The URL can be used to link to this page

Home My WebLink About4691-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at . .l,~it.tl~a~k. 4[ .M~lmm .]t~ Street M~p No. ~. ~ock No ........... Lot No..~ ...... ~~... ~. ..... confo~s subst~tially to the Application for Bufl~g Permit heretofore filed M ~s office dat~ ........... &p~.. $~, 19. ~ p~su~t to wMch B~il~ng Permit No..~.~.Z. dated ~. ........ ~PF~.. ~.., 19~.,was issued, ~d co~orms to ~1 of the r~ ments of ~e app~cable pro~sions of the law. The occUP~cy for which ~ ce~fficate is ~sued ~ .. ~vat~. ~. f~. ~l~ ..................................... The certificate ~ issued to .~..~I~F. & M~e., ~a .................... (o~er, lessee or t?n~t) of the ~ores~d buil~ng. ~ S~olk Co~ty Dep~ment of He~ Approval ~...~. 1~...~: ~ [~ ...... ~e ~ ~ ~t~ ~ B~ld~g Inspector [ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT To~m Clerk's Office Southold, N. Y. Certificate Of Occupancy No...~..~.6 ...... Date ...... ~ · .]~Y.. .... $.., 19..'~.. THIS CERTIFIES that the building located at ....I~..t.t..17 .!~..e~...&. ~. ~eet Map No.~. ~,.. Block No ........... Lot No..~ ..... ~~... ~t~ ...... conforms subst~ti~ly to the Application for B~ld~g Permit heretofore filed ~ ~is office dat~ ........... ~...~, 19~. pursuit to which B~lding Pe~it No. ~.. dated ........... ~..~., 19.~., was issued, ~d confo~s to ~1 of the req~ ments of the applicable provisions of the law. The occup~cy for w~ch this ce~icate is issued ~ . .~g~. ~. f~y..~.~$~ ............................. , ......... The certificate ~ issued to ~. 0~.~g ............... ~F.: ................ (owner, lessee or ten,t) of the afores~d building. S~olk Co~ty Deponent of He~ Approval ...N~, .~..~g~...~. ~, .~... ~ ~,O, " ~id~g Inspe~o; ........... · row. OF Sou'rHOLO BUILDING DEPARTMEKI' T~N CLERK'S ~ICE · ....~ , ....................................... ,....: .......... ............................. ¢:...~ ........ ~ ............... i ......................... / ~ - O (Building I~r) . 1 9..~.~...~ o. ~i~ opplic~tion must b~ complot~lg filled in by ~ewrit*r or in ink ond ~ubmi/ted in ~plic~t~ to th~ 8uildin I~tor. b. ~1~ plan ~howin~ I~tion o{ lot and o{ buildin~ on pr~mi~, r~l~tlon*hlp to od~oinin ~, ~nd OivinO a d~t~iled ~*cript~on of lo,out o{ prop~ mu~t c. ~ work c~r~ bg lhi~ ~ppli~tion m~ not b* commenced d. ~pon ~pprowl of thi~ ap~licotlon, th~ 8uildln~ Inspector will i~u* ~ Buildin~ ~it t0 th~ ~ppfiC~t; Such permit ~holl b* k~pt on th~ pr~mi~* o~d~ble {or ins~tlon throughout e. No bulldino ~11 ~ ~cupied or used in.whol~ or !n p~ ,~11 hov~ b~n omnted b~ th~ 8uildin~ In~p~t0r. ' ~[I~TIO~ I$ ~fiR~BY ~D[ 1o th~ Buildino Dop~rtm~nt for th~ i~su~nco of ~ 8uildinO ~rmit pu~u~nt to ~he 8uildinfl Zo~ Ordln~nc~ o{ lh~ To~ of South01d, Suffolk ~n~, · h~ op~icont ~r~ to comply with o1~ ~pplic~bl~ I~ws, ordinonc~, buildin~ c~, hou~in~ c~e, ~nd r~ul~tion*. .......... ......................... ($'g ature 6{ applicant, or name, if a ~mtion) ¢ .......... / ........... : ........................ 7 ............................... ,~ ~. ~re~f a~cant) State ~ether applicant is ~ner, lessee, agent, arch,tect, .ng'n~r, general c~tractor, electrician, plu~er or builder. ..: ......................... ~.~.~ ....... ~......~~.....~¢.~):~z~& ............................ : ........................................ ........... ............