .................. Demolition...,~. .......... .O~her Work (Describe) ........................................ 4. Estimated Cost ............ .~...~...0..~....O...~...~.. .................... Fe'~r../..~....~ ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... .~....~'.....~... ...... Number of dwelling units on each floor ........... ~ ....... uT, CH If garoge, number of cars ....................................................... ~, 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use - 7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Numb_er of Stories ................... .~ .......... 8. Dimensions of er~tire new construction: Front ...... ./ ...... ~.....~.. ............. Rear ........... ~.....~.. ......... Depth ....?.....~... .......... Height .... ~.....~.~ ..... Number of Stories .......... ../...'./..~ ......................................................................... 9. Size of lot: Front ........~....O.~ ........... Rear I ~-.~ Depth ~ ~ I ~ /~ 5' -PT Iq q .. 10. Date of Purchase ................................................... ~'...mome of Former Owner 1 I. Zone or use district in which premises are situated '~ * ~'~1 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~ ........................................... 13. Name of Owner of premises ..~...~....~.......~....N....Z...~...~...~...~ddress .............. ~.~...~...~....,~....~...~... Phone No ..................... Name of Architect ,~/~7~,~r~ ~/:-~' Address Phone No. Name of Contractor ....~..~..-~........~...~.~.,~'.-~.. ................ Address .......... ~'~..~...M..?...~.?.../7...~.. ......... Phone NZ .~...~-.~'...~.....~...5..~- PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all setq~ck dimensions from property ~lines. Give street and block number or description according to deed, and sho~ street names and indicate whether interior or corner lot. STATE OF N~ YORK, COUNTY OF ................ .~ .............. ~'~' ~~ z~ ~ 0~ I n..~ duly sworn, d~es end s~Ys t~t he is the epplicent (N~me of individuol si~nin9 epplicotion) bow He ....................................................................... ............... of se~d, ~ner or owner~, .~s duly euthorized to perform or hove performed the suid work end to ~ke this epplication; thet ~11 statements conteined in this eppliceti6n ere t~e to the best of his ~owled~e end belief; end thet the work will be performed in the menner set fo~h in the epplic~i~fil~ ther~ith. ~ ~ ~ · Sworn to ~fore ~ this : /~ x) ~ ~ ~ ] ~ // ,~, ............... o, .. ' .................... ,-- '- '~ S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Date Bldg. TO WHOM at IT MAY CONCERN: The sewage ~disposal facilities for a structure located (Give deed~location) have been inspected by this department and found to be satisfactory. JUN 3 ~ i~7~ District Engineer District Engineer