The URL can be used to link to this page

Home My WebLink About5046-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icate O[ Occupancy No. ~br2.1+.9. ...... Date .............. ':aT ....27 .... , 19.71. THIS CERTIFIES that the building located at . -l~to's3or~- .I.~ea~l ........... Street Map No. l~.~tt o. Est. Block No ........... Lot No.. ~-_5 ...... 14at. tituet~ ~ · N...3 o. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... I'~ov ..... .10, 19.70 pursuant to which Building Permit No ..... dated ........... Nov ....1.0., 19..70, 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 .. 'Pr±v~'ce- o~e · £a~nl~ky' ~v~e~-~;t:[n-g ..................................... The certificate is issued to ... F,d~ar.d .Ab~.tz...(.owr. e.r-bu~i~.er) .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... !:ay...1 ~ ~..1-97]. · .l~y. ~;.. V$.~'~a. ....... :'. .... '-.1 ........... Building InspectorJ FORL1~ NO. ~ TOwN OF SOUTHOLD i~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREEMIS~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5046 Z Permission is hereby granted to: to at premises located at pursuc~t to application doted . Building Inspector; .Fee $ ....................... 1,9..,.~-.~,~u and approved by the . ..;.~.~ ,~ ~ . .12,., ,,,. ~ ..................... B~itdi~g ~ector lrOB~ NO. I 'I~O~YN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ...... .~,:. .......... .?.~.........~....(19....~.... Permit No......~...~....~......~...-,~.. Disapproved a/c ............. (Building Inspector) Application No......-~....~.....~....,~,. ....... APPLICATION FOR BUILDING PERMIT Date .............................. .(~.....X.~......~...., INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in d~plicate 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 an the diagram which Is part 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 pureu.?nt 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, al herein described. The applicant agrees to comply with all applicable laws, ordinances, building~code, housing code, and regulations. .................. ~.;.~.~.~ ........ ,~..c,..; ............ .~. .......................... (Signature cf applicant, or name, I~d corparatlon) (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. (Nome and title 'of corporate officer) ,~'-' ~-~ 1. Location of land on which proposed work will be done. Map No.: /-~Zz~/.~_.~ Lot No.: ~ ~ Stre~ and Number ................................................................................................................. ~ .... Monlcl~ll~ 2.State existing u~ and occu~ncy of premises and intended use and occupancy of pmp~ conitructlon: a. Existing use and ~cupancy ~ ~ ~ ~ ~ ~ ~ 7 3. Nature of walk (check whicl~ applicable): New Buitding ................. Addition ................ Alteration ............. Repair ................. Removal .................. Demolition .................. ,Otcb,~' Work (Describe) ................................... 4. Est mated Cost. ..~......~....f......~!...(.?....(~... ................... Fee ..... ~.....~,...~ ................................................................ (to be paid on fi',ing this application) 5. If dwelling, number of dwelling units~.~ ...................... '~ -//n'Nl¥~'cr .of ,~lCii~l'ing u%t~e~h~ ~x floor ....................... If naraae number of cars 7. Dimensions of existing structures, if any: Front. ........................... Rear ................................ Depth ............ Height ....................... Number o~ Stories ................................................................................................ Dimensions of same structure with alterations or additions: Front .................................... Rear ......................... Depth ................................ Height .......................... Number of Stories ................................ D mansions o entir~ r ' ' 8. f e new const uchon: Front .................................... Rear ....... ~.....~.. ........... Depth ........................ Height .... ./.?.. ......... Number of Stories ............. .~.....A¢...~ ......................................................................................... 9. Size of lot: Front ......... ..~....¥...¥. ....... Rear .............. .............. Depth .......... ..'~....~...?.......-~..... ]0. Date of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated Does proposed construction ~iol6te a~ny zoning law, ordinance or regulation? ............................................................ ]3. Name of Owner of premises ......................,~'......./? ......... ~'adress ............................................ Phone N .-~.. .................. Name of Architect ...................................................... Address ............................................ Phone No .................... /1~/77, . ................... Name of Contractor .................................................... Address ............................................ Phone No ~ '~ ~ - 0¢ ! !"3 PLOT DIAGRAM Locate cleorly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to dcec~ and show street names and indicate whether interior or corner Jot. STATE OF NEW YORK, COUNTY OF ................................ ~'~' ................................................................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He ~s the '' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this opplicotion~ that aH s~otements contained in this application are true to the best of his know~edge and belief; tha~ the work will be performed in the monne~ set forth in.~the~pp~icoHon flied therewith. Swam to before me this , , .-~ ~ , ~ ~ ~ ................. :.: do, of ............................... /. :::'. ,, f ._~d f: ,: d L ................. ;-:-:'..~:..-....'~" · ................ ' ......... '..~ ............................... Notar'/ Public,. ........................................................... ~'Ount~ ~ (Signature of applicant).~Z',_. MARION A. REGENI/ ~ I ~ /(] / '/ NOTARY PUBLC Sae of f~ew Yo ~./ , J ~- ~ ~ Lf , ~-' ~"~ ~ No. 52-3233120 Suflo!k~County j' Term Expires _M~!~h. 3_~?L,~ ........ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at /~, ~/fD-~/ ~/~/~G i~v~~ · de~ocation) have been inspected by this department and foX'nd to be satisfactory. Ch~ ef of General ~ngin~ertng Services