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Home My WebLink About3743-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..Med~-y..&..CO~..NO~..Roa~ ........... ...~.. Street Map No. TOtAyw~O~ Block No ....................... Lot conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................... l)e~oex'..'lO¥ ............... , 19...(~?. pursuant to which Building Permit No. doted ........... .De~enl~e~...]:8¥ .............. , 19.~.?.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ............ p~ &rate.. one.. ~l~.ty .. ~e.1.t .t-rig., ................................................................................. (owner, lessee or tenant) of the aforesaid building. Health De~t. Approval July 12~ 1968, Robert V~lla / mS....: ........ [ , Building Inspector J FOI~ ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT *"rowN CLERK'S OFFICE SOUTHOLD, N~ Y. ,. ~BUILDING pERMIT (THIS PER'MIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO/~PLETION OF TIlE WORK.,^UTHORiZED)- . N? :?.37~3 · Z ................. -......tl~,,tm~t..~,%~.~e~..~ ,~, ....................................... ................................... pur~ua;~' tO application dated .............................. ,.~-~.~...~.~ ............... , 19. ~.~.., and approved by the Building ~ inspector. ,Fee $..,,~.0.~ ......... Building Inspector N.I' 15'O0"E, ~ I00.0 FL._ r-r,---- L. C) 'T L j · h 0 'F. 74 C:. : S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. ~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. District ~glneer .~., District Engineer Approved ........................................ , 19..~.... Permit No .... ~ APPLICATION FOR BUILDING PERMIT~ ' '[ BUILDING DEPARTM[NT TOWN CLERK'S OFFICE [ INSTRUCTIONS d. ;i'his application must b6 completely filled ?h 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 detaiied description of layout of property must be drawn on the diagram which is part of this application. 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 used in 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 pureuant 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 a[terations, ror for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and, regulations. ...... pp .c;';:; ......... 814 G~.E%~I'PORT AYf~ i¥~DFORD, N.Y.11763 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. BUILDER Name of owner of premises ~R. &...~,...~S.......~..~...~,.~.Q~.~.Q.T~. .......................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) M~ OF TOLL~VOOD 1. Location of land on which proposed work will be done. Map No.: ...M.~.~.~.U..0.~ ................... Lot No.: ..7.g.....&....7..3 .......... Street and Number .C./.0...~.9.~.....~..~.0..~...~.0....~...A.~.~Y...-.~ ............................. .g~T~.~..~.s~r.~ ...... [.:...i ................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....¥.A..0...A..~?...g..~....D. ........................................................................................................ b. Intended use and occupancy ..0.~IE..FJWZ~¥..~LI~A.V~H..-&m~3J31~D..D3Z¢~'~ .............................................. 3. Nature of work (check which applicable): New Building .....~. ............ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost $].~,500 F (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ..5.~- ....................... 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 .................... Fleight ........................ 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 ..... .5.~.'. ......................... Rear ....~!. .................. Depth ..2:.~?. ...... ~ .......... Height .JkL~. .......... Number of Stories .~ ................................................................................................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ....~.O. .......................................... i .......... Name of Architect ..... ~Oj..~.. ......................................... Address ............................................ Phone No ..................... ~',~DFORD N Yo 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 inte'Jor or corner lot. STATE OF NEW YORK, 1.¢ c COUNTY OF . ~'~' .............. ~ii~iiiii~.~... .......................... beir duly sworn, deposes and"says that he is the applicant. ///~,!ame of individual s~Q?~ing ~t?_Jication,..~,_. 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 d.nd file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in, he manner set forth in the application filed therewith. . Swornz ,,~.~zto before me this // / _~ ' ......... - .................... ............................. ,. .......... Notary Publi~~~ ................ County '~ (Signature of ~nt) j No. 52.7582220 ~u~lo~ ~u,~,~ Term E~ir~s ~rc~ 30, ~9~