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Home My WebLink About4887-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.g.~?0 ..... Date ............ Mar.ch ..... ~6.. , 19.7]. THIS CERTIFIES that the building located at . W/S..D~l~ar. D~ive ....... Street Map No.L.a~u'~l .Gty. ~d~k No ........... Lot No.. 2~...La~el .... N .Y.. ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ &~g...$ ...... , 19 ~0. pursuit to which Building Permit No. ~8.8~.. dated ........... ~.. ~ .... , 19.70., was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P.~ivate. e~. f~ily, dwell~g ....................................... The certificate is issued to La~e!..Celery. ~.~$~.~ ..... ~er .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Departmem of Health Approval M~r .~.,..197]...by..~ ·. Villa ....... FOH, M NO, 3 TOWN OF $OUTHOLD ~ 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) Ne 4887 Z Permission is hereby granted to: .......... s~e3~ ........ ;II.~ ................................... to, ..... ~ :¢~, ..~l¢...~'~...j~i~,.~.~r..~t~'~ ~.&~ .................... ~ ......................................................... at premises located at .............. .~t,~-t..~ ....... ];~g~'~..~O~Z~.-~.~.~,e~ ..................................... ........................................ ~ .......... r~_~,,.~.~...~ve ............. ~....~ ................................ pursuan~ to application dated ............................ ~'l~'~ll!l~- ...... .~.~...., 19...-~0, and approved by the Building Inspector. Building Inspector TOWN OF souTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building~ Inspector. b. Plot plan showing location of lot and of bu.ildings on premises, relationship to adjoining premieee or public streets or/ areas, and giving a detailed description of layout of property must be drawn on the diagram whlch Is part of ~le 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 Certlflcoto of Occupant shall hove been granted by the Building Inspector. APPLICATION IS I-~REBY 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 I.awl, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein deecrlbed. The applicant agrees to comply with all applicable laws, ordinances, building c ~ode, housing code, and regulations. g~~a coq)oration) (Address of applicant) State whether applican~ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · - f nrof rem,se r~ame o ow · p s .......................................... ~.~ ................................................................................ If applicant is a corporate, signature of duly authorized officer. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exostmg use and occupancy ............................................................. ~ ................................................................ b. Intended use and occupant', . ......... J ........ ...~....~ ............ ~' ................................... . 3. Noture of work (check whicl~ aoplicable): New Building ~'""~'"~ ° ' ' · ................ Addition ................ Alteration .... Repair ................. Remora! .................Demolition .................. Other Work (Describe) ................................. 4. Estimated Cost ......... c~..~..~....~....~..~3. ..................... Fee ................................................................................... (to be paid on fi!lng this application) 5. H: dwelling, number of dwelling umts ............ /. ............ Number of dwelling units on each floor .....(;. ...................... If gorage, number of cars ............/.. ............................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of exist!ag structures, if any: FJont: ..... ~ ...... Rear ........ ,r...::..:: .............. Depth ..::;~;~ ...... Height ...... ~ .... Number of Stories ......... ~ ............................................................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ......................... Number of Stories ............~ .................. 8. D ~ns ons of__~,ent,ru new construct on: Front ...... ~...~. ....... ~ .......... Rear ......~...c~.......~.. ........ Depth ..... ..c~.......~. ......... Height ....../...C... .... Number of Stories ....... ./.. ........................................................... 9. Size of lot: Front ........... /...Ct.~ ...... Rear .......... /....O....C/. .............. Depth ............. ..~:....~....~ ....... 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated .................................................................................................... 12.13.DOeSName of O~r~er of premis~sPr°p°s~d construct;~ ,,io~~,~_ '"~_ ~z°ning law, ordinance or regu at on? .......................... Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor .................................................... Address ............................................ Phone No .................... PLOT DIAGRAM Locote clearly and distinctly oll buildings, whether existing or proposed, and indicate all set-back dimensions from property lines, Give street and b~ock number or description according to deed, and show street homes and indicate whether interior or corner Jot. STATE OF NEW~ORIi~i.///L JS.S COUNTY-°F ........ · , '('l~me' ' ~"~'~'~':'-m"T'~'"~d~- being duly sworn, deposes and sa s thot he is the a dcant ..................... .'":'. . .' ....................................... y PP of ,ndwidual si~)hing application) above n~med. 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 and file this applicotion; that all stctements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the a~ilication filed therewith. Sworn to before me this ..~ t ...... ....... dayof .......... ............. ETH ANN .............................. NOTARY pUBLI~.'.~L~.~,f;Ik Cou~t~ t4o. 52-8~25~)u, Term ~xpire~ tAm*ch 30, ~.9,~..~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date 15~ Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities (Give deed location) for a structure located have been inspected by this department and found to be satisfactory.