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Home My WebLink About4812-zFORM NO. 4 TOWN OF SOUTHOLDi BUILDING DEPARTMENT Town Clerk% Office Southold, N. Y. Certificate Of Occupaacy No. ...... Date ............ De~.. 22 ....... , 19. THIS CERTIFIES that the building located at . ~/~B&y. ArS ............ Street Map No..:Ix ........ Block No...Xx ...... Lot No... 1~ ..... l~.titttglt.. N.,Y, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... gllr4e.. ']9 , 19 70. pursuant to which Building Permit No. bS]RZ · dated ......... gtme..49... , 19 7(1, was issued, and conforms to all of the require- .ssuf of the applicable provisions of the law. The occul~ancy for which this certificate is ' . is Priva.te. one. family ¢l~.~lling ............... (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval House # 2~2~ · ' ' / Building ..... ; '-'<< ~' ' ''~ ¢ ...... Inspector / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AuTHoRIZED) 4812 Z Permission is hereby granted to: ................ l~,a ~' ',~1...~ ,, .. lia,~'J.~, ...................... ................ ~&....~,..l~m~..l~ ........................... to ...... ,llml,~..m~.~..~.. ~.~ ............................................................................. at premises located at ............. J~lll~..,,,....J~/f~...:J~l~T'..&~'t ................................................................. ...................................................... l,~t,'tt~'lr,.~m~ .............. lt~.'J'., ............................................................. pursuon* to application dated ................................ ~ .......... ~Jt'" 19..7~., and approved by tl~e Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewag~e disposal facilities for a structure located (Give~e ed lo~ion) have been inspected by this department and found to be satisfactory. Chief of General ~n~neerxng~ ' Services District Engineer Z % 'TOWN OF ~OuTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined .. 7'"": .......... ,19 ...... ,. ^pp, ............... , ..................... 19 ........ Permit No ............................. Di~aaproved ale ...................................................... APPLICATION FOR BUILDING PERMrr ~.~ ......... ................... ,19..Z..o.... 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 premiee~ or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram wh]ch is pert of thle 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 permit shall be kept on the premises available for ir'apection 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 Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ond other appllcoble Lawl, 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, ond regulations. (Signature of applicant, or name, If a carporetlon) ...... (Address of applicant) (7/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of ' f i ~ ' owner o prem s es ...~,,~ ............. ~ ..................................................................... If applicant is a 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.: ........................ St~ and Number .~~ ~.~ ~7...~L(.~.~.ZX~......, ............................ -' State exl~lng u~ and ~cu~ncy of promises and Intended use and ~cu~n~ of p~ ~tm~l~: b. Inte~ u~ and ~capan~ ~...~....~.~..,~..~..~ .. 3. Nature of t/vo~k (check which applicable): New Building .................. tion .................. Alteration .................. Repair ~. ................. Removal .................. Demolition .................. Other Work (Describe) ........................................ o 4. Estimate~d Cost ......... ~, .... ~. ................................... Fee .......................................................................................... (to be paid on fi!ing this application) 5. If dwelllng, number of dwelling units ....... t~:~:~,~...'Number of dwelling units on each floor ............................ If garage, number of cars ~ .............................................................................................. 6. If business, commercial or mixed occupancy, specif~ 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__ ,~,°f entire new construction: Front ....&,~"~....~-:~:~..../ ........... Rear ....~..~,~:..~,...[....-... Depth ..,~.../~/.. ,~.~ Heighl~l~..../.~/~.~ Number of Stories ..... ~ ..................................................... · I I ~. · ............. I '" 9. S,ze o~o~: Front .~..~.' ............... Rear ....,~.~...~.. .................... Depth ..,~.....'.~_.~...~ ///,~'~t' )~e.-~,,~ 10. Date of Purchase ~,~e.../.~./..,O.. ......................... Name of Former Owner ~a',.~.~....¥.........~.~ ! 1. Zone or use district in which premises are situated ....... /~ ...................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regu at on? ;~11~C~ .................... :: 13. Name of Owner of premises~l~~Address,~/.~....~...~.~?~...~.,./~.~.~Phone-- No.~..~?.~...~.~.D...~...O.. Name of Architect ... ,.,,~,~..I...... ............................ Address ............................................ Phone No ..................... Name of Contractor-~..~..~r.v:~r'....'.~....'r~..~......~...-~.~.::~..Address/'~ ~Z.'""-- ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all ~et-bock dimensions from p,ra~..rty lines. Give street and block number or description according to deed, and show street names and Indicate wnether interior or comer lot. ........... ~(~~.....~,~...~.~ ............ being duly Iworn, deposes and says that he is the applicant (Name of individual 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 tha{ the work will be performed in the manner set forth in the application filed therewith. Swom to before me this ,~ ry 'cJL,,/~-,~._.~r,,/~4g~r.~County ~ (Signature of applicant) No. 52-81258S0 Suffo k .i;:~ : ~ Term Exp res Marc]~ 30, 5524-2