HomeMy WebLinkAbout4254-zFOBM NO. ~
TOWN OF $OUTHOLD
BUILDIiNG DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at 4}~. ~ .................. Street
Map No..~.Y., .~a. ye.l~.. Block No ........... LOt No..~.2. .......... ~.Op.~..O.!4...N.:~... ....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......... April.. 1~. , 19.~ pursuant to which Building Permit No..t~2 .~.
dated ........Ap~u~-- ~. -.., 19~., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .. P. ri~ate, one. family, dwelling ......................... ! :.. ........
The certificate is issued to .. ~/tlliam .Wells ...... 0w~te~ .-.. t~lil~el~....~'.. .........
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval
FOR~[ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 4254 Z
Permission is hereby granted to:
to ~d.l.d ney tree fal$.l~. 4.~11...~1..
at premises located at ........................ ,~t,..i~...~-~....,J~..~l~l~.~l~l..~g~,t~l~ ...........................
....... ~q.~......~... ........ ~.,~.~ ....... ..a....~...~ ....... ~.e~t~;l~.,..~.,~., ...................................................
pursuance to application dated ...................... ..~I~, ........ t~. ............. , 19.~1~.., and approved by the
Building Inspector.
Fee $. ]..0.?...(~... ..........
Building Inspector
$-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
TO WHOM IT MAY CONCERN:
Date
Bldg.
March 20, 1970
Permit No.
at
The sewage disposal facilities for a structure located
Gin Lane~ Southold
(Give deed location)
Bay Haven, Lot 22
have been inspected by this department and found to be satisfactory.
BuJ lder-Owner - Wm. Wells
District Engineer
TOWN CLERK'S OFFICE '~'~M~g.- .~,:~ , .~
SOUTHOLD, N.Y. ''
, p,,cot,on ,o.
Approved ........................................ ~9 ........ Permit No.
Disapproved a/c ..............................................................................................
....................... iBuilding Ins~ector) ..............
a,~ ~ r~-r OOJ'
APPLICATION FOR BUILDING FElt, MIT n ! r
Date ........... A.? ........................... 19. ......
INSTRUCTIONS
a. ,, This.application must be corr~lp~j~[~i~lad in by typewriter or iq J~ and su~m~ed 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 part of this location.
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. Such
permit shall be kept on the premises available for inspection throughout the progress of the work.
e. No building shall be occupied or usedin 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 o Iterations, or for removal or demolition, as ~rein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
'" ....... i~i~at~r, of applii~'nt, or name, i'~';;'~:;;~ii~;i .........
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~ ~uil~e~.
remises ..... .~..i. 1 ! ~ ..~.e. ]..1...J. ................................
Name of owner of p ........ .....................................................................
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 Number .~.{j$~n.~.~.~.~g~.~.~....~"....v..~.~.a.~s~.~..~.`~...~..~.~...~.~.~.'~ ....... ;/.'. .................. : ..............................
R.i~-~t* ~'~,65 Municipality ~q , ~.;~ ~
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
Existing use and occupancy ......................................................................................... ~ ...........................................
Intended use and occupancy ........... ~.~,1~'.~,.li~...~W1~,~13~ ..................... '. ........................................................
3. Nature of work (check which applicable): New Building.....~, ............ Addition .................... Alteration ....................
Repair .....~ .............. Removal ...' ................. DemolitiOn .................... Other Work (Describe) ....................
4. Estimated Cost ......... ~/~l[,~.~.~.l~.~..~.. ............................ Fee ...... ~,.1~.~...~ ......................................................................
(to be paid on 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 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 ............................
Height ....... .~..~...t .............. Number of Stories: ........ ..~.~ ..............
9. Size of lot: Front .ll~ ................... Rear ...... ~.....#. .............. Depth ....~,~.~. .................
10. Date af Purchase ..... ~..g.~.~. ......................................... Name of Former Owner ........................................................
11.r,,~Zone or use district~rwl~iFh~,p~remises are situated ......... ]:Le. ll.~de.q:l;.~lt,~. ............................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~. ...................... .s ............. :...
13. Name of Owner of prernises....?.~.]r..1....:~ll-..~l....?.?..~.~.~.....Address ...~.e...~..~.~e..~..~ ...................... Phone NO.~..~.~..-..~.~.4..?..
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of Contractor....?.~.~...]:..~l'...~....l~....~..1..I.. ................. Address ......~...e.~.~..e..~.~.. ................... Phone NO. e ,
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 numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW YORK. ) S S.
COUNTY OF J~l~J~]l ........... ) n ~
.................. ~.~.~,.~.~1..1~,~,.1~. ......... ~.~.....~.....r..co,¢.~,,~bei~ ~om, ~ps~ ~s that he is the applicant
(Name of individual signing appJicatl~) ~ " ' "''
the .......... ~e~ ........
above named. He is ............................................................................................ ~ ........................................
(~ntractor, agent, co~orate officer, etc.)
of said owner or owne~, and is duly autherized to ~orm or h~e ~o~d the said work a~ to make and file
this application; that all statements contained in this application are tree to ~ ~st of his ~owl~ge and belief;
and that the work will be performed in the ~n~ ~ i~ ~licati~ f~e~the~i~., e ~
Sworn to ~fore me this '~ ~ ~ ~./ /F~ /,/ F~
. .u-.~~ ~. . .
........... ~.~. ....... d~of .~ ........ ~~ ~. s~ (Smgnamre of a~hcant)