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Home My WebLink About4758-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No... Z~4)~.... Date ............ 0et.. -~3 ........ , 19.~. THIS CERTIFIES that the building located at ... ~e~Ft~ AW..(i~rt) ...... Street Map No. ~n~ ......... Block No.. ~ ...... Lot No. '~13~ .... Ila. ttitlaek. · 1~, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~' ' '~9 ......, 19. ~ pursuant to which Building Permit No~ ~.. dated .'. ......... MI~ ..... 19., 19..~ 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 .... l~.~ate ~ae..f~=e 1~, .~weI1..~1 .................................... The certificate is issued to . (~ha~'lell .&./~eFet.t& -. 8ell~el'~ ....... O~el~ ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval - ~1~. - '$~... '~970' ' .b~- ~,. '~ · '~l~a-. u' ding~ ..... 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? 4758 Z Permission is hereby granted to at premises I~oted at ......................................................................................... l~ ~1~1 t 19 , and approved by the pursuant to application dated ............................................................ , Building Inspector. Fee $ ........................ Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deeff location) ~/ have been inspected by this department and found to be satisfactory. District Engineer '~OWN OF soUTHoLD ;'~ ~' ~ '~'~'~ ~ BUILDING DEPARTMENT / ~ ~ ~~~~ TOWN CLERK'S OFFICE /~~ /~ / ~ ~H~, N. Y. on ....... * ro.d .................. No ............................. " ' (Building Inspector) APPLICATION FOR BUILDING PERMIT Date /~' '//~"~ )~' 19,.7.,,~. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted In duplicate to the Buildi . Inspector. b. Plo. t .plan showing location of lot and of bui d ngs on premises, mlationshi~ to ndl~lnln~ n~m~ ~. areas, aha giving a detailed description of layout of re must be drawn n r --, ..... , .......... public streets or P pert7 o the diagram ~l~'J'ch Is part of thle appllcation.~ I 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 t~.roughout the progress of the work. shalle' haveN° buildingbeen grantedshall bybe the°CCUpledBullding°r usedlnspector.ln whole or in part for any purpose whatever until a Certificate of Occupancy B .A..P. PLI,CA. TIO_N,IS HEREB. Y.MA_DE to the Building Department for the Issuance of a Building Permit pumuant to the u,mng -'one urainance of the/own of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ngs, additions or alterat OhS, or for removal or demolition, al herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. , ~ %,_~'~,X~ : ~- (Signature c:f applicant, or name, If a'~)q)~r~tl'on) .... , ............ ,&z.. .......... ~, '~ ~ ~' ' (~ddress of applicant) 7 .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises . ..~..../'~...~...~...Z;. L-"S ~c, '/" ~ ~i' E '-/7':~q If applicant Is a corporate, signature of duly authorized officer. (Name and title'of corporate officer) '.,~/~.'"~/7.~,,.~.'./~ Street and Number ........ ..~..~.//~'0'l"f/~' 7: . '~ /7~/_ /.~ ~0 "~ .... "~ ...........................................................................................Municipality 2. State existing use a,nd occupancy of premises and Intended use and occupancy of proposed construction: a. Existing use and occupancy V',,~c~/~/I/~' b. Intended use and occupant,.. ................ 3. Nature of work (check which applicable): New Building ................ .~ldition .................. Alteration .................. Repair .................. Removal .................. Demo t on.. . OtheruWork (Describe) .................. ' ............. 4. Estimated Cost .......... ./..~.,...~...0...~....-~.. .... Fee . ./...~. ~ ..... (to be paid on fi~ing 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 exi,sting 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 ........... Height ..../../. ............ Number of Stories ~/(/~'~ F 0 9. Size of lot: ront ......... ./,.,~, ............ Rear ....... ~,...~,. .................... Depth ........................ 10. Date of Purchase ................................. ~.. .................... N-..- of Former Owner ...... ..,/~,.~...-~.....~..~...~........,,-~,,/~....~ ..... 11. Zone or use district in which premises are situated '~FS' ~ 12. Does proposed construction violate any zoning law, ordinance or regulation? 13. Name of Owner of remises~,..~....~....~../~..Z)FX"~ .-, ?-~7 Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..................... ~ ............................. AckJress ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dlmens OhS from property lines. Give street and block number or description according to deed, and show street names and Indicate whether interior or comer lot. _ S' r'A~ OF COUNTY OF ................................................................................................. being duly ~worn, d~s and saya ~t he Is the applicant (Name of individual signing application) a~ve nam~. He is the O~ ,:" (~ntmctor, ~t, co~omte officer, ~.) of said owner or ~ners, and is duly authorized to perform or h~e pe~o~ed t~ ~ld work a~ to ~ke ~d file this application; that all statements contained in this application are tee ~ ~e Nit of his ~owl~ge a~ belief; and that the work will ~ perfo~d in the manner ~t fo~h in the application fll~ therein. Sworn to ~m ~ ~ls .......... ............................. ........ ............... .... ...................... I ~ NOTARY PUBLIC, State of New York ~ ~ ' -- / -~ No. 52.8125850, Suffolk Co~ ' v r Term ~pi~ March 30,