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Home My WebLink About4819-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy No. Z..1~ .... Date .......... .D. eC.e.~..be. ?..2.~. .... , 19. ?0. THIS CERTIFIES that the building located at . II/~t .Pea.. Ba~..B19de ..... Street Map No. ~ ......... Block No....xX. ...... Lot No...ZX .... .La...~.el .... .~,.Yt confoms substantially to the Application for Building Pemit heretofore filed in this office dated ....... J~ · .~.2 ...... , 19.7.0. pursuant to which Building Pemit No. dated ......... June.. ~-~ .... , 19.7.0, 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 .. Pr~L~ate..one. ~e~Ll~.. dYeJ, J.~g ...................................... The certificate is issued to .R.~.C.~...rd.. &..G.i,..a.e.e..G..r.~.f.f.~.t .h ..... . .0~..e.r.$ ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Dec ... 5.5 .... 5.9?0.. by. R.o. 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? 4819 Z Permission is hereby granted to: · ..e~e~e..O~r~....~/gllt~lm~..ll~l~ & W~ at premises located at ................. .ll/l~.....~(~l~l~..,~'..~,~,~ ....................................................... ............................................................. /~..e~, ......... ~..t.~.., .................................................................. pursuan¢ to application dated ......................... ~1~ .........~,~ .......... , 19..~1~., and approved by the Building Inspector. Fee $...%0~.OJJ ......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: T~e sewase disposal facilities for a structure located ~J~e d~-ed location) d have been inspected by this department and found to be satisfactory. 1970 Chief of General Engineering Services District Engineer APPLICATION FOR BUILDING PERMIT .................. \ 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 p remises, relationship to adjoining premi~ or public struts or~ tion.areas' and giving a detailed description of layout of property must be drawn on the diagram which is part of this' applico-~] 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 throughout the progress of the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY JV~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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all appl~able laws, ordinances and~r~gulations. ~<-~ 12.q'~, ':,,- .......... ...................... ~ {4/~'~ '~' 4 / a ~ (Signature of applicant, or name, if Q corporation) '5'W ............... ........................ ~" d't3~/~3S3 ~,'1~ )~L~ (Addrl~ss of applicantY Stoce whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, Nome of owner of premises ...... ~.. ......................................................... If opplicant is o corporate, signature o{ duly authorized officer. State existing use and occupancy of premises and intende~ use and occupancy of proposed construction. /31/ a. Existing use and occupancy ......... ~.....~........~T.. ............................................................................. b. Intended use and occupancy ....... ~..~...~......~T.....~~~....~ / 3. Nature of work (check which applicable): New Building ....... ~. ........ Addition .................. Alteration .................. Repair .................. Remova! .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost .............. ,~...~'.y..~ ........................ Fee .......... ./.....O...:..~ .......................................................... (to be paid on filing 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 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 ...... 't ........................ 8. Dimensions of entire new construct on Front ~./..' ~ Rear /",/- ¢/ r~=,-,,r, ~/~/c~ .'t ~,~,~eight ..... L.~.....~........, .... Number of Stories ...~ ............. !~: of lot: Front .....~/......~.....t. ........... Rear ...J....'~....~.....~ .............. Depth .~/....~..~...~.../...?.....Z~. 10. Da~e of Purchase ..~....~.~..7~ ................. No,ne of Former Owner .....~....'.......~/_~.~,~.[ ................ 11. Zone or use district '~ which premises ares tuated K~l~l~,,~.~,....*~'.. ............ . .~...-.....-~.. ....................... 12. Does proposed construction violate any zoning ]aw, ordinance or regulation? ...~...-.~. .......................... 13.', Nome of Owner of premises ..~.'..~ ......... Address ""[~'""~':'7"'--' ..... Phone No ................... Name of Architect .......................................... ~' ......... Address ................................................ Phone No ................... Name of Contractor ~...4~z-~.~ .......... Address ~1~'~. ~ '.~. · ,.....~,. ........ Phone No.~..~.~.~.~..~ PLOT DIAGRAM Loca(e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. Z. Y 7 STATE OF NEW YORK, ) COUNTY OF ............................ ) S.S. .............. '{~'~'~(~' '~..~. ....................... being duly sworn, deposes and says that he s the applicant (Name of indi~id'~ ~igning ~pplication) 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 ond belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this , . · ~o.~c~Z_-S]25850, Suffolk Co~tv.L '~res Marc~