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Home My WebLink About4907-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~$ ...... Date .......... ~pF~...¶ ~. ..... , 19 .~. THIS CERTIFIES that the building,located at .~F.1..~ae. DI,~ ............ Street Map No... ~ ...... Block No...~... ~Lot No. 'XXX ..... Ila~t ,~edlk.. lle~ ...... conforms substantially to the Application for, Building Permit here,,t~ !ore filed in this office dated ........... &l~ ... ~8., 19. ~N) p,~,suant to which Build~ Permit No..1~90~. dated ........ &t~...18 ...... , 1~?0 ..~ Was issued, and conforn~s to all of the require- ments of the applicable provisions of the law. The occupancy lo'which this certificate is ~ssued ~s . P~$Ya~ .~ .fa~ly. 5ve,,~l[~[ .............. '/'V ..................... The certificate is issued to .. if&ll:l~a ~'J*. Clal~1~. ...... Rldt~l~ ..................... il, / (owner, les~,,ee or tenant) of the aforesaid building. ~ Suffolk County Department, of Health ~p, proval,, ~ .. Jan. L~.. ~ ~ [ b~. ne..~.lla · ·. UNDERWRITE S CERTIFICATE No. /~,~g. ................ :' . ............. NUMBER --' 1 ~-1'~ ......Street . ':'.. '~1~..D~ ....... -l:~--~.: ........... HOUSE .............. · ..................... .................... ....... FOI~V~ NO. ~ 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? 907 Z Permission is hereby granted to: ........... O~e ,.. ~lm~...k/~ ....~,~ ,/,..~ .................... · ~,~llll~ .................... · ...... ; ......... to ........... l~t~.3~l. · ~e~. · e~e · · ge~l~lg,..~e.~ ~1~ ............... ......................................................... ot premises located at ...................... Jj~lit~....J~t~j~ijt.,~... .................. ', ...................................... ................................................... · ~.~ ......... 'l~j~ '"-'"' · '"'". · ................... pursuan.t to application doted ................................ &JJl~'"'~jj~ ...... t...., 19,...~.~ and approved by tho Building Inspector. iFee $....~l,~10 ........ .......... ""'~'"'""" - ~'~'~JDuilaing~ ~ ~l,~spector .................... $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~JA~ 29 19;74 TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure (Give 'deed loc~) ~ located have been inspected by this department and found to be satisfactory. Shf~f o£ Gm~eral ~ngineer~ng So.~-~i'o~ JAN 29 19;74 Approved ........................................ , 19..)..~. Permit No. ~ ? ~ 7 ~ ~ ~'P x~,~ Di~ppr~ed u/c ..... .................................................................... ~ ~ ~~ APPMGATION FOR BUILDING PE~IT ~ C.o. ..................... ..... u ....... ............. *. lhi~ application mu*t b* complet~l~ fill~ in b~ ~writ~r or in ink and ~ubmi~ed in ~plic~t~ Inspac~or. b. Plot plan ~howin~ I~otion 9{ lot ~ o{ building, on pr*mi~, relationship to od~oinin0 premix* or areas, ~nd ~ivi~ ~ det~ilod ~tion o{ I~yout o{ pro~ mu~t b~ drown on th~ diagram which i* c. ~* work ~ov~red by thi~ ~pplicofion m~ not b~ commenced b~fore i*~uonc~ o{ 8u[IdlnO d. H~n ~pr~ol o{ thi, ppplic~tion, t~ Buildino In~ctor will i~u* ~ Buildin0 ~it ~o th~ ~plie~nt. Such ~h~ll ~ k,pt on Ih* pmmi*~ ~voil~l~ {or insp~tion thmuohout th* pr~r~ of th~ work. ~. ~o buildin~ ~11 ~ ~cupi~ or u~d in whol~ or in p~ {or on~ purpo~ what~wr until ~ ~ificot~ o{ ~cupanc~ ~holl h~ been ~ronted by th~ Buildin0 ~n~tor. 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, Now York, and other applicable Laws, OrdinanceA 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 and regulation§. 'i (Signature-- of al:~511~ant,~r .~ ~ ~.or,fame, if a corporation) ....... ................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber', or builder. .................................... .z~...~-. 4f. £/z.~ .~ ....... C...~. H. C~r,~.c E..~.. L%. ....................................................................................... If o~oplicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. tocotion o{ land on ~hich proposed work will b~ done. Map No.: ........................................at No.: ........... i.... Street and Number .~.l~../~.~fl~..~.....~.z~..(~-. ........ .....~,..~..~.~..~......., ............. Z~I.,~..~../.,C..~..~J(~ .............................. ~[~- JO'7 "5 Fe.-,--T PIOK. T~f 'J'">i:.'COGH ~c . I~^¥ Municipality 2. State existing use and occupancy of premises and intended us~e~aVn~ occupancy of proposed constructiOn: a. Existing use and occupancy ................................................................................................................................... / 'b. Intended use and occupancy ......... .e...~/..~7. ...... .~..~t.~J..c..Y.. ....... /~....~..e.7..&~.Z~./,c--.. ............................................ 3. Nature of work (check which applicable): New~ B~Jiding: ...... ~ .... Addition .................. Alteration ...... ~..J...L.?, Repair .................. Removal ................. : Dem~liti~ii.;. ........... Other Work (Describe) ........................................ 4. Estimated Cost ............ ,~..~/....~...~....~..,.....~...~.....~?......:i,;~e~. ~,...?,;; ............................................................................... , · ? (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ..~...~..~.~. ....... Number of dwelling units on each floor ........ ~.../Y.~.-. ......... 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 .................. 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 ....... ~.-~...~.:...~..:.~. Depth ..~....'~'...~..~...~.'.... Height ...../.,~...,~. .... Number of Stories .............~..../~..~,~ ............................................................................................ 9. Size of lot: Front ....... /.,~....~.....[..... Rear ....... ./..,~..~t.-...~ ............ Depth ...... ,Z~.~..~....~ ........... 10. Date of Purchase ................................. ; ............ ;;....;..;Norne 0f~Fo~ Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any' zoning law, ordinance or regulation? ........ ~/..~ ............................................ 13. NameofOwneref~remses.l~'....~.~'/~/~7;.~/-,~P.~. Addres~d~/~/J~=~,~ z.~ ~'~a?Y7~'c~ No.,~.,~... ........... ~ ..................................................... ..~.~..~. ....................... Phone ~'~0 Name of Architect ................................................... tess Phone No ..................... Name of Contractor .~...~~ress :.:[~~i[:~:::: Phone No~.~.~..:..~./...~...~ 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 ~ I STATE OF NEW YORK, t c: c COUNTY OF ................................ ~ ~'~'- ~. ~~ ............ being duly sworn, deposes and says that he is the applicant" tmame at ,no,v,auel ~ign~l aj~ice~tio~ above named. He is the ......... ~ ............ ~ ..................... ; ........ ................... ; .................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty authorized to perform or h~ve performed the said work and fo 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. Sworn to bqfore me this ~ .....da , of ............... , Notary Public, '"~"~~.'~"1~"'" C°unty""~'/g~~~"/~'~'"" .......................... ~l~ary Pul~/[c, State of NeW Yore No. 30-5712500 Qualified in Suffolk County,. ~erm Expires~March 30~ 197~-