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Home My WebLink About4643-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~'01~ ... Date .. Oct 8 ... , 19, THIS CERTIFIES that the building located at Wf~ Camp M~neola Roa(~ Street Map No. Howell... Block No. XX Lot No. XX~ l~ttttuck conforms substantially to the Application for Building Permit heretofore filed in this office dated . . 14a~oh t2. , 19 70 pursuant to which Building Permit No. dated . . l~areh :12 , 19 ?D, 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 PI'irate..one. fa~i:l.y .dwo!iing ....................... The certificate is issued to David S~;l'ol~g ...... 0'~*l' .......... (owner, lessee or tenant) of the aforesaid bmlding. Suffolk County Department of Health Approval 0¢i;..~,. ]970 bY. .R, Villa ~Eouse ~ 2v, O0 NO2E: floor .not fully finished at this time. Building Inspector FOEM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 643 Z Permission is hereby granted to: ........... [~..~..~....~.....~../~...~,~..~'~,w,~ ..................... l~,.~...0mmt~...~ ............. ......................... ,~..~.~ ......... ~.~ .................... to .................. .t o.. ~u~,;l~..~sv..~...~..:ky.. ~;~*J~ .......................................................... at premises located at ........................ ~l~r/~.....~tMl~..~U~..~t~ .............................................. ~ ................................................................ l~at t~t tu~k .............. ~I~1:~ ................................................. pursucm~ to application dated ................................ J~.~.~.~,J~. ......... ~JJJ., 19....~, and approved by the Building Inspector. · -I ?l_~o~' 12'8" /.5- 'E" b./A Lt.- S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Petrol/No. ~ ~ ~- TO WHOM IT MAY CONCERN: The sewage disposal facili~ a structure located (Gi%e deed location) ' ' have been inspected by this department and found to be satisfactory. District Engineer TOWN CLERK'S OFFICE SOUTHOLD, N. Y. xam ned . .... ~ppraved ........................................ , 19 ........ Permit No..~.,?..?,....Z,..~......~....~;~,T'Z ~~ , Disappraved a/c ............ ..... o. 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, relationsh p to adjo n ng prem ses or public streets or areas, and giVing a detailed description of layout of property must be drawn on the diagram which is port 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 Jn part for any purpose whatever until a Certificate of Occupancy shall hove been. granted by the Building Inspector. APPLICATi0J~I IS HEREBY MADE to the Building Department for the ssuance of o Bui ding 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. ( 'g u e of applicant, or name, if a corporation- ..... (Address of applicant) State whether applicant is owner, lessee~ agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem ses .~. ~. --'~~........ ---.--- /~ .................... ............................................................. ................................................. (Name and title of corporate officer) ,~X, ~'~ ~ Str~ and Number ~ ... ' ~~ ~ _ . ........... ................ ..... - Sta~ existing u~ and ~cu~n~ of premiss and intended use and ~cu~ncy of p~ con~mction: a. ~isting u~ and ~cupan~ ....................................................................................... ' ......................... ........... ................................ -- ~~ ~ ~.: ......... ~.....~ ........ 3. Nature of work (check which applicable): New Building ....~. ........... Additipn .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........................................................... ~ee .......................................................................................... (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 ........................ ~u~ Numbe_~s~f Stories ................................ 8. DimenSions of entire new construction: Front ....Q,...?..~......~..°..~.~ear~......~...°...... Depth ...~....~'.. ............. Height ....... ~..~.. ...... Number of Stories .........'/'./..../...~.. ............................ ~.~i ............................ : ....................................... 9. Size of lot: Front ..... ~...~.,..~. ........... Rear ....~....~..~ ................... Depth ....... /..~...~.. ............ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... '12. Does proposed construction vio~,~e any zor~ ~_l~w,__ordinance or"-'z._ ,~,~,_~- ~regulati°n? ........ ~ ............................................. 13. Name of Owner of prer~es ..?n~..Oc,~...~...~...Address ......'?..~ .......... Phone No Name of Architect ..... .~,'~.~ .......... ~......Address ...~....~...~... Phone No ..................... Name of Contractor ..~..~..~..Address .......,~....~ ............. Phone No ..................... 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, COUNTY OF .......,.,.~ ....................... .f~"~' ~ ;i ............................ ~.,~~ ........................... being duly sworn, d~es and says t~ he is t~ applicant (Name of indiv~ual signing ~licati~_ above named. He is the ............................................................................................................................................. (Contractor, ag~t, corporate officer, etc.) of said owner or owners, and is duly authorized to pe~orm or have perfo~ed the ~id work a~ to ~ke ~d file this application; that all statements contained in this application are tree to the best of his ~owledge and belief; and that the work will be performed in the manner set fo~h in the application fil~ therewi~. Swam to ~fore me this ......... · ..... ....... /L_ .... .................. ......... Notaw Public, ~..~...C~Coun~ ELIZAB~H AN~ HEVILLE ~ARY PUB~, s~te of New Yart ~o, ~2~JJ, ~lt ~un~ .~erm