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Home My WebLink About4992-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . B~i, etstall~ .C$11~; ....... Street Map No. 8~tlaf.~l~ .l~ock No ........... Lot No..~. .... ~th~l.~....N.:~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... (}St... 8 ...... , 19.70. pursuant to which Building Permit No..II~Z.. dated ......... 0et .... 8 ..... , 1970.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ~.~,~&.t~..~#..£U;I,~lf..~.W~..],~a. 8 ....................................... The certificate is issued to .. Fl~lei't~k. I~ab~F ..... 0t~e~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Mai,. · .~..$~?1- · .by. Ro .¥~l& ...... Building InspectOr FORM NO. 2 TOWH OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~99~ Z ~e ..................... Oe,~ ......... ~ ............... , l~....~ Permission is hereby granted to: .......... :.~.,~.~.~,.~ ..e..~w.. ~Z~;.,~e~ ....................... ~,~ut~e~t ....... S,'Z.,.,.'. ................. pursuon¢ to application dated .................. ~D~...}{..y.~ ................. i...., 19....r~t and approved by the Buildi?g Inspector. .Fee Sit"eGO ............ " S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage a t disposal facilities for (Give deed location) a structure located have been inspected by this department and found to be satisfactory. ~hief of General Engineering Servic~'s . ..................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted tri duplicate to the Building Inspector. . b. Plat plan showing locatiOn of lot and of buildings on premises, relationship to adjoining premlies or public streets or areas, and giving a detailed description of layout of proparty must be drawn on the diagram whlch Is part of thie application. 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 permit shall bekept 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 pursuant to th? Building Zone Ordinance of the Town of Southold Suffolk County, New York, and other appllaable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal clr demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinate, es, building code, h~sing cod. yand _regulations. (S,i~.ature af applicant, or nome, if a corporation) State whether app~ee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~ ...~ ................................................................................................................. if appIican~)~.~,or, o,t~lgna~thorized off leer. (Name and title 'of corporate officer) ~r ot NO.: ./...~.. .... 1. Location of land on whlch_.~roposed work will he done. Map Street and Number ~ .......................................................................................................................... 2, State existing use a,nd occupancy of j~remlses and Jntlnded uil and occupancy of JDI~ cOnltr~ctl~n: o. ,s,,nguseondoc uponcY... ......... .. ................................................................................. ,,,.,,,,,. ...................................................................... 10. 11. 13. Nature of work (check which applicable): New Building ..../~............. Addition .................. Alteration ............... Repair ........... ;~... Removal ~ ............... Demolition .................. Other Work (Describe) ...................................... Est,mated Cost .X/~.~.~.~. ........................................ Fee ..... .~....~...~ ............................................................... (to be paid on filing this application) If dwelling, dwelling units ....... ~.. .............. Number of dwelling units on'each floor ...~... .................... number of If garage, number of cars ....... Z. ................................................................................................................................... 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 .L ...................... Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ new construction: Front ....,,~1~....~ .................. Rear ..~..~..'' ................ Depth e,~.~ ................ Dimensions of entire Height .,,~..../. ...... Number of Stories ....... ~-- ........................................................................................................" Size of lot: Front .../..~..~.. ........ "... Rear .../.e~:~. ...................... Depth ~' .~... .................. Date of Purchase ........................................................ Nome of Former Owner ........................................................ Zone or use district in which premises are situated ..... ./,,~.~ ....................................................................................... Does proposed construction Violate any zoning law, ordinance or regulation? ...~. ................................................. Name of Owner of premises~_~'_~...~./,~/,~9,~.. .......... Addres .~.~.~hone No ..................... Name of Architect ..... ~ ............ ~ ............................... Address ...... A ................................ Phone No ..................... Nome of Contracto .~'.,~,,',,,',~.~~,,~....Address .~..., ...... Phone No .................... property lines. Give street and block numbe whether interior or comer lot. or description according to deed, and PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all sat-back dimensions fram show street names and indicate ~ STATE OF NEW/~,~)RJ~i n~ J S.S. / ............................. ~,..,,~~,,,..:be~ly sworn, d~oses and says t~t he is the applicant (Name of ~dividual signlng a~lic~ above named. He is the ...................... ~ ................................ ~,....., ................................................. (~ntmctor, ag~t, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or~ h~e perfo~d the said work and to ~ke ~d file this application; that all statements contained in this application are tree to the ~st of his knowl~ge a~ belief; and tha~ the work will ~ performed in the manner set. fo~h in the app/icat~'fil~ the~ith. ~ Swam to ~fore ~ ~is ~ , // __ ......... ....... ................ , to ~ h ~" e_~. D ~ .Jo ..~~~ ............