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Home My WebLink About4939-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Cerlificnte Of Occupnncy THIS CERTIFIES that the building located at .Brigan.t.i~o. P.r ........... Street Map No.tI.a.r.b..o.r. .L..i g.h~ck No ........... Lot No.. ?.1+ ..... .S.o.u..t .h.o.l.d....N. :Y.; ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~.ep.t....~ ..... , 19 .7.0.. pursuant to which Building Pemit No. dated ......... 3ept... ~ .... , 19.7.0., 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 . .P.r~.v.a~e..o~c. ~.a.m.i. ~.),[ .~..w.e.l.l.i.n.g ...................................... The certificate is issued to ...S..a.m~..e.l...~..r.k..e..1.~. ....... .0w~...e.r. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...D..e.c... ~. 3...~.~.....by...R... UNDERWRITERS CERTIFICATE No. .p.e..n.d.~.n.g .............. i i ................... HOUSE NUMBER ...1.2.6~, ...... Street .... .B.r..ig..al~..t .i.n.e..D..r... 'i. ................. FORM NO. 2 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) N? ~939 Z Permission is hereby granted to: 8~uel to btttld new one i'~i.3..y, tl~'el!~.~.l~ ........... at premises located at ..... ~.~... ,~.. ......... ~,l~..l~,~...~t~i~'~.~ ................................................... -. ................................................. ,.-~-S.~.t-.~.,~ ......... .~a., ....................................... pursuan¢ to application dated ............................ .~..~.,~..~ ........ ~.........., 19...2.0.., and approved by the Building Inspector. 10,00 Fee $ ........................ TOWN OF SOUTHOLD ~, . BUILDING DEPARTMENT ~/~/7 · TOWNCLIRK'SOFFICI .'~ SOUTHOLD, N.Y. "/, ~, Application No ...... .,. .................. ........................................ , ~ ........ Permit No ........ ~~ ,~" ~. h.,~,~ "~ ~- .............................................................................................. . .......... .......-.. ...... ................ APFLI~TION FO~ ~UILDIN~ Fl~l~ ~ .............................. ~,~.~...,~,. ~,.2~ .... INST~ION$ a. This opplicatl~ must be c~ple~ly fill~ in by ~ewriter or in ink und submitted In ~pllcme In~r. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premleel ~ public streats or areas, and giving a detailed description of layout of property must be drawn on the diagram whlch It part ~ ~hil ~t)llcation. c. The work covered by this application may not be commenced before iwJance of ~uildlng Pemdt. d. al~roval of this application, the Building Inspector will I~lue a Building Permit to the c~¢)llc~nt. Such permit shall beU~t on the available for inspection throughout the progreu of the work. premises e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Oocupanc¥ ~.~ shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit punluant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, Grid other applicable Law~ Oedinanca~ or Regulations, for the construction of buildings, additions or alterations, or for removal ar demolition, al heeMn dsecribod. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatlam. (Signature of applicant, ~ name, If a C~l~mtlm) .............. · ~au~:Jao~l ............................................................... (Address of applicant) State whether applicant is owner, le~see, agent, architect, engineer, general contractor, electrician, plumber ar builder. ....................................... C)~ne,r.... ,..b.u.~3,de~ ...................................................................................................................... Name of owner of premise~ ....§~l~.~.~e,~ ................................................................................................................. If applicant is a corporate, signature of duly authorized officer. / (Name and title 'of corporate officer) ~ M Harbor L~ hts 1. Location of land on which proposed work will be done. ap No.: ....................... Lo No.: ..................... Street a~nd Number ......~=;I,~a~t;~ue..~);r&ze ........... ,2Gu~,ho~l ........ i ......... , .................................................... ~/.-.'/...-.-- /,,~. ~, ~ Municipality State existing use and occupancy of pmmMs and intended use and occupancy of prppmed comtructlon: a. Existing use and occupancy ...~lL~,a~t..,~3~. ...................................................................................................... b. Intended use and occupan? ......o~.e...~'lJ~],y...~.~e~lJJt33.~ .............................................................................. 12. 13. 3. Nature of work (check which applicable): New Building ~ .......... Addition .................. Alteration ............. Repair .................. Remova~ .................. Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost ..... ,2~)34)00..~ ................................... Fee ...... .~0.~,00. ...................................................................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units ..... ~ ............... Number of dwelling units on each floor ............................ If garage, number of cars ...........~ll[O. ......................................................................................................................... 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 ...~J'.....lf.~. ...... Height .................... Number of Stories ......... o~e ...................................................................................................... 9. Size of lot: Front .~[00 .................... Rear .....100 ......................... Depth ..20.~e .................... 10. Date of Purchase ......... ~..~.~ ..................................... Nome of Former Owner ........... ]lease ................................. ! 1. Zone or use district in which premises are situated ........ #~.11..t~.~ .......................................................................... Does proposed construction vJoJGte any zoning law, ordinance or regulation? ..... I~0 .................................................. Name of Owner of premises S el..F :ice:L ........ Address ....... JiD.l~.t, hO]L(J, .................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..... sa~e. ..................................... Address ............................................ 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. _1 STATE OF NEW YORK, I S,S COUNTY OF ..~11~.~O~C ............ )' · ................................. J~3J;IJ. lJ~,..J~J'lrO~ ................................ being duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the ....................... eT~'~eD'.,,...b'~J~].~e'z' ................................... ;~ ........................................................ (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 Jn this application are true to the best of his knowledge and belief; and ~l',at the work will be performed in the manner set forth in the application filed therewith. ~ ' wom to before me this /~ /~ / .................. ~.... doy of ........... ..__..;.~,.]~ll]P. eZ'......, 19..~'.C)....~ .~.__~.~.., ~..,,~. ~ ~ (,/ ELIZABETH ANN ~[VILLE ~1 l~' *' HOTARY PUBLIC, ~te of N~v York No. 52-8~.25850, Suffolk CouJ~ T_e? Expiml Mf~rch 30,,1'J,..:/.~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give dee'd~/locatiozfi) ~' J have been inspected by this department and found to be satisfactory. Chief