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HomeMy WebLinkAbout4667-z~.. ' FOEM NO. 4 TOWN OF $OUTHOLD BUILIHNG DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No.~ .1~01.~ ..... Date ........... : riel .....~ ...... , 19~). THIS CERTIFIES that' the building located at .. -gegwoed' 'La ............. Street Map No~a~e .~..~ll~ock No .... ~T...Lot No...~ ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Ape'S,%' - ~", 19. ~q). pursuant to Which Building Permit' No..l~g~l[. · dated .......... :Aple~,...$.., 19. ~O, 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'grate ~lae. f.a~.l~ .1[~1.1~ ........................................ The certificate is issued to .,/ell~ph. g~*lle~te ..... ~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval leper .l~t. .~..by. ~[..*f~LIa ..... FOR~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT Cfi-tiS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~667 Z Permission is hereby granted to: .......... .fft~c~-..P.~....~...,.Jts,,~.......~..,~.~.~.~.t,/t ~ t) to ....... ~.uJ.t..~ ........... ~:. ........... f:~.t~.+,..y .............. ~'E'~.'~'r'm"~ ............................... at premises located at ........................................ ]~)~,..Ji/J/~ff)..~ ......... .j~.~./~t~./~. ............................ .~.~.r~...~...m,....w.~....~,.~.,..... ',~,4~';'""~,~'~;'/'~'7 ................................. .......................................... .'. ........... ~ ................................. : ............................... ,. ............ ~:..b. ............ pursuan¢ to application dated ............................ j ...... ~jl:)/~./.:.. ....... , 19.,,~., and approved by the Building Inspector. Fee $..~..i~J.....'~.. ........ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date September 14, 197© Bldg. Permit No. 46672 TO WHOM at IT MAY CONCERN: The sewage disposal facilities for a structure located 117 ~ Dogwood Lane ~ w/o Old Orchard Lane (Give deed location) Oardiners B~y Estates~ ~ection 3, Lot 177 have been inspected by this department and found to be satisfactory. Dist~io~ ~lnee~" District Engineer TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT ~*/,~/7' ~," /V'7-__ C.~ 7~ TOWN CLERK'S OFFICE O' r~ SOUTHOLD, N.Y. ~' ~li~tion ~o ............................. APPLICATION FOR BUILDING PERMrI' · ............................................... m ............ INSTRUCTIONS 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 ning premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicat on ~ c. The Work covered by this application may not be commenced before issuance of Building Permit d. Upon approval of this application, the Building nspector wi I 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 in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depa/tment 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. ....... .............. //Sigr~l)ure of applicant, ,~name, if a corparationi' ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................. Name of owner o, ramses L/..~.~'C~ ,~. ~.., ~"'~..~. ' --~t~a 1~ '1~ p ........ .d A . / If applicant is o corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) ~. Location of land on which proposed work will be done. Map No.: ......~"..~ .~....'~. ..................... Lot No.: ..J..7...~. ........... Street andg~u~mber/r/- /''~-~';'~''~'''(d~'''g'''O''~)'/C) ...... "~"/~1' '~'~;7' ...... ~'~.~....~'.,t~.~./.C2.A~....~..~...~....~.~..~:.. Municipality ............ " 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occuoancv //~-~ b. Intended use and occupancy ...... .~...~...v~....v~J..~..'~........~.~.~.~,~ ...................................... 3. Nature of work (check which applicable): New Building .....~... ......... Addition .................. Alteration ....... ...~. ,.:..~ Repair ....... ii ...... ;.. Removal .................. Demolition .................. Other Work (Describe) ................................. i ...... 4. Estimated ~Cost ..?,~...L~.,~...~..~.O.. ................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, numbe,r of:dwe!ling units ........... ~... ............. Number of dwelling units on each floor ....~ ....................... If garage, numl~r' of cars ..........-~..~ ............................................................................................................ ~ .................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of eXistin~ 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 ........ .z/~..~..~ .................. Rear ...... ~.~..../. ............ Depth ...,;~.4~'.../.. .......... Height ...fi/.../. ......... Number of Stories ...../. ............................................................................................................... 9. Size of lot: Front ....... ./..~.~.../. ......... Rear ....~..~....~. ...................... Depth ..,~...~..~...~......~.../...~.../ 10. Date of Purchase ...~.~S~/~.....~...~,...../...~..~..~. ................... Name of Former Owner 1 I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....~....O.. .................................................. 13. Name of Owner of premises~.~r/s~....~'~_~.~...~.~i!..~.~...Address ~ ~.~..~. ~.~.C~ ~J-- Phone No.7.~...~....~...d..G...'Z Nome of Architect ...................................................... Address ............................................ Phone No ..................... Nome 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, COUI',J.TY OF ~.....~..~?.~..~- ........... [Name of indivi~M'al signing application) above named. He 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 make 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 forth in the application filed therewith. Swam to before me this ........ ~......'~ ....... day of ......../~..?~..c..~. .......................... , 19...7..o... Notary Public, '""~"~-'"'~':"~""~I~1~ t~ F~NI~! .................... C°un~'-~' ............. ~-~l~ii~';;;i ............................. ~;.e. ', ,2.~!mu ~h~~a~'