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Home My WebLink About5035-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icale O[ Occupancy No. Z1~2~9 ...... Date ............ J'~J.~.. 2 ....... , 19 .~. THIS CERTIFIES that the building located at .. Hom'~'* · .I, mao ........... Street Map No. l~ee.. Helel Block No ........... Lot No..2? ..... Pee. enll.... ~..~ ? ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 0e~; ... 23 .., 19 ~0. pursuant to which Building Permit No. ~03.~.. dated ......... 0O-t. · - 23 , 19 ?0., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .l~i~ate. ~ne. family. AwellLug ....................................... The certificate is issued to ,..Imgo .¢laus®l~ ........ O~mer .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approval ...guJ.lt... 2.197.1... by..R,. ¥],11&.. lt.u... 10~0 /.~ ..... f" '-" ~'~ii&ing ~nspector I TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFI(:E $OUTHOLD, N. Y. BUILDING PERMIT ; (THIS PERMIT MUST BE KEPT ON THE PREMISE,$ UNTIL FOLL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ............. 2a~ae..~a~,a~: ........................... · ......... ........... ~..-.~,-.-~er,~...~l~.,~ ................. ...............~l~e~ela ~:' ~ .......... . : ........... i ................. to ........ ~1.~;~., ~ ..O~J.. ~P. Ga~l~ .. ~;b~Gl~ .............. ~ '",'"" "r'"': ........ , .......................... at premises located at .......... ::.....~;t..:~.....19~eg}~,.~ ....... ~ ...... ,.; ............ , ..................... ( .... -~e;~ ~ '.~· ~ , ' '. · ' ~ ' ................................................. --" --~ ....... ;~ ?r~---~ ..... '~'"'"~ ? '~ ............... ? ..................... pursuan¢ to application dated .................... ;...0~.,..~.;:,~,..~..~;~...., ,19;~;~ ~and approved by the Bui}ding Inspector. Fee $., .~.~, ,~.~. ......... SCHD TO WHOM IT MAY SUFFOLK COUNTY DEPARTMENT dF HEALTH :JUL 2 197! Date____~ Bldg. Permit No. CONCERN: The sewage disposal facilities for a structure ~ (Give deed location) located have been inspected by this department and ound to be satisfactory JUL 2 Chief of General Engineering Services f97'~ Approved ........................................ , 19 ........ Permit No. . Disapproved a/c .................................................................. ~' ~ ,/ TOWN CLERK'S OFFICE , SOUI'HOLD, N.Y. "//':~'t/~', , ~ ~ -- ~ m Application No......~....~...~......~..........~. INSTRUCTIONS '~, 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 ~nd 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. ~'l APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 all applicable laws, ordinances, building code, housin~ code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~.~ ............................................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ..... ,..~.../.....~..../.....!.... .......... Lot No.:..~...~... ............... Street and Number .~.....'~.....~...~/..~...~,..~..~....~'.....~.. ~ ~ ~ /~ ~ ............................................... Munici~li~ State exi~ing use and ~cu~n~ of premiss and intended use and ~cu~ncy of pr~s~ construction: a. ~i~ing u~ and ~c~n~ ~ ~ ~ b. Intend~ u, and ~capancy ~~Z ~/......~~.~ .......................... 3. Nature of work (check which applicable): New I~ui-lding . ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demo t on ......... Other Work (Describe) ........................................ 4. Estimated Cost ~ ~-.-...~'.....~'...~../.....~... ................ 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 ..~...~'..~..[..~'...;.~. ....... Depth ....~...~..[..~..~/. ....... ..../.. ............. Number of Stories ........ Z .......................................................................................................... ~" Height ,'~// 9. Size of lot: Front ..... ./../.~.. .............. Rear .../'~..~- ........................ Depth ...~..~..~.. .................. · ~-~.~.......~---.~.-- --"__ ............................... Name of Former Owner~.~'...K~...~../~.. ....... ~.4~..4~.~'..~.. ............. 10. Date of Purchase 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~,~'./~E..~......-~...~r...,'/....~...~ .~.'..(~..o..~../..Address ~--..f('-~.--.//.../.~..~.-~.~..~'...~.~../~ .//~'Phone No..?..~.~...~..7....~..- PLOT DIAGRAM ~',~'/,~//~'/v' 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. ~$7~ STATE OF N~ YORK, COUNTY OF ................................ ~'~' ............. ~.~...~~ ............................. being duly sworn, d~oses and says that he is the applicant (Name of individual signing application) above named. He is the ................ ~ ................ (Contractor, agar, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and ~lief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ......o, ........ ...... , ..... 4 'fl.. / /I .... H_ ........................ .om~ ~umic~.~.&~... Coun~F~ (Signature of applicant) ~ ELIZAB~H ~N NEVILLE NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk Term Expires March 30,