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Home My WebLink About4966-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..~.. ~1~ ...... Date ............. J~... THIS CERTIFIES that the building located at~41pt.l~ .]}~. & .]~1.~. lid. ·. Street Map No. H~okeX~. A, Block No ........... Lot No..~ ....... ¢~tohO~.. I~.]E. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 8®p~;. · ~.., 19~O. pursuant to which Building Permit No. 1~6~'~.. dated ........... 8®p~. · 2~., 19 .~/~, was issued, and conforms to all o£ the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...P3'~.~&~;~. ~o. fmll~].~, tl~]..l.~lI ..................................... The certificate is issued to . J~]~. ~,.~ .~e .&. 1/.~.E~ .... O~r~ ................... (owner, lessee or tenant) of the aEoresald building. Suffolk County Department of Health Approval . ~/une...].~. ]9.7.0.. h~ .R,..'~.~l& ... Building Inspector ~ FOF~ ]NO. 2 · TOWN OF SOUTHOLD BUILDING DEFARTMENT' 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? 4966 Z Permission is hereby granted to: ; .......... J,~m.D,..~,,... ,~i~,~..& .l~$f~..... !. ................ ............. .............................. .................. l~e3,],e~.o~. ...... lJ,~'.,...... ................. to ... J~t~.;l~e~..~!a~,.X~tJ,~../~l~ ...................... i ......................................................... at premises located at .:......l~'j;....~....~J~J~..A,a~..~iJ'i.~ ...................................................... ...................... :. ....................... j .$~l::a,."~N~-. j · .j~l~ Sn ......... jt,~ .-...Ji[:,r,]. ................................ Building Inspector. Fee ' $..].~Jj. ......... pursucm¢ to application dated ........................... (D~FJ~"'i'"~J~'"'"!?"', 19":'~1) and approved by the S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure (Give.~eed location) / / J have been located inspected by this department and found to be satisfactory. JUN 1 5 lg71 Chief of General Engineering Services /~ H ~-~ APFLI~TION FOR BUILDIHO FE~I~ ~ ~ ~t* ...~:~.~...:.~.~ ........ ~. ................ , 19..2A .... ~. Thl~ ~p~licofi~ mu~t be c~l~t~ly flll~ in ~ ~writ~, or in ink und *ub~t~d In In~r. c. ~ ~rk ~r~ b~ thi, ~pplic~flon m~ not ~ ~omm~n~od befo~ i~u~ o{ 8ulldlr~ ~all be k~t on th~ pmmise~ ~v~ll~bl~ {or iospa~tion throughout th~ p~res~ o{ ~h~ work. · . ~o bul~din~ ~11 ~ ~upied or used in whol~ or In ~ fo~ ~n~ ~u~, ~h~t~r until ~holl h~ ~n ~mnt~ b~ th~ 8uildin~ In~p~tor. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pumuont to the ~Build!ng Zone. Ordinance of the Town of Southold Suffolk County, New York, and other applicable Lmm, O~ingnces or Kegu~atlons, tar the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ...... ........................ ~,,~gnature cf applicant, or name, If a corporation) ....................... ................. /., .... (Address of applicant) / / '/~-~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ~..W.~..~. ....................................................................................................................................................................... Name of ow era prem.ses J,~,..(.q, ................................................. ..~....~ ........................................................................ If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 'R=/=~ ~,,2 5~ 1. Location of land on which proposed work will be done. Map No.,~'..~.~.,T'.~.;../~..~.~,,.~,,O.,.~.~....~...~....~. Lot .o.: ..'~: ............. ~'7'[-- & I 0 -~/ Municipality - 2.State existing use and occupancy of premises and intended use and occupancy of proPosed construction: a. Existing use and occupancy ..~...~ b. Intended use and occupan? ~.~$/~'~'~' . .. 3. Nature of wink (check which applicable): New Building/~. ............... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ..:~,3.~.17..~...~.. .................................... Fee ~ .'0 (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 business, commercial or mixed occupancy~ ~'pecify nature and extent of each type of use ............................ 7. Dimensions of existing structures, Jf 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 ..~.s~..~.~..~ Height ...../..~...'./../... Number of Stories ..../.././?. ........................................................................................................... 9. Size of lot: Front ..... /..~...~..[ ............ Rear / ?~. ' Depth ..~.,/~...:/.~..°...~......H/~'~ /~ / 10. Date of Purchase ...../..:..~...:...~.~. .................................. Nome of Former Owner ~.~..~..~...~..~.T.~...'~..~,. ....................... ! I. Zone or use district in which premises are situated ...]~.E'~../.~.~....Z: .~./~.: ............................................................. 12. Does proposed construction violate any zoning law, ordinance or r_egulation? ...~.O. ................................................. 13. Name of Owner of premises .~..~ ....... Address ..~~ ........ Phone No .................. Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor ....... ~.~ ........................ 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 comer lot. STATE OF NEW YORK tee COUNTY OF ..... ......................... .~..~..../~J~.....~..:......~....~...~..~ ..................... being duly sworn, depose~ and says thor he is the applicant (Name of individual signing application) ' ~' ' ?~ above named. He is the ....................: .................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or..a~ae~, 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 tha~ the work will be performed in the manner set forth in th~ application filed therewith. Swam to before me this of ...... ....... i Notary Pub~.~...~-'-~.~~ County '~'~' (Slgno~re of applicant')' ............................