The URL can be used to link to this page

Home My WebLink About5065-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z1~%80 ..... Date ............. Ilar .... 31 .... ,19.?1. THIS CERTIFIES that the building located at .Custer. & .Breitstel~t .... Street Map No~latthf. i~l~1. ~ck No ........... Lot No. 12 ...... S®utheld · · N.,¥, ........ conforms substantially to the Application for Building Pemit heretofore fried in this office dated ..... Ney ..... ~, ...... , 1970. pursuant to which Building Permit No...~06~Z. dated ......... ]o.v.... I~. .... , 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 ...Private. ~®- f~mit~ -~well .illg ..................................... The certificate is issued to . MFS ,. ttew&F~. Lee .... Ow~eF ......... ' ................. (owner, lessee or tenant) of the aforesaid bu.ilding. Suffolk County Department of Health Approval lla~.. L~f · ~ 9,~4by. R.. V.$11& ........ 37~ Breitltadt Ct Building ~ -//~-Inspecto~ ...... t' '~ '~ .... ...... ~. ,~a: .... .-./ ........... FOEM NO. ~ TOWN OF $OUTSOLD i 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) N? 5065 Z Permission is hereby granted to: : ....... ~ ......... L...L ........... : ............ ~ ...... i....'.. ............. a~ premises I~ated at .................................................................................. ~ ....................................... .............................................................. · t .............................. ~.' 'f ............ ~- ................................... pursuan¢ to application dated .................................... ~.~...,.~.~ 19Z~., and approv~ by the Building Inspector. Building inSPector $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at (G~ve de~'d- locat::ton) : have been The sewage disposal facilitte~s for a struct:ure located inspected by this department and found to be satisfactory. IPOBIf NO. I TOWN OF soUTHOLD BUILDIN~ DEPAR?MENT TOWN CLERK'S OFFI¢! SOUTHOLD, No ¥o Application No.....:~....~....T.,.-T. ........... Oiwpproved a/c ......... ~..-,~. ................................. r' (Building Inspector) APffLICATION FOR BUILDING FEIIMI'I Date .....~. ......... 2--- ~- ..................... , 19..~,~.... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink -,nd submitted in duplicate to the Buildi~ Inspector. b. Plat plan showing location of lot and of buildings on premises, r~lationship to adjoining premlees or public streets or areas, and giving a detailed description of layout of property must be drown an the diagram which Is part of ~le application. c. The work covered by this application may not be commenced bafora issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. S~h 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE t° the Building Department for the issuance of 9 Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ond other applicable laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein deKrlbed. The applicant agrees to comply with all applicable laws, ordinances, building cede, hj~uslng code/and regulations. ........ (Address of appllca~J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or,builder. If applicant_is a corp,o, rate, slgnatur~ of du~y agJ~orlzed officer. · (Name and title 'of corporate officer) 1. Location 0f land on which proposed work will be done. Map Ne~~ '/'.~ ........ ..,,.'~ street 2. State existing use a.nd occupancy of/p~/~ises and Intended use and occupancy of proposed construction: O. Exlstin~ U. Ond OCt p cy ...~/.~t~_ ............................. b. Intended use and occupon: ...~ .............................................................................................. 3. Nbture of work (check which applicable): New Building ~....~.......... Addition .................. Alteration ................ Repair .................. <~e. moval ............ ~.~. Demolition....: ............. Other Work (Describe) ....................................... 4. Est mated Cost ..?....~.~.2.. ~>~. ~..: ....................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 c~rs ..~...~-.Z/,~. ...................................................................................................................... 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 olteretions or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... 2~...../. .................... Rear ....~...~.. ................ Depth ....~...~.....; ......... Height ........ Number of S r os ..... ...................................... ......................................................... 9. Size of lot: Front .. ../. .~. ~.'.. ./. ........... Rear ..... ./....~'...?...~ ................ Depth ...~.,~:.~..../. .............. 10. Date of Purchase ....................................... Home of Former Owner .......................... 11. Zone or use district n which premises are s tuated ...... ~....~..~...~. ........................................................................ 12. Does proposed construction Violate any zoning law, ordinance or regulation.;) .....~....~.. ................................................ 13. Name of Owner of premise~...:..~.~ ............... Address .~.~...'-R~..../~....,~...~.. .................... Phone No.~...~'..~..~..~.... Name of Architect .................. ~ .................................. Address ........................................... Phone No. ~'~/~ Name of Contracto ..~..~.....Address ............................... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ind Cate all set-back dimensio.ns from property, lines. Give street and block number or description according to deed, and shOW street names and indicate whether mt rlor or comer lot. ]~0TARY PUBLIC, State of NeW Y~ No. 52-8125850, Suffolk CmJJl~,~ STATF OF NEW YORK, tS./? .,., '""'"~ r / ................. t~~~Z.Z ................ being duly sworn, d~ and says ~t he is thelapplikant ( of 'ndividual ~g~ ..... J above named. He is the ....... - .................................................. : ............... '~[ ............................... ; .................... (Contractor, ~t, co,orate officer, ~c.) of ~id ~ner or ~ners, and is duly authorized to perform or ~e ~rfo~ed the said work a~ to ~ke ~d file t~s ~plicotiOn; that all statements contain~ in this application are tree to ~e ~t of his ~owl~ge a~ ~lief; and ~o~i~iP~°rmed in the manner ~t fo~h in 1he q ~t,~ fil~el~ t~ ~