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Home My WebLink About4951-z FORM NO. 4 TOWN OF SOUTHOL~ BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~.~.52 ...... Date ............. Jan · .27 ...... , 19-72. THIS CERTIFIES that the building located at .S/S.i.i~el, gell .Ave .......... Street Map No. ~ ......... Block No... ~X ..... Lot No..~...Ea.t~g~ek$. ~,~, ....... conforms substantially to the Application for Building Permit heretofore flied in this office dated ........... Sapg...ti.., 19. ~O pursuant to which Building Permit No.. bg~Z. dated .......... S~pt.. 1] .... , 19.~0., was issued, an~ conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P~ivate ,o~e..~am.i, ty. d~e!!i~g- The certificate is issued to .... ~eo. D~. R~$~I~..&. ~'~ .. o~ae~s .................. (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 0ci' ' ~0 "~ 97~ 'Dy 'R &' Villa ...... I~ House ~o .... ...... FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPA, RT/v~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NV 951 Z Permission is hereby granted to: at premises located at .................................................................. ~ ......................................................... Building Insp,~, Fee $ ........................ :! Bui d ng Inspector o' RECEIYEB SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ; Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located ~ (give deed location) have been inspected by this department and found to be satisfactory. DSstrict Engineer TO WHOM IT MAY CONCERN: The water supply of. the property located at Bergen ~venue, 250' West of Cox Neck Lane~ Mattituck, has been approved with the understanding that ~he water is not to be used for baby's formula since the nitrates are in excess of approved standards. Any~future owner or occupant is to be informed of t~e high nitrate level of the well water and forewarned about its prohibition in the preparation of baby formula. Very truly yours, Robert A. Villa, P.E. Chief General Engineering Services TOWN OF' souTHOLD /,../,~...~,/,~/' /./".~'~ 0,' /{ ~, BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOU), N. Y. G.xomlned ....~/~.. ....... .,/~../ ......... , l'...~..~ ^pplicotion No. "' ' " ^pproved ........................................ , ]9 ........ Permit No ......... Disapproved a/c ~. r' ......... ................. ................................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of bu.lldings on premises, relationship to adjoining premieee or public streets or areas, and giving a de, ailed description of layout of property must be drawn on the diagram whlch II part of ~Jl application. c. The work covered by this application may not be commenced before i~bance of Building Permit. d. Upon approval of this application, the Building Inspector will Is~ue a Building Permit to the applicant. Such 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 pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, e, nd other applicable Lawl, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ' tSignat~e' cf applicant, or ncn~e,~ If a corporation) /~1 ,Box la g /~'7,,~ ~r / ~-~,, c ~. ............................... i'~i~'~;;';F~'~'~ii~;;~;~i ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premise= ................................................................ .I.. ...................... If applicant is a corporate, signature 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.: ........................ · . /~1- S'~o ;~'~,w ,~r~ Stre~ and ~lumaer ............................................. ~. ........................ ~1 ................................ ~ .............. Municipality 2. State existing u~ and ~cu~n~ of pmml~s and intended use a~ occupancy of pmp=~ co~tmctl~: a. Existing use and occupancy b. Intended use and occupant, 3. Nature of woik (check which applicable): New Building .................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................. Oth~Vork (Describe) ...................................... 4. ~t ~ted Cost /~ 0~'~..+... . Fee ./.O ~ (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 ...................... L...-~:..~ ........... ~J: ......................................................................................... 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 ................................................................. .~....~'~-t~...~..~[~.'~ .......... 9. Size of lot: Front / O o Rear / ~> O Depth ..~.O O lO. Date of Purchase ..............~....~.....L:.~.. ....... ./..?....~..~.. ............ Name of Former ~(~ner ..~...~../?..~...~'.../..~.....~. ....... ../~....~...~...L.~'..~.....'/~'../~-- 11. Zone or use district in which premises are sitdated ............... ..~.....~...-~.../....~...~... ~ 'r/,4 ~, . . 12. Does proposed construction violate any zoning law, ordinance or regulation? 13. Name of Owner of premises ~., ~>V-~$A-'Z/_.. . Address . ~/~/'l'rU~...~... Phone Nome of Archit~t ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ............ ! ....... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimens o.ns from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, lee '1~'~ COUN~ OF ................................ I~' ..................................................................................................... u duly sworn, d~oses and says t~ he is the applicant (Name of individual signing application) ~ow n~med. U, ~, ,h, .................................... ~.~.~.~:~ .............. '.L'~ ....... L...: ........................................................ (Contractor, og~t, co~orate officer, etc.) of said ~ner or owners, and is duly authoriz~ to pedorm or have perfo~ed the said work a~ to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will ~ performed in the manner ~t fo~h in the application filed therein. Swam to ~fom ~ .................. y · ......................... ~..:., lY ........ . . ....... .................. ~ELIZABETH ~N NEVILLE NOTARY PUBLIC, ~ate of ~ew Yor~ No. 52-8~2~50, Suffolk Coun~ Term ~pires March 30. ]~