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Home My WebLink About5025-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . l~equash. A.v.e. ............ Street Map No. Fle~tm. l~ae~Block No ........... Lot No...x~X......C.~..t.eh.$.~. e...I~ ~.Y... ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Oct .... 23.., 19 '70. pursuant to which Building Permit No..~02~Z.. dated ......... Oct ..... 2~' '" 19.7.0, 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 .Pti. rate e-e. $a~tty 4wetl~ng .......... '. ............................ The certificate is issued to . .Har.l~y.. ~h~pa~ - · · O~er ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Fsh. Ro .v la ..... U~dwerwriter. Cert , , 8~9069 ~o~ ~ Heus. g~ ~630 ............ .... , ..... N? 5025 Z FORM NO, ~ : TOWN OF SOUTHOLD !. BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNT!L FULL Permission is hereby granted to: ..~.c~33..~.~r...~..~.:...~..~... ~ &w .... ::...33~....~.~.....I1~. ....................................... ................ . ,~, .,~..o_z:.a.. ............................. : ................ at premises located at .... W~. ~e~t~s ~-~ ~ (P.e~ ............................................. ~t~ ......... ~:t.~ ................. pursu~n¢ to application dated .......................... J~....:..~ ........... :..., Building Inspector. Fee $. ,, .~.l~.~.l~l ......... ]9.....~. and approved by the' inspector · ,,,=,,o., 'town SOUTNO,D BUILDING DEP*RT ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved ale ............... ~ ............................................... ~ .............. ........................... (Building Inspector) / ..................... APPLICATION FOR BUILDING PERMIT I NSTRUCTION5 a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of this 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 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 pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, or~.gl3~ding code ond regulations. ~ignature of d~pplicont, or name, if o corporation) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or '~e~. [J-ee~icgr)t-~ a corporate, signature of duly authorized officer. ...... .......................... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No.: .~,~.~..~...:.~/LOt No.: ...................... Street and Number ..~....~......~./-~-.~....~...~.......~..~...~..../.~......~ ................. ~.~ ............ Municipality ~ 2. State exis{ing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................ . ...... b. Intended use and occupancy ~. ~/¢...~/..L.. 3. Nature of work (check which applicable): New Buildin~..................J Addition .................. Alteration .................. Repair .................. Removal .................. Demolition..:.;...~ ...... ~... Other Work (Describe) ........................................ 4. Estimated Cost ..... .~....4~..?,~ ............................ Fee .......................................................................................... (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, 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 ..~...~.Q..?.. DMtL Height ~ .......... Number of Stories ....~. ...................................... 9. Size of lot: Front ...../..~ .............. Rear ..... ~...~ .................Depth ....../..~ ........... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regu at on> · ~..../~-..~:... Phone No ..................... Name of Owner of premise~....~Address .................. ~::~";~ .................................. 13. Name of Architect .................... ;~. ....................... · ........ Address ........................................ Phone No ..................... ... Nome of Contractor ~ 7~ ~ ~-~p~ 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 corner lot. STATE Of NEV('~_OJ~,. ~. I c c COUNTY OF~.....J~'~' ........................ ~'. ....................................................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing ap~/~ above named. He is the ............... i .................................................................................................................-~"~L"~'~-;'~z::::~9'--4~ ............... (Controctor, ogent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rn~ke and file this application; that oll statements contained in this application are trJ~,to the best of his knowledge and belief; ond that the work will be performed in the manner set forth in the applicgt4o~f~ed thi, rewith. Swam to before me this __ // / / /. / ~VIAP 0~' LAND S-9 SCHD SUFFOLK COUNTY DEPARTMENT OiF HEALTH Bldg. P~rmit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ! (Give deed location) have been inspected by this department aud fbund to be satisfactory. District Engineer ALL iJ IJ J. <9' JoE~ C r ~- 14" ~-" GL O 2" wood ~' '] ~zRDs'z~ "1 _,~ L _J