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Home My WebLink About4668-zFORM NO. & TOWN OF SOUTHOLD BUU,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. g~i~2~ ..... Date ............. /)et ....2¶ ..... , 19. ~ THIS CERTIFIES that the building located at ~b~. ~O~tl ............ Street Map No..l~ ........ Block No .... ~ .... Lot No.. ~... ~$~ .... ],~. ...... conforms subst~ti&ly to the Application for B~lding Permit heretofore filed in this office dat~ ....... ~h .... l~..., 19.~. p~su~t to which B~ng Pe~it No.~... dated ........ ~h'" '~" , 19. ~, was issued, ~d conforms to ~1 of the req~ ments of ~e applicable pro~sions of ~e law. The occup~cy for w~ch t~ ce~icate ~ issu~ is .. ~$~ .~ .f~ly. d~ll~ ...................................... The certificate is issued to ~b~. ~ .... ~F ............................ (owner, lessee or ten.t) of ~e ~ores~d b~ldMg. S~olk Cowry Dep~ment of Health Approve J~e...~..$~...~. ~ .~ ..... B~d~g I~pector l~O~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 668 Z Permission is hereby granted to: to ......... t~Ll:d: "~ · ~ "'~ma.t:l.7" ~er.t ~.a~ .......................................................................... at premises located at ............... t~'"RD~twlll~"~i:l~l~ ................................................................... ............................................................. Olree~D~t ............................................................................. pursua~tc to application dated ................................... J~....~ ........ , 19..~j., and approved by the Building Inspector. JJ~l Fee $...~0~C~ ......... ' ' TOWN OF SOUTHOLD -/- '/' . ,/ BUILDING DEPARTMENT ~4,.., ~ /,'~ TOWN CLERK'S OFFICE ~ v" /o~'~ L.,. ~ /-4[ ' SOUTHOLD, N. Y. Examined .................... ~. ................. , ....... Application No...(...~..~. ................ ,oved ..................... , ........ Perm,t No .......... ................ . .................. ,.. ................ .............. ........ ......... ............. ,// ............................. ........................... , ..... ~. APPLICATION FOR BUILDING PERMIT Rte ...~ .......... ~.~ ........................... I~)...~. .... INSTRUCTIONS a. 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, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is I~rt of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this app. lication, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises avadable 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. APPLIC_~TION 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 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 of applicant, or name, if a corporation) (Address of applicant)~ J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~....~ ........................................................................................................ If c~oplicant is a corpo__mte, 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.: ........................ 7P/ .~o0 n ~. ,, ""' '"Mu~cipallty J State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .~..~ ...... ~ ................................................................................. ntended use and occupancy ~.. ~~' ' . ....................... b. 3. Nature of work (check which appli a w Building ~' . Addition ........ Alterotion'...,~.. ............ Repair .................. ~emoval .................. Demolition...,,'~,, ........... Otl'kqr Work (Describe) ... ' ' ' 4. Estimated Cost . ~...O.~. d , ~e, ~/O" .......... ~ ........................................ tee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .....6...~...~.. ............... Number of dwelling units on each floor ......~...~..~'~.. ............ If garage, number of cars ...........T~..(~ .............................................................................................. 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 .. Height ...~...,~. ......... Number of Stories ......... .~..~...~.'.. .................................................................................................. 9. Size of lot: Front ...../..~..~. ......... ~ ....... Rear ........... /..o...~.. ................. Depth ....... ~.~..O......~.. .......... 10. Date of Purchase ........ ./.~...~....~.~ .................................. Name of Former Owner ...~..,.~....~...~., ....... 9.?....~.~..~.. ................ 1 1. Zone or use district in which premises are situated .......... /~. ..................................................................................... 12. Does proposed construction viola[e a_ny zoning law, ordinance or regulation? ........................................................ 13. Name of Owner of premises~ ~ -, ,~ m'l'~"'~"~'"~Address ........ ~ .......... Phone No...~...~..~..*..~..~111~ Architect, ...~.......~ ............. Address ...... ~ ............. Phone No Name of Name of Contractc~r ~ .../~....P..~ Address~~ Phone No ~/~.o~.~.~ 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 occordin to deed, and show street names and indicate whether interior or corner lot. 1' STATE OF NEW YORK, ~ c e COUNTY OF ................................ ~°'~' ..: ............................................... - .............................................. being duly sworn, depbses and says that he is the applicant (Name of individual s~n_i, ng ~p_lica~.io~n) above named He s the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized 'to perf')tm or have performed the Said work and to make end file this application; that oil statements cont<~iried ink'this aPplication are true to the best of his knowledge and belief; and that.the work, will be performed in the m~nher~set forth in'the.apPlication f ed therewith. Sworn to before me this ~ ........ _ ........ :::::::::::::::::::::::::: ............................. " NOTARY PUBLIC, State of New York No. 52-8~25850, Suffolk County_ ~ Term Expires March 30, 19.~7 _ S-9 SCHD TO WHOM IT MAY SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. ~/~,8 '~ CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. District Engineer District Engineer