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Home My WebLink About4709-zFORM NO. 4 · TOWN OF $OUTHOLD~: BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z1+0-%2 ..... Date ......~ ..... Rll~ig'' '0et' '2 '" 19..70 THIS CERTIFIES that the building located at . .Sl~ttg..Harbor. Road ....... Street Map No. Cleaves..Pt Block No... sec. ?tZ. Lot No.. '3~.. · 6rockport;. · · I%,-Y, ...... conforms substantially to the Application for Building Per~it heretofore filed in this office dated ............ April- · '2g 19.. ?0Pursuant to which Building Permit No. .L~?ogZ dated ........... Apt. il. · 21+ , 19.70, 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 .. P. riva.~e, one .family. dwelling ......... ............................. The certificate is issued to · .EI'.iC ~ Koch .... 0w~ep ..... ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. House 700 / '''~ ~ ~'"~''~ .... ~' ...... I ........... ~uilding Inspec~o~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4709 Z Permission is hereby granted to: ............ at premises located at ........... ~,lJ~.4~.....~lJI..J~.....141g.~.~..~T~ ..................................... ::. ...................................... Iml..liJ~be~..~4 ............. lt~*e~l~Jt, ...... 31,3[, ........... ........................ &J)J'~ ~ 19.~J).., and approved by the pursuant to application dated ............................................................ , Building Inspector. · Building Inspecto1 Examined ~ .................... , ! 9..?...~.. Approved ........................................ , 19 ........ Permit No ............................. Di.~pproved a/c .. .~. . (Building Inspector) I APPLICATION FOR BUILDING I~ERMI't D~ . ' ' g~ ~/ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat plan showing location of lot and of buildings on premises, relationship 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 ir~oection throughout the progress of the work.- e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ~1~ shall have been granted by the Building Inspector. ,~ APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Building Permit pursuant to the Building Zone. Ordinance of the Town of Southold, Suffolk County, New York, and other applicab · Laws, Ordinances or Regulations, for the construction of buildings* additions or alterations, or for removal or demolition, as herein described. ~ (Signot~ of a_p, plicant, or name, if a co~'~i~) " (Address of applicant) ~/ State whether applicant is owner, lessee, agent, architec~t,,e~gineer, general contractor, electrician, plumber or builder. , owner of premises ................... ............~. .................................................................................... ......~ Name o If appli~, is,,~a co~__~naturej~uly authorized officer. -'~'""~'~-~e and title of corporate o~i[~';~ ................ 1. Location of land on which propq~,ed work will be done.,~Map No.: ...... ..3..~..Z,.l ........ .~..~.c..~.. Lot N~.: .....~..~ Street and Number ............ ~ ........ .~...~ .......... .~ .................. ~ t - . ...................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: aa .isting .se and occupa.,:,, .............................. "; ................................................................................. Infended use and occupancy .......................... ~.~ ............................................................................ 3. Nature of work (check which applicable): New Building ....~ ...... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ................. Other Work (Describe) ........................................ 4. Estimated Cost ............ .~.5~..,~.gLc2~. ................................ 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 ....... ~..~'.../...~. ................. Rear ......... ~ .~../..~.. ........ Depth ...~'..?'..~./.d...~ ..... Height ........ ./..~. ........ Number of Stories ...... ./. .............................................................................................................. 9. Size of lot: Front ......... ./.~:.f'~. ..... Rear .......... .(..~.~.;.,~'..~ ......... Depth ......... f'.~,-.~., .............. ]0. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................ 13. Name of Owner of premises ....x ...............~ ................. Address .!.~..~J,..~..C.~.......f'..~...~... Phone No.../~.~.....2......~D.-,Z.~' Name of Architect ................................ Address ../K'.....~..'..~.,J~7..!~.~....~.~,...~...~.~ Phone No ..................... Name of Contractor .~.'...~..~....../~.../L./.E..~.~ ......................... Address '~........C~.]2~..~..~......~...~.7~.¢~..-- Phone No. ,2.3:Y..,.:~?!~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oll set-back dimensions from property lines. Give street and block numb~ji~ or description according to deed, and show street names and indicate whether interior or corner lot. ~ * ' STATE OF NEW Y(~RY-/,/,~fl~ ),cS ...................... '..'~..,d-~r.-.~· ........ .~ ............................................... being duly sworn, deposes ond says thor he is tho opp icant (Name of i~ividual signing application) ~~ above named. Ne is the .......... ~.~ .......... ~ ....... .......... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke 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 fodh in the application filed therewith. Sworn ,o before me this ~ '~ 1;:~ ~ '~ ..... o, ........ ................... , ' ' ' ............................. ELIZABETH ANN NEVILLE ~OTARY PUBLIC, St~te 0f New York ~o. 52-8125850, Suffolk Co~ )erm ~pires ~arch 30, 19 S-9 SCHD SUFFOLK COUNTY DEPARTMENT OiF HEALTH Date i September 2~ 1770 Bldg. Piermit No. hTOgz TO WHOM IT MAY CONCERN: at The sewage disposal faciliti~es Snug Harbor Road, Greenport (Give deed location) Map of Cleaves Point~ Section 2~ Lo~ structure located have been inspected by this department and found to be satisfactory. D~strict Engineer