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HomeMy WebLinkAbout4679-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 2J+l~O ...... Date ........... ~.etmr&ry.. 3..., 19.~.1. THIS CERTIFIES that the building located at . .Seund. View. AVe ..]~e. · Street Map No.. ~ ........ Block No .... ~ .... Lot No. ~... 6e~5- · '~,Y, .......... confo~s subst~ti~ly to the Application for Buil~g Permit heretofore filed in this office dated ........... &p~l' 10', 1~0" p~su~t to which Building Permit No...~ dated ............ ~$~.. 10, 19~0., was issued, ~d conforms to all of the req~ ments of ~e applicable provisio~ of the law. The occup~cy for w~ch this certificate is issued is . ~tvata .one..f~y. dw~ll~g ....................................... ~e ce~ificate is ~sued to .Mrs, .~a~. C~be.ll ..... ~r .................... (o~er, lessee or ten~t) of ~e Mores~d b~ding. Suffolk Co~ty Department of He,th Approval J~, .~$..19~... b~ .R.. ~tlla · · · Ave Exten, io, 1/ House ~ 12~0 So~d View ................ ~*.~...~. :"7/ ' B~ld~g I~pector ./ FORM NO, 2 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) N? ~679 Z Permission is hereby granted to: ......... ~, ~ ~tle~e..s~..~...~,~...W~.¢ ..................... ~.~ .................. i .................. ............................... ~,,Y..,. .................... : .................. Buil8 new one fami3~y d~elli~ at premises located at ........... JJj.~.....$~tZ~d...¥:;Lfg.~_~,t~'~. ........ ~ .......................................................... .................................................... ....... ...................................... pursuan¢ to application dated .............................. ..~.~..~..~.. ....... .'J..,O......, 19..?0.., and approved by the Building Inspector. Fee $ LO.....~. ............ Building Inspector FO*BM NO. I TOWN OF souTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , 19 ........ Permit No ................... Disapproved a/c ........... ~...~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........... A~. ~..I .I~ ...... I...~. ................ , 197 .~.. ..... 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 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 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 o 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 port 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 all applicable laws, ordinances, building code, housing code, and regulations. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................... ................................................................. Nome of owner of premises ..e .... ~..~.. .... ~l~.l.?.J~l~;.I.,.~ .............................................. .~ .l'~.nt is a corp~rdjte,~jll~ature of ~uly outh?ize, d officer. ...... (Name and'title ~f corporat~l~officer) Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and ~nb._er ................... ..~.~l.~l~.~..%~...~...~..~..~...E~,..~.~..~....~)..~.[~f~.=O ................... /o~ O~ Munici~li~ State existing use and ~cu~ncy of premises and intended use and ~cu~ncy of propos~ construction: a. Existing~eand~cupancy ~1~ ~0~ ...................................... b. Intended use and ~cuponc~ .............. ~.~.~e F~'.~ ~~.C~' 3. Nature of work (check which applicable): New Building .,~ ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .............. ..4Q.e~J~.t.....'~... .................. 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 ............................ f 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 af Stories ................................ I t 8. Dimensions of entire new construction: Front ..... .~.~...~..l ................. Rear ....~./..-J. .......... Depth .~eL..-....~. .... Heir:Iht ..~ ............ Number of Stories .~. ........................... ~ ....................................................... 9. Size of lot: Front ..~...j....l~... Rear '~' ............................ Depth .~..~..... ................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ l l. Zone or use district in which premises are situated ..................................................................................................... ]22. Does proposed construction violate any_ zoning law, ordinance or regulation.> ............................................................ 13. Name of Owner of pre~smises Jd)..~i~..~..~.l~l,~,.AddressCCtk~)...~.~.~/.~.~ll.~l~/~hone No ..................... Name of Architect ..[~4e~M~....~ ............ Address .....L~..'?.[..¢~,, ....................... Phone No ..................... Name of Contractor ~..~~..~L~ ........ Address ...~6~.'~..I.~..~,~.~.~.)~..~. Phone Nc~.9.~t..'~..?J..~ Locate clearly and distinctly all buildin property lines. Give street and block whether interior or corner lot. PLOT DIAGRAM whether existing or proposed, and indicate all set-back dimensions from or description~ ~acc°rding to deed, and show street names an~pdicate % STATE OF NEW YORK, ! S.S COUNTYwide,, ,~OF ~ ~..h'..G~,..~,_...... $~ ,"~, ~'o · .-~. ,.ll~e..~. L~.,...~%=~¢~.~.~ ~J X~,.^ ............... being duly sworn, deposes and says that he is the applicon, (Name of individual signing application) He is the ............................... ~d~,N~'j~LI~....~Idj~..~.i(~.G,.~.~ ....................................................... above named. (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 application; that all statements contained in this application are true to the best of his knowledge and belief; and thaz the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ....... ..................... County Ms&R? ANN CYIUL$1~' ~OTARY PUBLIC, State of New ye~k RESIDING IN SUFFOLK ~ No. B2-5~g5900 ~mmisslon E~pires March 34% SCtlD SUFFOLK COUNTY DEPARTMENT O,F HEALTH Date__ January Bldg. Permit No. g679 g Southold TO WHOM IT MAY a t N/S CONCERN: The sewage disposal facilities for a structure Soundvi~w Avenue: ~OQJ_" . - " . d -(--~.ve deed location) located V~.llage of Southotd~ Town of Southdld Owner - ~irso ~arah L. Campbell (~rSo Wsrd) have been inspected by this department and found to be satisfactory.