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Home My WebLink About4969-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy THIS CERTIFIES that the building located at . Jl~ebl. La.&. ][,. ~®W. Street Map No. ~lewl~[. A~i~l~k No ........... Lot No... ~18 ·. Jl~t~tl~ .. Il,!,. ~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~fl..2R 19 ~0. pursuant to which Building Permit No.. dated ............ 8®pr,..2.~, 19.7~., 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~x'$V&t.e. erie. £a~l. lF .dvel~:tn~ ............................ .......... The certificate is issued to . ~,eev~-~d. ~.~1. ~ne ...... Ovn~, ............. ~ ........ (owner, lessee or tenant) ~ of the aforesaid building. Suffolk County Department of Health Approval . J~e..1~'. 1-97l. -by. R, ilov, ae I~ ROI+O Jaeebs ~ 6.t6o n. hrv er ad · FORM NO. 2 TOWN OF SOUTHOLD 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? 4969 Z We ......................... ~.~,i ...... .~ ......... , ,~.29.. Permission is hereby granted to: · Building Inspector. Fee $. ~)~ .......... Lg.,.~ and approved by the Building I hs~ectbr , ~ TOWN OF soUTHoLD BUILDING DEPARTMENT ~'/~/?/ TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Approved ............................. !.? ........ , 19...~.... Permit No ............................. Disapproved a/c .............................................................................................. - (Building Inspector) APPLICATION FOR BUILDING PERMIT /~_ ,, - ~te ........................ ~ ................................ , INSTRU~IONS a. This application must be completely fill~ in by ~ewriter at in ink und submitted In ~plicate to the Building In~r. b. Plot plan showing I~ation of lot a~ of buildings on premiss, relationship to adjolnl~ pmmim or public ~tmets or or~, and gtvl~ a dmailed de~ri~l~ of layout of pm~ must ~ drawn on the dl~ram ~lch c. ~e work cover~ by this applicati~ may not be commenced bafore i~ua~e of Bulldlr~ Permit. d. Upon ~proval of this appllcatl~, the Building In~ctor will l~ue a Buildl~ Permit to the applicant Such ~it shall ~ kept ~ the premises ~allable for inspection throughout the p~ren of the work. e. No building s~ll be occupi~ or used in whole or in port for any pu~e whate~r until a Ce~ifleate of shall have been gmn~ by the Building Insp~tor. APPLI~TION IS ~REBY ~DE to the Buildi~ De~ment for the issuance of a Building Permit pumuant to the~ Buildi~ Zone O~inance of the To~ of Southold, Suf~lk County, N~ York, ond other ~ll¢oble La~, O~l~nce~ or Regulations, for the construction of buildings, additions or alterations or for rem~al or ~molltion, The applicant agrees to comply with all applicable laws, ordinances, bui ding c~e, hou~ing c~e, and ~u atl~. (Signature cf applicant, or name, If a corporation) (Address of applicant) State whether applicant is oWner, lessee, agent, architect, engineer, generat contractor, electrician, plumber or builder. ° .......................................................................................................................................................... Name of owner of premises ..................~.e~e)/~,3~,..A,~.3~fl ................................................................................................... If applicant Is a co~orote, s~gnature of duly authorized officer. ~ , ~_ ~ ~,. ,~ _ ~ .... ............ ...... · (Name ~nd ~le 'of corporate officer) ~~ /~ ~ I. L~ation of land on which proposed work will be done. Map~'.~..~....~ ...... Lot ~.: ................... .~ Strem and Number .... ..................................... ~O O~ Munlcl~ll~ ~o~o~ ..... 2. State existing uM a~d ~cu~ncy of promises and intended use and occupancy of pmp~ comtmcti~: a. ~isting use and ~cupan~ ....... ~.Q~ .................................................................................................................. b. Intended use and ~cupan? . .............. ~.~.~ ............................................................................................. 3. Nature of wink (check which applicable): New Building ~.~...e.,8. ......... Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work. (Describe) ..................................... 4. Estimated Cost ....20.,.0D.Q, ........................................ Fee ......................................................................................... (to be paid on fi:lng this application) 5. If dwelling, number of dwelling units ....o...~.e. .................. Number of dwelling units on each floor .Ol2e .................. If garage, number of cars ...... .~..~.0. ...... :. .................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....x....'7.L ............... 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 ..... ~...0....~...~. ................... Rear ..... ~.~...~'.~. ........... Depth .~.4..~'.'J; ........... Height ......1.~...~...1;.... Number of Stories ....O13,e[ ........................................................................................................... 9. Size of lot: Front ....1.6O...f.t, .......... Rear ..,...I..(~.Q..~..~ ................ Depth ...2.~0...:~.~ ............... 10. Date of Purchase .....~.c, Jj~.~. .......................................... Nome of Former Owner ......~.~.~.~,J~.~.3~. .................................. 11. Zone or use district in which premises are situated ......... ~eB.'Ld~I~.~La.~. ................................................................. 12. Does proposed construction vi'olcte any zoning law, ordinance or regulation? ........ ..~.O. ............................................... 13. Name of Owner of pre_raises ....... Address .~..!..'Z...~)~J)D.L,'~e..~,~e ........ Phone No. '[.~..~...-.~...~.~... tverhe d Nome of Architect ...................................................... Address .......................... : ................. Phone No ..................... Nome of Contractor .~....8~...8.....a....~....o....9~...e..?. ..................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly oll 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 Jot. STATE Of NEW~ORI~././l~ ice: COUNTY OF ...~...J'"'"' ~Z,.s}..n..lrl~n ,.To BO~n -. ............................................ .~.st...... ...................................... oetng duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............. .0...o..~.~..o..~..e:.~...e.....0..~.~.:l:..a...e.?.. .......................................... . ....................................... :. ............... (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 perfojP/rned in the manner set forth in the application filed therewith. Swam to before me this ¥ n ~ · Notar'/Public, [..-. _ .!.f~u~"~' '"'"'}"J';J ........... )t' ............... "~~["~'f~'/~"K'~'f'~ ........ ' ' -' (Sig~atur;~f applicant) SCHD , ' ,~ ~ " " ....... ' SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) ' ! s/¥ have been inspected by this department and found to be satisfactory. 241.6S VAiN