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Home My WebLink About4651-z FORM NO. 4 TOWN OF $OUTHOLI BUILDING DEPABTME? T Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~.~,L.~ ...... Date . Dee 29 19 THIS CERTIFIES that the building located at ~S Nor. tll Dt*fLve Street Map No. ~'~re..Acre~lock No ........... Lot No..D.~i P.~.~. ~ :....Ma~*?-~qk.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~..., 197.0.. pursuant to which Building Permit No.. dated ......... ~g~... ~ ...... , 19.?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 l~rivate. ~na. fa~aily..d.w0.Z~.i.n.g ......... ~ ............................. The certificate is issued to ...I. 4.a..~.O~.a:.~r.~0~. 9 ........ ~.~l.~.~ ........................ (o~ner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N.o?i..2.9. by R. Villa UN DFRWRITEI1S Ck]RTIFICATE No. ~e~d~'l~g .~..~. ~..~. ! .1. ~ .~.) . · .~-'t..%.~-~q '. ~ ~.'.. · ItOUSE NUMBER... 3.~.0 ...... Street .... ~].o.r.~h. P~.~?~... i ............................. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT ,(THIS PERMIT MUST BEKEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4651 Z Permission is hereby granted to: ................ tt~o..~t..~r~ .......... .................. .................... /~.t~ ..P~.*,~I~....~..,~,, .............. to ........ l~,/L ~...~... ~1~... ~;~ ................. i .......................................................... ........................................... j~/~..;l~e~ta..i)~.~e r .,t~tt~.....lt~x+ ....................................... pursuo~ to application dated .................................. ~b..-.~.-..~- ...... , 19.~.., crud approved by the Building Inspector. Fee $~ ............. Building Inspector! · FORM NO. 4 TOWN OF SOIJTHOLD/ BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~?..~9.~. ..... Date ...... ....... THIS CERTIFIES that the building located at Eft8 .i~o~.th. D~,ve .......... Screet Map No.~hore .&,... Block No ........... Lot No. pa~¢. p~o~. [., · · conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... F. eb.. ~ .... , 19.~0. pursuant to which Building Permit No..~. dated ............ ~a~...~0..., 19.~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~iV~e- one. family..~.wel.~g .......... ~ ............................. The certificate is issued to .~da. ~ell~or~ ........ ~r ....... .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · .NeY · .29.-.~ 9~.%..bF. u' di~ ]~s~ec~o/ '" 8-9 SCHD SUFFOLK COUNTY DEPARTMENT Or HE,~'LTH, Bldg. P0rmit 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 f~und to be satisfactory. BUILDING TOWN CLERK'S OFFICE ~/? ~ Aparoved ~(~-.'~- ..'~.,0 19 ~.0 Permit ....................................... , ......No .............................. /~/~ o~.pp~ ~/~ ....~.....~.~......~__--~- ........... ... ................................................................................. mt, ......... ~.~:....~- ............................. ~ ~..7.~... /%7 ~. ~i~ o~lieotion must be completely fill~ in by ~ewriter or in ink and subml~ed i~ote to the Budding InCr. b. P~ ~on ~wing I~otion of lot and of buildings on premises, relationship to adjoining premi~ or public struts or o~, ~ ~ ~il~ ~ription of Ioy~t of p~ must be drawn on the diagram which is c. ~:~ ~d by this application may not be commenc~ before issuance of Bu ~. U~ ~ol of this application, tbe Building Ins~ctor will issue o Building Permit to the applicant. Such ~rmit i~ll ~ k~t ~ ~e p~ ~oiloble for inspection throughout the pr~re~ of tbe work. ' · . No bulldi~ ~ll ~ ~cupi~ or used in whole or in part for any pu~ose whatever until o Ce~ificote of ~c~oncy shall h~ ~ gmn~ by the Building Insp~tor. APPLI~TION IS ~REBY ~DE to the Building De~ment for the i~uonce of o Bu Iding Perm t pu~uont to the Building Z~ ~i~nce of ~e T~ of So,hold, ~uffolk Count, N~ York, and other applicable Reguloti~, ~r the c~struction of ~ildings, additions or alterations, or for removal or demolition, os herein ~e oppl~nt ~s to comply with oil o~licoble laws, ordinances, building c~e, ho~sing c~e, and reguloti~s. .' ....... ........ ~, _, ~- ~ ~ . ', . · -fl~~ . I",.~ .............................. ~A~;;;~ ~:'~i~ ............................... '~, ~'~ State ~e~ro~llcont is owner, less~, agent, architect, engin~r, general contractor, elemrician, plumber or builder. ......... .~.~.~.~ff.~.~.....~.[.~.~ ..................... : ....................................................................................................................... Name of ~er of premises ....~...] ...................... ~...~ ......................................................................................................... If ~pllco~ Is o co~orote, signature of duly outhoriz~ officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map ~lo.: ........ ,~./. ........................... Lot No.: Street and Number l~..~..s;[ ~r ~ ~ ~ ~ ~ ~ ~' ~ ~ ~ T~ C ~ ~' / -- ~0 ~ Municipality 2. State exiSting use and occupancy of pr~mises and intended use and occupancy of proposed construction: V 8 ~.~7 o. ~iSting ~ and occupano~ ................................... .~. .............................................................................................. b. Intended use and occupancy ............................................................. . .... 3. Nature of work (check applicable): New ~uilding .................. ~'l~'er°~ion .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .J .......................................................... tee .......................................................................................... f,. ~..~ ; (to be paid on filing this application) 5. If dwelling, number of dwelling units ....~....'~.-~..~.~.....Number of dwelling units on each floor ..... .e...~...~.~...~....~.....(~ If garage, number of cars ........ ~ ..................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... ~ ............. ~ 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 ..... ..4:..o..!:.~...~. ............... Rear ............................ ~1-o"o~ Depth- ...~.~..~.-...O..~ ....... Height ...I.~.~...". ...... Number of Stories 9. Size of lot: Front ..... .~...~.*..~..f.. ........ Rear ..... ~..c/.;..~.f. .................. Depth ........ .~....~..~ ............... 10. Date of Purchase ...'.......3..!../../..?...~. ............................... Name of Former Owner .~..4'..x.~..~..~......~.~..~..r~....~.:.~.....~.~.~4..'. .... 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? ' /V ¢?. 13. Name of Owner of premises ....................................... ~aaress ............................................ Phone No ..................... Name of Architect ......................... ~ ........................ Address ....... ~ .................................... Phone No ..................... Name of Contractor ..~..~.!.~!..~.....~...~...~.~..~..!.;..~.~ ............ Address ....... i .................................... Phone No..~..['...~..:.~.~..?'. PLOT DIAGIG~M 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 _~hether interior or corner lot. STATE OF NEW YQRK. ! ,. ,. COUNTY OF ....... ./..v...,~...~ .~...u. ......... .( '-,.-,. ......................................................................................... bem~ duly sworn, deposes and says tha~ he is the applicant (Name of individual signing application) above named. He is the (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 ar/~\true to the best of his I~owledg~,and belief; and thar the work will be performed in the manner set forth in the applicafli~n filed there~. X. //-,. , ,/~~ ........................ aay of ....... /.. .................................. , 19 ........ Nota .................. County ............ ............................ Plo+ L 5cote: 50'-- ~ [-~ !--t i ~.~._ ii.-: T~,WN