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Home My WebLink About4895-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. z. 1~] ~l~ ..... Date ............. Fob .... ].7 ....., 197].. THIS CERTIFIES that the building located at . CIearv~®w' ~v® ........... Street Map No..Ya~.r.v~.ew..p~i~k No ........... Lot No.. ~. ............... f~uthold .... N conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... AUgUSt .... 10.., 19 .?O. pursuant to which Building Permit No. dated ............ at~ ....1 ].., 19.70, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .. 'G ~,.~5,~h. &' ~ons' 'ln~ ...... Ownt, rs ................ (6wner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Fe~b.,..]$...~c)?]...by. t~,.¥4.}1& .... ~OlJ~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S oFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE: COMPLETION OF THE WORK AUTHORIZED) N? ]895 Z UNTIL FULL Permission is hereby granted to: ........ ~ ...... ~c~/..~ : , O. £~.:... Y.~ .............. to ........ ~.~.D.....4....~.~ ......... ~:~.~.'.~.~..L.y.. ........... D.-~z~.~.~/,.~;;~ .............................. at premises located at ................................................................ ,? .................................................. ~.. ............................................................ .S.~..7.?~ ~. . . pursuant to application doted ................................ Building Inspector. Fee $ ....... ~..t~. ........... '...., 19..7..~, and approved by the B~ilding Ihspector FCsum NO. I '~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLER.'S OFFICE $OUTHOLD, N. Y. Examined ...................................... /! ~,,~, 19 ......./~/ Z-/ ~.~.~./.. ~ .~.~.z. Approved ........................................ , 19 ........ Permit No.....~.. . . Disapproved a/c .................. ~'"~' "m ................................................................. ........................................................................ .......... .............. .............. (Building I~spector) APPLICATION FOR BUILDING Date . ........... ../..i..~.. .................... , 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 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. Sudh 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 Southold Suffolk County, New York, end other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo ition, as herein described. The applicant agrees to comply with all applicable laws, ordinanc/~uilding code, hou~:~g cLde~ regulations. ~(Sign~ru re. c~fc'~l~i~~r'~'l~ ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. tf applicant is a corporate, signature of ~uly authorized officer. (Name and title of corporate officer) ' atio,~n of land on whic.h~ proposed work will be done 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ....... .~.'.Y.~ .................................................................................... 3. Nature of work (check which applicable): New Building '....L~...... ...... Addition .................. Alteration .................. Repair .................. Removal .................. Demotitian ........ ~ .....Other Y/ark (Describe) ........................................ 4. Estimated Cost ~..~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... 7... ............ Number of dwelling units on each floor ............................ If garage, number of cars ........ Z..~'..~ ......................................................................................... 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 ...~.'..'~....2:~... ............... Depth ...~....~.. ...... Height ..,/'.~.. .......... Number of Stories ...~...~...~'~.~ 9. Size of lot' Front ...,~..i.Z....~... Rear ~ 2,~'"'~'Depth ,.~.. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ..... ~.~.x~. ......................................... 12. Does proposed construction vioiate any zoning law, ordinance or reaufation? -~..O .................................................. 13. Name of Owner of premises,c~./,c'..~'f~".Address~/~...~.~... Phone No ...... ~...~...~..?... Name of Architect .......................... Z 7'"~"~''2 ............ Address ..... .~._._~ ................... Phone No ..................... Contractor,~'.,~/~...,..~~:'~...~m...Address ~ ............ Phone No ..................... Name of 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 i.nterior or corner lot. STATE OF NEW YORK, ~ S S .... ~ COUNTY,,Q~ ............... .,...;;~..__,~.,f,-,..~. ,- /? /~,.~.~,~ /rJ~.~.~ ;'x~- .......... ~~ ........................ being duly sworn, deposes and says that he is pplicant -- (Name of individua~[,~l~..ni_ng ~p,~plication) 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 and 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 ............................................ , 19 ........ Notary Public, . ........................................................... County (Signature of applicant) S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: at sewage disposal facilitiels for a structure located (Give deed location) have been inspected by this department and found to be satisfactory.