HomeMy WebLinkAbout4228-zFORM NO. 4
TOWN OF SOUTHOLD
BUILBING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z~,~.~ ...... Date ................
THIS CERTIFIES that the building located at .Deep .Hol. e .1~ ............. Street
Map No.. ~ ........ Block No... ~ ..... Lot No..~rzv... ~l;i~.~k...l~,Y.. ......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......... Apr:il. · ~..., 1969. pursuant to which Building Permit No. 1~-21~...
dated .......... Ipl~il...?..., 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~i.v&t;e. ~ne. rally..dwelling ......................................
The certificate is issued to . ~loseph .~il~.c~e ....... .~111~. ......................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval
I ou e
.10...~97.1...by. R.
Building Inspector
FORM IgO. 2
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? 4228 Z
Permission is hereby granted to:
............... ~.e~.e~a..;~..~:~.~ ..................
.................... 2t6a....~b...3~..S.l; ..........................
................. ~r. eok~:a..:~:~, ....... il2$.b. ...........
to ....... .~.~.. ~.e..v....~.~...~'~,~...~;~l~. ~ ............................................................................
.......................................................... :~.~,-:~ ........................................................................................
at premises located at ............ ~....~]~-~..~Q~..}~.~,.~ ................................................................
............................................................ Iii .t.t,t.t-u~k ......... lt,~,, ...........................................................
pursua:n¢ to application dated ................................. ..~.P...~..~...~......?. ....... , 19....~..?., and approved by the
Building Inspector.
S-9
SCHD
SUFFOLK
COUNTY DEPARTMENT OF HEALTH
Bldg. Permit No.
TO WHOM IT MAY CONCERN:
T.he sewage d~sposal facilities for a structure located
// ~' (Give deed locati n)
have been inspected by this department and found to be satisfactory.
Chief of General ~agin~ering Servlcem
AUG 1. 0 lg71 ~
'rOWN o~ SOUT, OLD ~,_ ,_~ ~, ~. ~,
BUILDING DEPARTMENT . / /~ ~ ~'~
TOWN CLERK'S OFFICE~//~//~'~' ? ~/~"~'~"~' ~'~
SOUTHOLD, N.Y. "t//~,/~,~ ,.~c~a.x,v.~ 73
,oml,ed ........... .F.. ......... .. ......
....................... ............. , .... Pe i, ,a.
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.
APPLICATION FOR BUILDING PERMIT ~
D~e ...... ~?.~.;.~......Z ................................ , ~..~..~. .....
INSTRUCTIONS h~
d. Ul~bn approval of this applic(~tion, the Building Inspector will issue a Building Permit t° the applicant. Such permit
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 !S 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, housing code, and regulations.
(S'gnature of applicant, or name, if a corporation)
..~/...~..,o.../.~:....~.~...~:7......~z..-z......~.~....~..z...a..y.. ....
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, eng"neer, general contractor, electrician, plumber or builder.
............................. .O....'~....q..~...,3.. .......................................... : .....................................................................................................
Nome of owner of premises ~.~..~.. · L. ~,~ e/.~../~e~v o . . .
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: .......................
Street and r~umo .................................................................................................................... ,.....:.~... .................
Municipali~
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy /~..~c~' ~..~
' / ~ ~.~ ~ ~;.
b. Intended use and occupancy '~,/-~... ~' ~
3. Nature of work (check which applicable): New'Build[hg' .........~.. ....... Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Estimated Cost ............................................................ Fee ..........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ....... f?../~ ............... Number of dwelling units on each floor .......--ZTT.. ...................
If garage, number of cars ...........c?....~...~.. .................................... ~' ......................................
6. If business, commercial or mixed occupancy, specif~' nature and extent of each type of use
7. Dimensions of existing structures, f any Front ........ ~ ................ Rear .......... ~ ................ Depth
Height ...... ~ .............. Number of Stories .................... '---. ............................................................................................
Dimensions of same structure with alterations or additions: Front ..... ,......'--. ...................... Rear ........ '~. ...................
Depth ~ ight N
................................ He ........... ~ umber of Stories
8. Dimensions of entire new construction: Front ......... .~....~...~ .................. Rear ........ .z.....~....~ .......... Depth
Height .....~.~ .......... Number of Stories .......................... ~**~ ......................................................................................
9. Size of lot: Front ..... ..~..q.:..o....~ ......... Rear ....~.?.:.e.~.:. ................ Depth ....... 2...~..?..'..°.....~. .......
10. Date of Purchase ........ ..~...~..Z:....'"Z.~,...~.~...g. ................. Name of Former Owner .....7~..~...o.F..~..~......,~F....~. ......................
11. Zone or use district in which premises are situated .......... /~.~...~.×/?.~.Z'.x.~..~. ..............................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ........ /~.~. .............................................
13. Name of Owner of premises ...J...°..~..:J-...:..~.~.~ .~..~.~.:..~.Address ...... ~/.~.?......,~...~..f....~...~.. ......
Phone Np...~'.~.~..~..°.C~f..
Name of Architect ....... ~ ................................ *. ......... Address ............................................ Phone No .....................
Name of Contractor .....~..~.....'~..f~ ................................... Address ............................................ Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate al! set-back dimensions from:
property lines. Give street and block number or descrtptlon according to deed, and show street names and indicate
whether i'nterior or corner lat.
STATE OF NEW YORK, ! ¢ c
COUNTY OF .... ~..'-~.~ .~.e .4..~ ........... /~'~' '~
............ :......: ...................................................................... Demg duly sworn, depc~e's:c~d~says that he is the applicant
(Name of individual 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 make and file
this application; that oil 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 filed therewith.
Sworn to before me this
.......... ........... ....... ..................... C
Notary
Public,.
*~e~m IlaTc'h ~0, ~u,l~
~xpiyes