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Home My WebLink About4683-zFORM NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. .1 01.8 .... Date .........~ ...... , 19. ~1~ THIS CERTIFIES that the building located at . Ik. Ila:l~t'. ~.:].~. (~). Street Map No. 13[ ......... Block No .... ~3[ .... Lot No. ! .... . .1~...~.;~.O..]~. .... !,.~.e. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........Apl'~. 1.~., 19.~). pursuant to which Building Permit NO...l~.. dated ........A~I'~ ..1.~ .... , 19. ~, 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 . ]~1~1~1 .~..£llt.~. d~llll~ll ....................................... The certificate is issued to .~1~1111~1~ .~t~l~ ...... ~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approval · ~'~1. , .......... 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? ]683 Z Permission is hereby granted to: at premises located at ................................................................... ; .............. ...................................... ........................................... X~i.....aeLaaam~.A~e ......... ~ ....... I.~L. ............................. pursuant to application dated ........................ ~1'~1, ........~ ........... , 19....~1~ and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ...... ~ _ t.~:/ ................... ~ ........ v ............................................ / .................... ~ ~' ~' ~ _~)_ _ . (Buildi~ In~or) / ~ ~ .... ~ .... ~ ' ~ ' APPLI~TI~ FOR BUILDING PE~I~ ~te ~ ................................... 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 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 shah 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. APPLIC-~TION 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. ..... (Signature of applicant,~~~or na~t~, if a cg~[poro~) (Address of applicant) State whether applicant is owner, lesse~q, agent, architect, engineer, general contractor, electrician, plumber or builder. Name o{ owner o{ ~mises ..~i .............................................................................................. '"7'""'"'"'"' If ~ic~ Is.a ~m~e, ~ignamre~of ~uly a~rized officer. (Name and title of co~orate officer) 1. L~ati~ of land ~ ~ich p~ work will ~ done ~p No ' ~ Lot No - St~ a~ ~mber .................................................................................................................................................. 2. State exi~g ~ and ~u~y of pmmi~ and intended use and ~cu~ncy of p~ co=mctim: Existing u~e and occupancy .............~ .............. · .................. ~ .............................................................. Intended use and occupancy ....................... ~...~ ....................................................... 3. Nature of work (check which applicable): New Building ~ ...... Addition .................. Alteration .................. Repair ............. .:~ Removal ..................Demolition .................. Other Work (Describe) ........................................ 4. -- ~.~ 0oO, 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 ............ ~...o.. ................. Rear .......... .6'..?. .......... Depth ....... .?.....?. ........ Height ...... /...~. ......... Number of Stories I 9. Size of lot: Front ........ ././....O. ............ Rear ........... ~./...O.. ................. Depth ............. ! ~O '10. Date of Purchase ....... ././/...~....~'/b...~. ......... Name of Former Owner '.~....'~'"':':'" 11. Zone or use district in which premises are situated ...................................................... ............................................... ~' 12. ~emS [~p~vende ~ o~st i~eCmt i~s~sV [o~ ~ r d i n a n ce ~.~;~;~ I~n~_~.~ .................. 13. .P ' -~..~.:..-.~.-~. .............. Address ............ ¢.....~....:.?...~m.~.~..~....... Phone No ..................... Name of Architect ....I ............ .~. ........ ~ ...................... Address ....................... ,~ ................ Phone ~ ..................... Name of Contractor .~..~.~...~ .............. Address .~....~....~.....~..(~..~.__~~.~.?..~..~...;~...o PLOT DIAGRAM 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. STATE OF NEW YORK, tee ,~ COUN Y OF ................................ ~'/~n~. ~- x~,~JJ ........................... e'..~,..?..~..;../...~Z'...?:..~...beina duly sworn, deposes and says tha¢ he is the applicant (Name of individual signing ap~oljc~Uon). /~ /~ above named He s the ~'~'' ~' .~.~"' ~ ' ~ ................................................................------ ----, -u-"-, --.~----- -i~'~'~;~;"~"~'~'fficer, etc[i ............... of said owner or owners, and is duly authorized to perform or have performed the said work and to make ond file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed Jn the manner set forth in the application filed therewith. Sworn to before me this _ ' ~ . /~ ................. of ...... ........................ ........ X / ~o ~ _~/' / '/q . ,, .............. ~.....~....~../...x....x.~ Notary Public,~.~./..~.... CountyWide& ' (Signature of applicant) ........................... ff ELIZABETH ANN ,NEVILLE ~,' NOTARY PUBLIC, State 01 Hew York No. 52-B~25850, Su(t01~ C0u~ ~ml ~xpi~a March ~0. 1~,.~ /V ~ ak su~u o~ ~c~-~c,~ N826162 85 JOHN STREET. N~W YO~K. NEW YORK 10038 ~ i,,,,,,August 26, 1970 ,l,l,li,',,,h,,,% ...... i~:'~ 300~8 N ~hts ~e~tfies. ~o~ ~/~o ~I~ ~I~ ~0t o/o Bol~se~u ~.~ ,.,~...,,,,,,;,,,.,~ .... August 21. 1970 ..... ~,,,.,.~ ,., ,,,. ~,, ...... ,,~.,,-,. ,,~,~, ,~ ....... ,,,~,',. ....... Warren Scott Elec.Co., 32 Arlington Rd., Lake Ronkonkoma, L.I. 11779 ' SYSTEMS STATE SUPERINTENDENT S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH E~dg. Fermit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities (give deed location) for a structure located here been inspected by this department and found to be setisfactory. District Engineer I/~"= ¢L o ; , ,? MAYF'LOW'E R,, '