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ,., ., ~',. _ ,, ~ · "HAe oF: .~u~' o~-~ ,, /~ ~ L~ation of land on wh,ch~r~sed work will be dane. Map No.: .............. ~/.~ ............ L~ No.: .~.Z ................ D State existing use and ~cu~n~ of premiss and intended use and ~cu~ncy of p~ con~ction: a, ~istl~ use and ~cupan~ .............. ~ ........................................................................................................ b. In.nd~useand~cupa.. ............ ----4~1~ ........ Z~.~."~ ............................... 3. Nature of wore (checE which applicable): New Buildlng~''.......... ...... .. Addition .................. Alteration .................. Repair ................. .,~ Rem. oval .................. Demolitio~ .................. Other Wore (Describe) ........................................ 4. £stimated 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, sp. ecify nature .a]~,~ qxt~t of each type of use ............................ 7~ns~ons of ex~st[ng structures, ff any: Front ...~....3T~..... I~ar , ........ I...~.'....T.;.:;. uepth ..;~..... ........ I~ght~. Number of Stories ..~....~. .................................................. ; ................... ,., ............................ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ..................... : ...... Number of Stories ....... .~--~__,~" ............ , ........... Fro n t z~..,~'../../'~...~.~....~.... ~ .~...~.....¢'.`.. / 8. Dimensions of entire new construction: Rear .~...'..~.i.~.?...~.'~Depth Heightr~.~:..,~b ..... Number of Stories ..... ~ ....................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ......................... , ..... 10. Date of Purchase ~} ..~Z~... J ~ /.~..~.. Nome of Former Owner ~'' ~.J.~ ~.~... 11. Zone or use district in which premises are situated ~s. ..................................... 12. Does proposed construction violatej~, I~.~n ,,~ ,/~c~any zoning,law, ordinance or~, L.~.pregulati°n> ~..' ................................ ............................. ........... ........ Owner of prem, ises/3 ].l~,~'J~'l'~":h~!!"'~'"'l~'"l'~'"Address '/~'"'~'"'"'~"~'7'"'"'Z~'~'~'''~''~''~''''~ J~L, JL,,~r~./ Z~_ ~ ,e_ Phone_,,~ ,3 13. Name Name of Architect .I~....J~..~...I.I?...~....ET.~.....~. ....... ............. Address · .~/,~3.-..:!..W~l.J...~....~....... Phone No ............. ./..'...~.Y Name of Contractor ....R.J.~...~...~ ............. Address ./..~...'~.......~..:.7..?..~.~..'~...~..~..I-.~...~.: Phone~q~o.~..~..~..~..~/ PLOT DIAGRAM LocaYe 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, ~ ¢ c dqome of individuol signing opplicatiOn) above named. He is the .................................................................................................. 2 ...................................................... (Contractor, agent, c~t~ ~,'f;~,, ;tc.~- of said owner or owners, and is duly authorized to perform or have 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 that the work will be performed in the manner set fo~h in the application filed therewith. Swam to ~fore me this ...... ........ ....................... NOto~ Public, ~.~ ................. ~unW ~-'~~Zf~ii~b~) ...... . s-9 SUFFOLK COUNTY DEPA~8'MENT OF HEALTH TO WHOM 1Y MAY CONCEHN: The sewage disposal facilities for a structuro located ag ....... ~ , ~ ~)~. ~,., , , ~- _ ,, ~v~ bo~n ~n~p, egod b7 gh~ Dop~ong and fomd ~o ~ ~a~sf~o~o~, D~triet E~gineer