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Home My WebLink About4169-zFORM NO. 4 : TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte of Occupnncy THIS CERTIFIES that the building located at Map No .... ~ ...... Block No.. ~ ...... Lot No..l ....... B~t~tho],& · ·. l~,,~e .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Jell ....1.?..., 19. '$9 pursuant tb which Building Permit No, . dated .......... J.,~ .... i?.. ,, 19 .(.~?., was iss[~ed, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .... ~fii.ll~a~ -~Itt~; ......... 0~1' .................. -" ,'~ (owner, lessee or tenant) of the aforesaid building. .. Suffolk County Department of Health Approval~ :~pt...10~.-%9~9...by Il, .lfi.Lla... Goose Building InspectOr TOWN OF SOUTJ.IOLD 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°. ~169 Z ~e ......................... ~ ....... t~.., 19..#. Permission is hereby granted to: ........ ~h..-.~.~lL.A~....~.&.Jem..~e~ ...................... tbmtlm3A ...................................... at premises located at ...... pursuant to application dated ............................. ~T.~...,.,..~. ......... , 19...~.~, and approved by the Building Inspector. ~ee $.10.,~g~ ........... S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH E~dg. ~ermit .o. TO WHOM 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. SEP 1 0 1969 District Engineer. District Engineer Appr~.ve'..1 .............. ,19 .... Permit No ................... Application L ..... Disapp~oved a/c ........................... APPLICATIC~N FOR BUILDING P~RMIT Date .............. ....... INSTRU~rlONS 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 o n premises, relatic~tship to adjoining premises or public streets .or ~reas, and giving a detailed description of layout of p~operty must be drawn on the diagram which is part of this application. c; The work covered by this application may n~t 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 pregress of the work. e. No building shall be occupied or used in whole o~ in pa~ for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS I-IEl~qY MADE to the Building Departxnent for the issuance of a BuiMing Permit pursuant to the Building Y~one Ordinance of the Town of S~uthold, Suffolk Oounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or dem~- lition~ as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building eerie, housing eode, and regulations. . ~_ ~ ,~.] . ~..~ .~,L~....~....~..._~. ~'~ ~ (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 '--~//~~ ~'z~-~ . ..................... Name ~ ~[er of premises. ~ i i i ~~'.'.~.~/~.'/.~ ........................ If applicant is a corporate, signature of duly authorize d officer. ~' ' (Name ~nd title of corporate officer) 1. Location of land on w~, l~roposed work~ wil~l be done. M.a~N0 ........... ~... ~t N~ .......~ ..... ........... State exi~g use and ~cup~c~ of pr~ ~ d i~end~ u~ ~ ~P~ of p~ ~ct~on. ...................... '... a. ~is~ng use and ~cuP~cy .... ~~~. b. Int~ded ~ ,~d ~cup~cy .... ~~ ........................................ 3. Nature of work (check which applicable): New Building ...J~.... Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ..... .~...-~. ........... Fee ... / ............................................. (to be paid qn filing this application) 5. If dwelling, number of dwelling units .... ~. .... Number of dwelling units on each floor .............. If garage, number of cars .......... ..~ ............................................................ 6. If business, commercial ~r 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 S~ries ..................... 8. Dimensions of entire new construction: Front .... 7..~. f~..~.... Rear . .~. ~. f..~.:~... Depth . .~ff.~. ....... Height . J..~'~.. .... Number of Stories ...... / ...................................................... 9. Size of ]~t: Front . ,~..-~..~. ........ Rear . ~ ~ ~. ~. ~. '. ..... Depth . .~.~...~. ..... 10. Date of Purchase ....... ~.~.~.~.. ............... Name of Former Owner 11. Zone or use district in which premises are situated ...... '"~. .................... ~. ..................... 12. Does proposed c0n~truction v~.e,t~n,G~ zoning law, ordinance 91; re, gl~lation? ..... . ./~..~. .................. 13..Name of Owner,of premises .~/'~..~...~..~..~-~. ifladress~'f~: .~'... Phone No.~..b'.~..~?..~'.~ Name of Architect . 4.' .................. Y..I ......~ddress .......... i..-. ,~ ..... Phone No ........ . ..... Name of Contractor .~...'~.~......~..~.. Address ~ ..... Phone No.~.~...~J..~. f~' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from prot~rty lines. Give s~eet and block number or description acoording to deed, and show 'street names and indicate whether interior or corner lot. STA'I~ OF ~Y(IRK,~, )S.S. ......................... eing duly sworn, deposes and saYa that he is the appli- (N. ame of indiv!du_al signing appli~nL y~. .~ .- cant. ~ ~amed. He is~the ........... ~........~.~....,~...~. ....................................... (Oontractor, agent, corlx~ate 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 centalned in this application are true to the best of his knowledge and belief; and that the w~rk will be performed in the mann er set fortl~ in the application filed therewith. Sworn to before me this ................/ .?~.da~ ~f. ~ ' '~~.,~L~' .~.I .~..~ ..,~.~,: ...................... ~ Co~slon'~. Expires ~a~ , - ~- / t/