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Home My WebLink About4943-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificete Of Occupency No. Z~+231 ...... Date .............. April .... 28.., 19.71. THIS CERTIFIES that the building located at . S/S .New. Suf£olk. ~ve. &g~t~ Map No .... ~ ....... Block No ..... ~ .... Lot No .... ~....~.~tUOk...N~Y.~ .... confo~ subst~ti~ly to the Application for Bulldog Permit here~fore ffl~ in this office dated ........... Sept...~.., 19 7.0. p~su~t to which B~ldMg Permit No.. ~.~ dated ............ 3ept .... 8, 19 .~0., was issued, ~d conforms to ~1 of ~e r~u~ ments of the applicable pro~sions of ~e law. The occup~cy for which ~ certificate is issued is ...Pr[~ate..erie. f.~ly .d~ell~[ ..................................... The certificate ~ issued to ...R$be~. ~....~F~ ..... ~$F. ....................... (owner, lessee or ten~t) of ~e Mores&d b~ldMg. S~olk County Dep~tment of Health Approval .. Apr,. ~ ~.~..~9~.. b~..R.. Yilla H.~. ,. 6100 ~ew ~uff. Ay. ~// ._~ ~ 7~ Deep Hele Dr W. ~,~ ~... Building Inspector ~ FOF,,~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT trillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4943 Z Permission is hereby gronted to: ~,_ ~ ~ I T ~ at promises I~ated at .......................................... ~ ............................................................................ ................................................ ~.,~.~..~ ....... ~.~.~.~ ......... ~~ ....... ~.~.Lt~ ................ pursuan~ to application dat~ ~ ~t'~ 19~, a~ approv~ by the Building Inspector, ..o Building Inspector TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFI4:E Application No. ~ SOUTHOLD, N. Y. Approved 19....~...gPermit No.....~....~.....~'.....~......../~.'. Disapproved a/c .........~........................................~ ............ APPLIGATION FOR BUILDING PIP. MIT u~ o Date ................................. ...~.......,~..~.?....T....., 19...~...~,~ ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Buildi ~ Inspector. n~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premiees or public streets or areas, and giving a detailed description of layout of property must be drown an the dlagrom which Il part of thie oppllcation. 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 per 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 Jn port 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 pumuant to the Building Zone Ordinance of the Town of Southold Suffolk County, New York, and other applicable Law~, Ordinances or Regulations, for the construction of bui dings, additions or alterations, or for remava or demo Ition, o$ herein described. The applicant agrees to comply with all applicable laws, ordinances, builclj~g code, housing code, and regulations. (S'g e ~ applicant, or name, if a~orperatlon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar builder. If applicant is a corporate, s~gnature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Munlclppllty 2. State existing use and occupancy of premises end intended use and occupancy of proposed construction: o. Existing use and occupancy ................................................................................................................................... O A/ /= A /W / L . b, Intended use and occupon;', . ............................................. 3. Nature of wink (check which applicable): New Building................../ Addition ................. Alteration .............. Repair .................. Remova~ .................. Demolition .................. Other Work (Describe) ...................................... 4. ~t Mated Cost .~.5 .?.~ 0 Fee /., (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 ............................................................................................................................................. 6. If business, commercial or mixed occupancy, speci~ nature and extent of each type of use ............................ 7. Dimensions of existing st'ructures, if any: Front ............................ Rear ................................ Depth ............ Height ....................... Number of Stories ................................................................................................. Dimensions of sarne structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... .~......~....I. ............. Rear ......... .~....~L.....! ........ Depth Height ...... /.~. ....... Number of Stories ............... ..~....'~....~.. ........................................................................................... 9. Size of lot: Front .........?...~.~...~,... Rear //) ~ '~* Depth ]0. Dote of Purchase ....................~....~..-..?.....'~.. ....... (..~...~'..~...Name of Former Owner ..~.:.....~...~.....~...-?../...h/..~..,~. .................... 11. Zone or use district in which premises are situated ...................... .'~...I-~.~'.../....D.....E...~...?.../..~....~_. ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises . .~...0...~...~..'.....~...E~....~....E....~.Address ...~..~../../1~...../-~....~. ....... ..~....~...7~/......'r~one N'~o.?.....'~.. ............ Name of Architect .../~.'~....'.~.....~../....'~....7..T. ....................... Address ............................................ Phone No ,, Name of Contractor .................................................... Address ........................................... whether lintd, ril J PLOT DIAGRAM mrly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from Give street and block number or description according to deed, and show street names and indicate ~r or corner iot. STATE OF NEW YORK, t S.S COUNTY OF ................................ ,f ' ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ....................................... ..~.....~.../....ZT...~....~ ........................ '~, ....................................................... (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 bef~:~ me this ................ .._***.o day of ......... .~ .............. ~.,.~....L.., ~ .7...~ -~_ ~,,'~/ I ~.,- - f,l._,../..~,.,;;;~.~ ....... · ................... ~,,~.....~ ..................................... Notar/ Public/.J:'~.,/~..'~....e. ......... ....~. oun~, (Signatur~cJf applicant) '' .~mo. ~. ~.T .. , ~IOTARY pUBLIC, ~ta'(e~( Hew Ym'k No. 52-3?33120 Suffo~ Cour,.~, ~ Expir~ Marr. h 30, 19,.~ ' S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal (Give deed/location) have been facilities for a structure located inspected by this( department and found to be satisfactory.