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Home My WebLink About4757-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . Mll~,~ .To.~ace..La ...... Street Map No. ¥~[llOv' .TeI*IP~k No ........... Lot No. 8 .... O~:~er~.~ ................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. May .... ][~9.~O pursuant to which Building Permit No. dated .......... 14&~ ..... ~8.', 1970'. 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 . j~tat® .o~le..£al~i.]:y · eI~te]:lir~g ....................................... The certificate is issued to .Horley. ~r. ho~p~Oll ...... 0vzlel* ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · 'd'~t~y '6' ] ~'2'' ~/4 'Ii'.' 'V~.l~lt .... UNDERWRITERS CERTIFICATF No... N. iRo .......................................... HOUSE N UM B ER. 'l ~1~ ....... Street .... W'l.']:lO~' ~Ol"l'a~O ' ~ ......................... Building Inspector 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) Permission is hereby granted at premises located at ................... ~l~...~.....~.~l~...~i]~'J~lL.~l~e,..Z ................................... ............................................... ~lIl~w.. ~ez~ .~ ..................... ~ ......... Ile~. ........... pursuan~ to application dated .......................... ~ ......... .~.~ ............ , 19...~., and approved by the Building Inspector. Building Inspector / S-9 SCHD SUFFOLK COUNTY DEPARTHENT Date Bldg. OF HEALTH Permit NO. ~ ~,~ 7 .~ TO WHOM IT HAY CONCERN: The sewage disposal facilities for a structure located at ' (Gi~e deed location) 7 have been inspected by this department and found to be satisfactory. Chi ef of General Engineering Service3 District Engineer mm~ ...................... ~ ................. ,1~ ........ ^l~roved .................................... , 1~...~)... Permit No .... .~..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjo n ng prem ses or pub c 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 appl cant. 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 part for any purpose whatever until a Certificate of Occupancy shall hove 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 app cab e Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations or for remova or demo t!on, as herein described The applicant agrees to comply with a Iapp icable laws, ordinances, building code, housing code, and regulations. (Signature cf applicant, or name,.if a corporation) ......................... ........ .................... (~ddress of~ applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................. ................................ .. If applicant is a corporate, signature of duly authorized officer. (Name and title'of corporate officer) ~'~/~ 7 1. Location of and on wh ch proposed work w be done Map No' ~.//.~'..6~....'~..~...A~.~.~¢~ot I~n ~:~ Number ..~.....~'..~... ~.,Z~r ~ ~ /~--A/7~' ~- / Street and ..................................................................... ..~... : ............ ~'1'1~/-- /~,~ I-/t 5~ J/I/I/_L& ~ '-/-E~2ttC i:- L/Jw,"Z- ~icipality .......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ............................................................ ; ........................... occuponc,' ....... .~......,~..~f~..~../.. ~-,..~..... ~......~X.....~....~....~.../..L~...~ ........................................... Intended and use 3. Nature of work (check which applicable): New Building ~......./:C~... ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... ~.. 4. Estimated Cost .2-~ ..................... · ;, .................................... Fee ...................................................................................... ,... (to be paid on fi!lng 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 olterotions or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ..,~....o...~ ................~ ~ Reor ...... ~ ................... Depth ,~..4. ................. Height ...../..~.. ......... Number of Stories ........ /.. .......................................................................................................... 9. Size of lot: Front ............ ./.o'"~ ........... Rear ....................... ../../...~. ......... r~tl,,, ................................. /~s$ ' 10. Date of Purchase .......... ,~..~....~..Z .............................. Nome of Former Owner Z~.e'...8'..~..~)m..Q..~.~.i.~...~....~.. ................ 11. Zone or use district in which premises are situated ,l~'A~.~. ?..~.....~'.....x~'...~...~...~:...../. ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... 4~.....O. .............................................. 13. Name of Owner of pramlses~.~.,.E...~.S....~'.~.q...~...~...E'...'~'..Acldress ~..,~..~.~ ~' ~2~'~E' ~'v,)Z~,~. . ................... ....................................... 7' ..... NO. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~...~4t~..~..~.~....~../. ....................... Address ....~S'~.~..ZT..~. .............. .~...., Phone No.~,.,~..6,.-..~..7,,~.,./ PLOT DIAGRAM Locate clearly ond distinctly all buildings, whether existing or proposed, and Indicate all ~et.back dimensions-from property fines. Give street and block number or description according to deed, and show street name~ and Indical. e whether interior or comer lot. STATE OF NEW YORK, ! ee COUNTY OF ................................ ,b'~'~f F: F, c me-w~.~ ~-~w ................................................................................................. being duly sworn, deposes and sa~ ~ he is the ~licant (Name of Individual signing eppllcatlon) ~ above named He s the ~M.~..~.~ ......................................................... '~ ............... ........................................ (Contmc~r~ ag~t, co~m~ officer, e~.) ~hf said ~ner ~r ~wner~ and Is duly authorized to perform or ha~ perfo~ the sa d ~rk a~ ~ ~e ~d file is applmatlon, that all statements contaln~ In this application am that the work will be performed In the manner set fo~h In the appllcatl~ fll~ Sworn to ~fore me this · ............. ~.~.. day of ....... ~,~,~ ................... , 19..~.~ ~; ~///. ~_ · J~ ..... ~.~...~..~~..;.~,~. ............ ......... ......... ~IZAB~H A~H H~ILLE ~ H~ARy PUBLI~, State of New T&rm E~ ~rch 30,