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Home My WebLink About5030-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy lVo. ~3 ...... rate ........... A.I~'Lt ..... aS.., 19.~. THIS CERTIFIES that the building located at . .RaS~ .~ .............. Street Map No~te .~k No ........... Lot No...pa~ .2 .&. ~ .... ~.. ~,~. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~t. · .2~ .... , 19. ~0 pursuant to which Building Permit No. '%~0 ~ dated ........... ~...2~.., 19~., 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 .. ~i~e · ~. f~. ~1t~ ...................................... The certificate is issued to . .~e~. Davl~ .(M~ .~. W'o' .Davio)-. ~ ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ' '&~' ' ~' ' ]9~' ' ~ '~'*' ~ UNDERWRITERS C~RTIFICATE No.. ~ ....................................... HOUSk; NUMBER. ~ ........ Street ....~. ~.~ ................................. .... Building Inspector [ FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ~m$~ .R~ .............. Street Map NoPar&dime. l~t Block No ........... Lot No...Pt. ~ ~,~. ...... 8$tlthold.. conforms substantially to the Application for Building Pemit heretofore filed in this office dated ....... (lOt .....27 , 19.70 pursuant to which Building Pemit No. dated .......... 0et .... 27 ...., 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 . p~.~,¥$.t.e..0~.e..f$~a~,~. ~.~.~llZlag ....................................... The certificate is issued to .l~l~tha. llavlm ...... (~®r- ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . Pending ........................... Hous., 280 Basin I~, ~ ' ' Building Inspector FOP,~ 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) 5930 Z Permission is hereby granted to: ....... bi~.~.lmmI....A~..~.~..~t~ ~)a~s Building InspectOr. at premises located at ........... ~..~..~l~..~..~...-~tl~.~t[~l~.~ ................................... pursuant to application dated ' .......................... ~.,........ ~..:.....~..., 19. ~ and opproved by the : ......... ( .".' ' ." '. "'-" .TOWH OF~OUTHOLD .~z~/?~...~/'~' ~.. ,...~0~,.~ ~ ~ .~ .~.~"~,~..o:.~.~. 'A~ ......... ;..;...;...; ...... ,.;..~ ....... , 19 ........ Pe~ t No .................... ~.. ' :' ~. *~ . :::::"~ ........... : .............. ~ ... . , {Bui~dl~ I.~r) ,.. ,. . ...... '" AFFLI~ATION FOR BUILDING FE~IT ................. . ............ _ .. ~~. .. ~te. .................. ;....~ ............. ,.....~; ........... , 19 ...... INDRO~IONS a. ~is applicati~ must be completely filled in ~y t~ewriter or mn ink and submitted in duplicate I~r. b. PI~ plan sh~in~ I~ation of lot and of buildings o~ premiss relationship to adjoini~ p~mi~s or p~blic streets ','a~s, a~ givm~ a d~aH~'~Kription of layer of pro~ must ~ drawn on the diagram which 'ms "c. ~e ~rk c~red by this appli~ati~ may .not be commenced ~fore i~uonCe of Building Pe~it. d. U~n a~al of this applicati~, the Budding Ins~ctor will issue a Buildi~ permit t6 the applicont~ Such ~rmJt~ ~all be ~t ~.the promises ~allable for inaction thraugE~t the p~re~ of the work. . e. No build~ ~11 ~ ~cupled or u~ in whole 0r in pa~ for any pu~ what,er until a ~fficate of ~cu~n~ . shall h~e ~en granted by t~ Building In~r. . . . · APPLI~TION IS HEREBY ~DE to the Building De~ffm'ent for the i~uonce of a Buildina Pe~it ~m~nt to the ~uil~i~ Z~ O~i~ of ~e T~ of ~thold, Suf~lk C~nW, N~ York, a~ other applic~le ~,' O~i~es ~u~ah~, ~ t~ ~t~i~ ~f ~ildlngs, ~itions or altemti~s, al for rem~l or ~liti~, ~ ~m n d~ri~d. ~ne a~,~nt ~ ~ c~ly w~th oil applicable I~, ordinances, budding c~e, 'housi~ c~e, a~ ~ulati~. (Slgnatura of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, ent~ineer, general contractor, electrician, plumber or builder. . of owner'o, prem,ses ..................... . . . ....