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Home My WebLink About4261-zFOF,~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ...a~t. &~ ............. Street Map No. ~1~ .......... Block No. ~1~ ....... Lot No.. XI~ ..... ~t.tittleil; ... li,¥, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Agl*...2~.., 19.69. pursuant to which Building Pemit No..~.I~6.1..Z dated .........April... ~,~., 19.6.~, 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~lva.te. ~ .fa~tly. d~el~Lin~...~ ................................. The certificate is issued to . .~:[e.tor. 0.tmpe~. ....... owner. ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .De.e.e. I~...~6.~ .................. ........... FOEM 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? 4261 Z Permission is hereby granted to: V~teto'A, O~mpel, hild new oM fmd, l.~. dwll.,.~.. at premises located at ........................ ~ ..................................................................................... ~a~t~tm~k pursuar~t to application dated ........................... ..~_p.,F. ......... ~ ........... , 19.~.., and approv~ by the Building Ins~tor. ~ ~..~ .......... J. ' B 'd' g mp~r ( Examined . Approved .................... ,19 .... Permit No ....... APPLICATION FOR B~q. DING I:~RMIT Disa ................. Date ................... INSTRUuriONS 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, relationship to adloining premises or public streets or area~, and giving a detailed description of layout of p~perty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuanee 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 used in whole o~ in part f~r any purpose whatever until a Certificate .of Occupancy shall have been granted by the Building l_nspeclllr. APPLICATION IS 1-il!~l~lY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Oounty, New York, and other appilcable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, and regulations. .., .n. ................................ (Signature of applicant, o~ name if a corporation) .. lg~.~tl~uck ..................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electriczan, plumber or/k builder ................. .~lli~ ........................................................................... Name of owner of premises .... ¥to-1;O1~ -Gllmp~l' ......................................................... If applicant is a eorporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which propased work will be done. MaP N0... ~ ......... Lot No. ~ ......... Street and Number ......... ~/.S.,..S?..~..s.e.t...Ay.e. ..... .M.~.t.l~;llck .................................. /~! ~ o~. _~ Municipality 2. State existing use and occupancy of premises an d intended use and occupancy of proposed construction. a. Existing use and occupancy . .V.a..~.a. ll~..~,/iq14 .................................................... b. Intended use .and occupancy ........ ~0..family. zlwelltiig .................................. 3. ~lature of work (check which applicable): New Building ....X~.... Addition ........ Alteration ........ Repair ......... Removal ........ Den~o!i~i.qu ......,..:, Q~her Work (Describe) ...................... 4. Estimated Cost .. 3. 6.,.7. .......... ,,-i(, /Fee J.o,l . ......................................... (to 'be paid ~n filing this application) 5. If ,dwelling, number of dwelling units Olle: ~ .'... Number ~f dwelling units on each floor .............. If ~arage, number of cars ..... t~O ................................................................. 6. If business, commercial or mixed occupancy, spec ify 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: F~ont .............. Rear ............... Depth ................ Height ................ Number of Stories ..................... 8. Dimensions of entire new construction: Fret ..... ~0 .......... Rear ...... ~0 ...... Depth. 2~/...~.. Height ............ Number of Stories ............................................................. Size of k~: Front ..... ~13.~ ....' . 'Rear ' .~31~ ...... Depth .... .%00 ....... Date of Purchase ....... 19~ ................... Name of Former Owner ...~O?!ll..~.~b~Ry ........... Zone or use district in which pr.emiaes are situated ...... ~..~?.. ~l~j$~ .................................... Does proposed construction Violate any z~ning law, ordinance or reguiatiC~? ... ~q .................... Name ef Owner,of premises .lrt~,tol'. .6~llllpel~... A, ddress .... .~.a.~..'c.i.t}..ll.~.k. ...... Phone No ............ Name Of Architect ............................. Address ...................... Phone No ............ Name ~f Contractor . .~.t.t..~.~,~g..C.~i~ ....... Address ..... ~;.t.J,'l;]l~k ..... Phone No ............ 10. 11. 12. 13. PLOT DIAGRAM indicate whether.interior or corner iot. Locate clearly and distinctly ali. 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 STAT~ OF NEV~_Y~Qp:I~_ )S.S. CO~ OF . .~.% ~... ) ............... · ~igt~..~e~ .................... being duly swo~, de~s~ ~d ~ys ~at he ~e appli. (Name of ~ivid~ signing applicat~n) ~ . c~t a~ve n~ed. He is the ..... ~ .................................................................. (~ntra~r, a~t, c~r~ate officer, etc.) of ~id own~ ~ ~wne~, and is duly auth~ to p~o~ er have pe~ file th~ appli~on; ~at ~ stat~enls ~ntaln~ in ~is applicat~n ~ ~e to the ~st of h~ knowl~ge ~d belief; .~d ~at ~e ~k win be ~ in ~e mann er sct fo~ in the application filed ~e~with. Sworn ~ befo~ me ~is ............ of ....... ..... .~ ,* ,~ .... ~~..~~~ .......... N~ ~blic, ................... ~unty~ (Si~tu~ of appli~t) ~TA~ PUBLIC, State of New ,TermN°' 52-81258~O,Ex~r~ ~ffolk C~ ~rch S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for (Give deed location) a structure located have been inspected by this department and found to be satisfactory. District Engineer l