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Home My WebLink About4017-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No .... ~. 34.7.0.. Date ......... May ..... 8, ........ , 1969.. THIS CERTIFIES that the building located at Azalem .Itoacl ............. Street Map No.Mattltuck.. Block No ........... Lot No.11..& .l~t. Of..10,./4~tt.&tue,-k.o. No¥o Estates conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... aeptm-al~r. ~t o.., 19.68. pursuant to which Building Permit No. 41117. ~... dated ..... Sept~b®r..3 o ..., 19.68., 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 ... pr~tv, ate..one..family, dwell lng ..................................... The certificate is issued to ...John .Mle~tner. of the aforesaid building. (owner, lessee or tenant) Suffolk County Department of Health Approval l~:rch..~.0, · 1.969,. llol~r.t .V&ll&... ( Building~t'o~ ...... FORM NO. 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? 4017 Z Permission is hereby granted to: pursuan,t to application dated . ................................ ~¢l~t,.....~, ......... , 19..~[, and approved by the Building Inspector. Fee $.!..0.~...0~.. ........... Bui ding Inspector t '" S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date MAR 1 0 )gF~ · Bldg. Permit No. ~Z~/7 ~ TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located 0 (Give deed l~cation) have been inspected by this department and found to be satisfactory. District Engineer BUILDING DEPARTMENT ~T.O~. ~. ~. ~ined ....~..h..... ,~.~.~ ~ ..... ~ ......... , ... Pe~ t No ............................. .... .............. .... ........................... ..'""....' ...................................... ................. ~ ...... =~.. ........ "-'"~F~V~ ....... APPLICATION FOR BUILDING PERMIT 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 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. 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 pursuant to the Building Zone Ordinance of the Town of South61d, Suffolk Cpunty, New York, and other applicable Laws, Ordinaoces 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. ~o- ~.~.~r -~ e. ~,~,~ ..... ~..~........~...~ ........................ (SignatuYe of applicant, or name, if a corporation) , ...... .................. (Add?e~s of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~...~Lv~,....../~.~.; ............................................................................. 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. Ntap No.: ......~.........~...~... Lot No.: .l.l..~....~......~"/...0 Street and Number ...~....~.~O:T~..).....~ ~1~'1 ~'~'":""~' 7f'! ~-.~3-~ " i ........................ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....~.../~:~L ......................................................................................................... ~ ........ b. Intended use and occupancy ..[~leg~l'. .................................................................................................................. 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 this application) 5. If dwelling, number of dwelling units ....... ~ ................... Number of dwelling units on each floor ....~. ..................... If gauge, number of ~ .......... ~. ........................................................................................................................ ~... · 6. If business, commercial or mixed occupancy, sp~J~ nature and e~ent of each ~pe of use ............................ 7. Di~nsions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Nu~er of Stori~ ................................................................................................................. Dimensions of seine structure with elteretions or additions: Front ....................................Reef ............................ ~pth ................................ Height ............................ Number of Stories ................................ ~U' ~" .~' 8. Dimensions of entire new construction: Front ......J .......... .~. .............. Rear ....~.~.....~.~. ...... D~th ................. Height .....~]. ......... Number of Stories ....... ~. ............................................................................................................ 9. Size of lot: Front ....L~ ............ Rear ....... ~.~. ................Depth ...~..J.~.~ ............... 10. Date of Purchase ........................................................ Name of Former ~ner .~..~.~....~~ 11. Zone or use district in which premis~ are situated ~..~.[~.~ ............................................................ 12. Does proposed construction violate an~ zoning law, ordinance or regulation? ..~. .................................................. 13. Name of Owner of premises .~...~.~.~.~Addre~ .~~.~..~:~t Phone No ..................... Name of Archit~t ..~.~.~......~.~.....Address ..~.~.~ ......... Phone No ..................... Name of Contractor .~.~.~...~....Address .~...~.~.~.~ p~ne No. ~3~.~.~~ 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 corner lot. ................_, ............... ~,~:~.~,~.~,, ......... ¥~,.(I.¢~.'~..~..~. ......................... being duly sworn, (Name of individual signing application) above named. He is the ......................~..~.~.~..l~,,¢'..~J~.~..l~ ......................................... ~ .................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ma:ke end 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 the manner set forth in the application' filed therewith. Swam to before me this ....... · .'~.....~.,,~ ..... day of i.......~.~..~,..e'Z~. ,~.,~,..~,, 19..~e.~.. Notary Pu~.~....~:...~ounty ........ 6.-~(Signature.....~..~of applicant) ...................... (. MARION A. REG,_i'll NOTARY PUBLIC, State of New York No. 52-3233120 Suffolk County Torm bPires March 30, 19~,..~