HomeMy WebLinkAbout4218-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificete Of Occupnncy
No.Z .3891~ ..... Date ............ July .... 2~ ..... , 1970.
THIS CERTIFIES that the building located at . 'Nortl~ 'Sea' 'Drive ........ Street
Map No. Green. Aol~i Block No ........... Lot No...20 ...... 0r-ient. t~,l[, ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......... t~lareh '" 26, 19-69' pursuant to which Building Permit No. 1,218F, .
dated ........... lelar~h' ' ' 2?' 19.69' was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ::~te 'one' fami'~y 'dvelling .......................................
The certificate is issued to . .l~a~al~l.
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval 'Noir "l 2' '1~)69 .....................
Building Inspector
House ~ 3300
FORM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 4218 Z
Permission is hereby granted to:
~ee~'le.. ~ e~s.....~'C~. ~a~l.. ~mlg~'.-
to ....... .~..ne~..~...~...a~ ............................................................................
at pren~ises I~ated at ........... ~..~ ...... ~..~$~..~..~ ..........................................
.......................................... ~..$ea..~ ................. e~a~t .................................................
pursuan.t to application dated ....................... ~e~ ......... ~. ......... , 19~.., and approv~ by the
Building Inspector.
S-9
SCHD
SUFFOLK COUNTY
DEPARTMENT OF HEALTH
TO WHOM IT MAY CONCERN:
at
The
sewage disposal facilities for a st.ructure located
(Give deed location)~
have been inspected by this department and found to be satisfactory.
NOV
(Building InsCtor)
· APPLICATION FOR BUILDING PERMrT ~ .A ~1--~'-
Date ................................................ ;.., 19. ~... ~. ....
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 showin Iocotion of lot ond of buildings on premises, relotionship to odjoining premises or public streets or
areas, and giVing a detaJ~ed description of layout of property must be drawn on the diagram which is part of t'his applicat on.
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. S.~ch Permit
shall be kept on the premises available for inspection througkout 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 hove 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 remova or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, hausing,~cg~le, and regulations.
........................... ,9 of ..................
Name of owner of premises .........................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed wRrk will b,,e done· A4ap No.: .~n'2....~ ............ lot No.: ..... "..~..~. ...........
Street and Number .......... ~ ........ ~ ........ ~..~..~... ...................... ,.....~..~ ............ ,.. ......... '....~ ........
/"~/ -- ~ ~ 0 0 Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
Existing use and occupancy ........................................ ~'"'"~7] ....................................................... ~'""; ................ :'
Intended Use and occupancy '......~ .......... '.'...~....~..... ............................................ ' ...... ~..i....:.....;'.....~.
3. Nature of work (check which applicable): New Building ....... ..~......... Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Estimated Cost ............................................................ Fee ..........................................................................................
(to be paid on filing t~is application)
5. If dwelling, number of dwelling units ............... ~... ........ Number of dwelling units 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 ............................ Rear ................................ Depth ....................
Height ........................ Number of Stories .................................................................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ............ ~/.. .................. Rear ............ .~...~.~. ......... Depth ....~...7. ..............
Height ....... '.~ ........ Number of'Stories .............. ./...//..Z:.. ................................................................................................
9. Size of lot': Front ....... :./../...~. ........... i. Rear .............. /.../.~......: ......... Depth ....... ~..,7..~. ............... ~,, ~'/)~J(J'~
10. Date of Purchase ........................................................ Name of Former Owner ............. .,,c~. .... '.: ..................
11. Zone or use district Jn which premises are situated ................................................ ~ .................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ...~. ............ ' ..................................
13. Name of Owner of premises .~.-C/.s*'.zn .......~..U.~.~./~...Address .l..6~.......~..)~...~. /~..¢/J/q6S~j~h~n~N
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ...~..~). ...... ./~..J~./~'..f~ ................... Address .~.(,~lT.~.~.s....~....~k~..~.~..:.... Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or comer lot.
z 7a
STATE OF NEW' YORK, ~ c ~
COUNTY OF .............................. ]' '""~:,.,
·
...-~lJll
......................... '....~ ......... ~ .......................... being duly sworn, deposes and says that he is the applicant
(Name of indiv~ual signing application) /~ ' /,)//).~
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 moke ond file
this application; that all statements contoined 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.
Sworn to h~fore me this
.... ...... ............ ......
No,o County'S' ............... .............................
(/ J~LIZABETH A~N N~V[LLE
tIOTARY PUBLIC, State of ile,~v York
No. 52-8~.25550, Suffolk Co t
Term [.xp;res ~arch 33,