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Home My WebLink About4783-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z .4029... Date ..... O~toi~r .... 26 ........ , 19. ?0 THIS CERTIFIES that the building located at N/S .Clue. tot. l~venue ..... Street Map No ........... Block No ......... Lot No... ~Old, · N~. Yo=k ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ... June ....... 2, ....., 19.70 pursuant to which Building Permit No. 4783. Z dated ... June ....... 2, ....., 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 ... ~va~ .one. family. ~elli~g ..................................... The certificate is issued to . .Lawrence. J.. ~sso,..J~. ......................... (o~ner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . Building Inspector House # 1785 CuSter Avenue FORM 190. 2 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE. $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF: TIlE WORK AUTHORIZED) N? 783 Z Permission is hereby granted to: ............. ~,~:,t~t~e ..~,~e.... ~ ....... i ................. ....................... ~t. ho~O, ..................................... to ............. ~tt~. :~d.-.t~.. oxy.- i*'~t:~ '~*' · L~:~ :~' ............ : ......................................................... at premises located at ............... ~/-~...-.g~a~e~..-.~ve ......................................................................... ................................................... ~;~t~],& ......... ~(,.¥. ............. ~ ......................................................... pursuan¢ to application dated ........................ ~l~}J'a~ ....... ~ ................ , 19.***~.0, and approved by the Building Inspector. Fee $..tO.*-O{~ .......... Building Inspector 8-9 SC~ TO WHOM IT MAY at SUFFOLK CONCERN: COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. The sewage disposal facilicie~ for a structure located (O±ve deed location) have been inspected by this department and found to be satisfactory. D1striot ~nglneer Diotrict Engineer Perm. Approved ........................................ , Disapproved a/c TOWN OF SOUTHOLD .BUILDIN~ DEPARTMENT TOWN CLERK'S OFFICE ~THOLD, N. Y. APPLICATION FOR BUILDING PERMI1 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 adjoining premises or public streets or/v 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 applicant. Such~ermit shall be kept on the premises ayailable 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 have been granted by the Building Inspector. APPLICATION IS HEREBY/v~DE 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 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. (Signature cf 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 premises ..... T~It:~eZZe~,..~,..T.:J~S~..~Tz'. .............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........... ~ ........................ Lot No.: .......:~.. ............... Street and Number ............ ~i/S....C~e~-..JLTe ..........~m, ttl~o.:l.4.....li.,Z, ......................................................... 7-'Fl- 1795 Munici~li~ 2. State existing use and occu~ncy of p~mi~s and infended use and occupancy of propos~ construction: a. ~isting u~ a~ ~cupancy ...... ~g.~ .............................................................................................................. Intended use and occupancy. ...... ~..el~e..J'~J~.~.~..iJ~-l-l...~11~ ........................................................ ................. 3. Nature of wo~k (check which applicable): New Budding .................. Add,ban .................. Aherahon ................. Repair ................. Remove! .................. Demolition ................. Other Work (Describe) ...................... 4. Estimated Cost .......... $.~.~.(~[X)...~. .............................. Fee ......... l:O.e.()~. ..................................................................... (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 occuDancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing st'ructures, if any: Front. ........................... Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height .......................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ..~.-,t0 ....................... Rear ...... ~h .~..~..Q' ......... Depth .~,,~.-..']1.1~. .......... Height .................... Number of Stories ....... ~. ............................................................................................................ 9. Size of lot: Front ........ 80 ............... Rear ....... J~.O. ....................... Depth ......!.~..0.. ................... 10. Date of Purchase ............~.~.r~.O.. .................................. Name of Former Owner .... ~..~i~.~'.~.[~'.9. .................... 11. Zone or use district in which premises are situated .~.~. Q.:l.J~.t~ ..................................................................... 12. Does proposed construction ~iotate any zoning law, ordinance or regulation? ................ ~ ....................................... 13. Name of Owner of premises Zu~...T.~IB&O ....................Address ............ ..~.g..~.~.q.~.~ ............ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........ ~ .................................. Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil 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 Jot. ~'O STATE OF NEW YORK, J~¢ COUNTY OF ..~'£O:J,~: ............. ,f'"'"' 0 .................. ;,~ ........ ~1¢~.e~i~.,..~.,1.~,O.....; ........... : ................. being duly sworn, deposes and says that he is the applicant tr~ame at ~nalvlauai signing application~ above named. He is the .................. ~....'.O.~l~'....-....~...~....~k'. ............................................................................................. (Contractor, agent, corporate officer, etc.) 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 oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the rnanner set forth in the application filed therewith. .................. 2-. day o.f ................... ,,,,.:.,,~'.'a,,l~$.,.,.,,m..., 17..,,..~..0 No,on, ........................... 6/ ELIZABETH ANN NE~/ILLE ,. ,/ NOTARY PUBLIC. State of New ¥orl~ No. 52-8125850, Suffolk Co~ Term Expires March 30, 1 / ~rO6A~ u.I. Liso, O~..