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Home My WebLink About4919-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ZI~I~ ...... Da~e ................ 1~/ .... 13", 19.?¶. THIS CERTIFIES that the building located at . .Dean .Dr~,v® .............. Street Map Bio. Dewalv.iew. Block No ........... Lot No..~ ...... C~he&,ue .... -N.]~, ..... conforms substantially to the Application for Building Pemit heretofore filed in this office dated ........... AI~ .. t.% ·., 1970 · pursuant to which Building Permit No..1~9%9-Z dated ............ ~%1~ ....21~., 19 ~0', was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thins certificate is issued is . P. rtv~te. Ina. family, dwell.iaI ...................................... The certificate is issued to . Hez'eehel.. P&~son.s ...... O~er ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... April.. 2.7.~. 19.7.1 .. by .lt,..V.i .la Underwriters cert #N ~~In peet ~' ;r~' 872~:~1 / / ~ ........... --s"--- " FO~M ZeO. ~ TOWN OF SOUTHOLD i BUILDING DEPARTMENT TOWN CLERK'S OFFICE : SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? ~§19 Z Permission is hereby granted to: ..~:~. ~,.~;~o~.....~1t.:1t~.~.....1~o~ .... l&~......~ ~...,~,~ ....... ; ............... i ................. to ....... ]~.].~...~ew..e~,..Ee,~&7~..~,~e ~,.3:.~.g ................... i~ ................ ~ ....................................... ot premises located at ........... ~.~.,~..~. ......... "~.]J).~.~[l~.t~.~. ......... ? ............... ,. ..................................... .......................................... ~..~,.~.~e ....... ~.~ ...... .~'-~-,.~-...~,.;, ................................... pursuan~ to application do?ed ........... ; .................... ~.~,, :1,9.~[~., and approved by the Building Inspector. ~1 ~!~ ~t~l~t~;[~ Fee $...'1..0.,.~ ......... TOWN OF soUTHoLD ,,/,//~*~, BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ....%,.~.......~1.. ........ ..~ ........... 19 ,. . .,, .... Approved ~ 19 ........ Permit No. ~ ..... Disapproved a~/_ ............. ........ ............... APPLICATION FOR BUILDING PEEM,T XO IZ~te ....... / ./..... ~...~.......~..'. ........................ , 19 ~O~l INSTRUCTIONS ~ This application must be c0r~pletelY filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premisa~ or public streets or ~-~ araae, and giving a detailed description of layout of property must be drawn on the diagram which Is l~rt of thio application. ~ c. The work covered by this application may not be commenced before issuance of Bulldlr~ 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. II~ 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 Ma, DE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lav~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein de~rlbed. The applicant agrees to comply with all applicable laws, ord~ c~/~ousing code, and regulations. (Address of applicant) ///. C./" State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. Location of land on which proposed work will be done. Map No.: ................... ~ .................. Lot No.: ........................ ~ Street and Number ......... ~..~.....'~.....~.......~../...b/..~... .L.I.~....~....C..../~....~.....~....~....~.~.....~..'.,~..*., ....... ~ MUniclpell~ "~ 2. State existing use and occupancy of premises and intended use and occupancy of propoeed conltructJon: o. Existing use and occupancy ................................................................................................................................... b. Intended use and occupant, . ............. ~....~r. ~.........~..t~...../~.. ,.,/.,~.,..~,,.... ~,~-,.,,.,.~.,.,./~ ,./.~..~.,,..~:,.. ................... 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 garage, number of cars ................................... ~ ................................................................................... 6. If busine~, commercial or mixed oocupancy~ 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 ........... ./.../....(?. ............... Depth ....... ~.....~.. ~.. .......... 10. Date of Purchase ........................................................ Nome of Former Owner ............ ..':~...:......~-......~'....'~..'~.. .............. .1 1~ Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed const~'uction violate an~v zon ng aw, ordinance or regulat on? ... ,,~....~. ........................................... 13. Name of Owner of premises .~....~.~..~.~....A~....~.. ...... Address ..~.~..~..~....~..../~.....~.~..'.~.~...~.'.~ Phone No. ~.~.'...~...~.~...~' Name of Arch tect ~', ~-~,'~7~/X,)OO~) Ad,4,.,..x~6/~'~.'/'/~'~'~, /g/.(~. ~. ~ 7Z'r7 ..................................................................................................... r.. Ph__, N .................... £, Pm. No. Name of Contractor ......................... ~ .................... A .................... PLOT DIAGRAM Locat.e clearly and distinctly all buildings, whether existing or proposed, and indicate al m-back d mens ons from property I,ne~. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. /-- STATE OF NEW YORK, J ee ' COUNTY OF ................................ I' ~"a.~'' ................. du y ,,,o,r,, dep,es and soys thot he the app,cont · (Name of individual s~gning application) ~_~ above named. He is the .......... .2 .~..~..~.../... ........... .~ ............ · . (Contractor, agent, coq~orate 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 a!l statements contained in this application are tn~q~ to the best of his knowledge and belief; and that the wO~k wi41 be performed in_the manner set f0rth ~h the applicatl.afi/filed therewi~. Swam to be]fore me this .,~ ~ ' ' // Qualified In S.ffdk S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. Ohief of ~ena.ra]. Mngineerf~g Services r