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Home My WebLink About5088-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at 'l~ ][~ ...... Street Map No. ~ i~'. ~ck No ........ Lot No.. 1~ .... ~i~t~/~X ' '~.Y~ ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated . E[~I~ I~ , 19. ~ pursuant to which Building Permit No. ~ dated ......... D.~ . .5 .. , 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 'PT~'~tS' '~t~iM~ 1~ '~[VI~ ................................. The certificate is issued to ~O]e '1~4~ 'F~[~t~I,'' & 'l~'lgi' ~ ][~!~'~ '~1~ .. ~'~l~e~O (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Jlll~[~l~. ~[.~. ~[~. · ~1~ .][.~$~& TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5088 Z Permission is hereby granted to: at premises located at ......... ]~Oj;jJt.~J~....J~lJ~J~..Cill;ljlJt/~..Jjllt~J/Mj ........................................ ............................................... l)eiJ~..~a~,vJ ......... ianit~.l.:...ll~, ............................................. pursucu~t to opplicotion doted .......................... jJ~ ......... ~ .............. , 19,..~J1~), ond opproved by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at Th.e sew~e dispos~t facikitiesgor a s,tructure located / (Give d~ed foc~tioni / have been inspected by this department and found to be satisfactory. 6~h~ef of General Enginceri,'~ ~ervi S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date UAR 1 ? J972 Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage dtspo~l facilitie& for a structure located (Give deed locatton)~ have been inspected by this department and found to be satisfactory. BUILDING?OWN CLEIUC'S OFFICE DEPARTMEHTI/'~'¢C~ INSTR~6TIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building b. Plot plan sho~in~ location of lot and of buildings on premises, relationship to adioini.n~ premL~s or public .~treets or areas, and giving a detailed descriPtion of layout of property must be drawn on the diagram wh.ch is port of ~his: qPplication. ,'~1 c: The w6rk covered by this application may not be commenced before issuance of Building Permit. · d. Upon approval of this app. lication, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises avadable 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 Occupancyll shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuan, ce of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apgJicab!e laws, Ordinances or Regulations, for the construction of buildings, additions or 'alterations,-0r for removal or demolition, as herein'described. The applicant agrees to comply with all applicable laws; ordinances, building cede, housing cede, and regulations. , .......... {$1gn~'ure o{ applicant, or harry, i{ a corporatio~ (Address of applicant) · State whether applicant is owner, lessee, age~t, architect, engin~r, general contractor, ele~riclan, plumber or builder. Name of ~nor of pmmls, ....~O~.~.~..~[~.~.~.~.~...~.~~.&~....l.~.~ .................................. If ....... ~pli~~.....~.~,nt Is a co~mte, sig m o duly a~horized officer. . ........................................ ..... a_....,.[ , ~ an~ ~ ....h~.m..~.~.~ ...... 2. $tot~ ~xi~in~ u~ and ~u~y o{ pmmi~ and int~nd~ Use and ~cu~n~ o{ p~ con~m~t~on: ~. ~st~ ~ ~ ~cu~ . ~ ~h ~ [, ........................................................... .., ...'. ........ -~ ~ ~6 M ~ · b. In~ u~ and ~cu~ .... pair .................. Removal .................. no · Demolition ........... : ...... Other Work (Describe) .L..; .................................. 4. Estimated Cost .....'~..~.~...~....~...."..~.. .............................. Fee ........ /...~....a.~ .................................................................... (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 .............. ./. ........................................................................................... i ................................ 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 ...,~.~..T..~. ............ Depth ...~...O...,...~.. ........... Height ..... ~.~/.-...O....... Number of Stories ........ ~ ....................................................................................................... 9. Size of lot: Front ..../..~..: ............... Rear ....~..~.~.. ....................... Depth ..... /.~.~.~.~.~. ......... ..~ ¢o;~e~ ~ ~' 10. Date of Purchase ..~.~....~...~..~... .........................Name of Former Owner ~....~I...~I....Ac:.~....A?.~.~..~...~..)..~.~.T.-~.. ....... 1 I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....~...~.. ............................................... 13. Name of Owner of premises ~,R~.~'~L~LD.~./~l~.~'/2,L~..Address .~,~...(~.I.R!~.....~/~ ............. Phone No./~.7.~.T..O..7....°~..... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor/,~..P..~..~,..~.~.~....~...a.)~T~&S~./A~.....Address ~,.(~..~1.~/~.~ .~'..~..~.:.~ ........... Phone No.~..7.~:..o..~..o..~. PLOT DIAGRAM Locot~ clearly ond distinctly o~1 buildings, whether existing or proposed, ond indicote oll set-back dimensions from property lines. Give street ond block number or description occording to deed, ond show street nomes ond indicote whether interior or comer lot. STATE OF NEW YORK, I S ~ COUNTY OF '°' ........... · ~[~. ~.~..~l-.~l¥....m.,...~t.~.k~,4~, ....................... being duly swan, d~s and says t~t he is the a~licant tmame at individual~n~ application) ' ' a~ve named. He is the ....... ~.~.~~..~ .......................................................................................................... (Contractor, agent, co,rate officer, etc.) of said owner or ~ners, and is duly authorized to perform or ~ve performed the ~id work and to ~e ~d file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will ~ performed in the manner set fo~h Jn the opplicoti~ fil~ t~rewi~. Sworn to ~fore me this ~~ .......... ~ ......... d~ of ..~C.~.~.~ .......... , 19~..__ ........ ~~ N~a~ Public, ......~..~~. .................... County (Signature of applicant) ............ ~o. ~ S~olk Co~