~ ...... ::..., ................ .If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location o~ land on which proposed work, will be done. Map No.:~.O,~'O~/~I'.S~.~.~.,./?I('..~..p., I'ot No. Street and Number .:.~ ~ .O.....~.~l:;~u~.l.~...~l~.t~..;C4(~ ~..'1~ ~6~:,.,~'~./.~.(21 ~;:,~:;~ ,.~4, .;.,,..~: .. .... Municinali~v - ' · 2~ State. ,exist ng use'and occupancy of'premises and intended use and occupancy of proposedconstrUction::~ .... "" ~ .o...Exlsting ~Jse. clnd occupancy .... .,. ~.~..(~.~l~,~..'t.. ,, ~ : ,:.;:... ..... ,...,~..;:. ,,., ..~ :; ' '-.:..:.:. ~, ..... .... a"~ocC pa '' i::.i S': ~.Z~' '" ' '" '" ~'~ u n~..~.~ .. ~ >.. ~ .t. ..r.~. ........ 3. Nature of work (check which applicable): New Building .............. Addition .................. AlteratiOn .................. Repair .............. .~. Removal ..................Demolitio~ .................. Other Work (D--~crlbe) ........................................ 4. Estimated Cost ~...~..~...~..~..~.a...t'/.~...S~...~.J...Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .~.~ ........... Number of dwelling units on each floor ............................ .d. ~ garage, number of cars ..........~;a,~..~..V'.........~...~L~...~). ~C~.D._~.. ........................................ If 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 ....... ' ............. ,L Number of Stories ....................................................................... , ........ ~ .............. , ................ Dimensions of same structure with alterations or additions: Front ...' ................ ~. ............... Pear ....; ....................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..~...~.~i.~.~c:~ ~.~,.). Rear ....~..~ ........... Depth ..~.~'..~..~...~. ..... 9, Si~e of lot: Front ........ L~.~.'. ......... ~ear ........... /~.~. .............. Pepth ....... ~.2,~' ' ]C~ Dote of Purchase ........ ~,..~/~..~ ................................... ~ame~ n ,d~ !al Former Owne,r ........................................................ · . I~ ~ · ]1. Zone or d,str,ct wh.ch pre s, ore s,tuated ...... ...................................... : .............. 12. Does proposed construction ~ialate any zonl~ law., ordinance or regulation. ? ...~. ......... ~ame of Architect Locate clearly and distinctly all buildings, whether ~hroparty. lines. Give street and block number or ether Interior or comer'lat. PLOT DIAGRAM proposed, to indicate all set-back dimensions from and show street names and indicate STATE of' COUNTY above named.' He is the of said owner or owners, and this application; that all ...being duly sworn, deposes and says that applicant (Contractor, ·agent etc;) have performed the said work and ta and file are true to the best of his kr~owledge belief; and that the work will be .perfg~'ned in the manne : Swam t~ before me. th,s /"~'~,-,~'---' filed therewith. N~atary pul~~~F,~l~t....¢'~lr'~/'j"~' )~""~J'~ ~ ' 'h.~.~.~.~... ~i:~f. ! . . .~'~..:'"~ ...',.:,~.. .......... , I ~' 'Z , ' . Ho. ~2.912~8~0, ~k ~: ' ' Te~m Expires I~r~h ~0, 19~ .~ ~. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. P~rmit No. ,~0 &o TO WHOM at IT MAY CONCERN: The sewage disposal facilities for a structure located (Give de'ed location)" have been inspected by this department and found to be satisfactory. i ' FIEST ,FLOOP. ,PLAI~ point 5'o~F~o~,l.,I,, Ida(