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Home My WebLink About4847-zFORM NO. 4 TOWN OF SOUTHOLDi BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Zl~Ob~2 ...... Date ....... ~tOV ... 19 ....... , 19.70 THIS CERTIFIES that the building located at . ~enlie~ot;t.. Da, ........... Street Map No..¥eral,. Pk,. Block No ......... Lot No. 31~..' · · · Sout~holtl...lto~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. g~Y' · · 9 19.70. pursuant to which Building Permit No. !tSL~Tik. dated ....... gaily ..... 9", 19.70, was issued, an~ conforms to all of the require- ments of thc applicable provisions of the law. The occupancy for which this certificate is issued is .Private. one. family .dw®~:]:ing .......... , ............................ The certificate is issued to . .George. Kohll ...... 0~riel,.; .......................... (oWner lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval SeDt'' ~Ik~ .... 1970 "by' 'R,' Villa.' Building InspectOr FOB, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOI. D, N. Y. BUILDING PEP, MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o <{847 Z Permission is hereby granted to: at premises located at .................. ..~O~;-.~i~ ....... ~,~*"hr~ ................................................. ................................... ~ ............................... ~m~ ....... I~e%w ................................ pursuant to application dated .......................... ~1~:~'. ...... ~ .............. , 19...~(~ and approved by the Building Inspector. SCI{D SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure UGiv~eed location) located have been inspected by this department and found to be satisfactory. District Engineer TOWN OF SOUTHOLD ' '/~ '7,/ BUILDING' IXEPAITMINT · TOWN CI.L:kK~S OFFICE 70 Examined ............ ,.., 19.., ..... o' ' ,-~- ....................................... , ~ ........Permit Application No ..... ~..~.Z ....... Di~pproved: a/c ........................................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application mu~t 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 premi.ses or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port 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 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 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 here n described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regu at ans. ;, [ 'g o pp icon, or name, it a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. ~.~ilde~' Name of owner of P~mises ...... ..~...~.~.l~?,..,.~..°...h..]: .................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Locat on of and on wh ch proposed work wiJJ be done. Mop No.: .~.....~:.....~...e....~. ................... Lot No.: ....3..2.. ............... Street and Number ......................... ............................... '/ u.ici ii ' ...................................... State existing use and occupancy of premises and intended use and occupancy of proposed construction: 'a. Existing use and occupancy ~a. il.8:.i~ ~].e% ..... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building . .~t~....x. .......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ $ 80t, O00 $ 10.,00 4. Estimated Cost ................. .......................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .e..a....e. .............. 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 olterohons or add hans: Front .................................... Rear ................. ; ...... ~JL Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ?J~" 8# Rear 78~ 8e Depth Height .........2~...~ ....... Number of Stories ...'...]'..'~ ............................................................................................................ 9. Size of lot: Front ....J~.~.4 ................. Rear ...... ./.~ ...................... Depth ..J.~.~. ...................... 10. Date of Purchase ...... .]...g....~..'~ ........................................ Nome of Former Owner .....~..~..~..~..~...]....~,?~.e.?...'~...~.. .............. 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? ....,a,e. ................................................... 13. Name of C~vner of premises ..~..o..~.~P~....][..o.~..I......i ....... Address .~.?..e..~.~.°...~..~.z...,~'....-..~.?. ..... Phone No..~....'~...-.~..0.?...~.. · Name of Architect ...... ~..o..a..?. ...................................... Address ....................................... ._.... Phone No ..................... Nome of Contractor ..C.*.;...?~t:..~.?,.?.?.~,l. ...................... Address ...~.?...e~;..~..o.?...~.R..~;.'....~...~... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whetl ter interior or corner lot. STATE OF NEW' YORK, COUNTY OF ................................ .~ ~'~' ................ ~..~......:.~ .......................... 2 ........... being duly sworn, deposes end says thor he is the opplicont (Name of individual signin~ 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 f~le 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 manner set forth in the application' filed therewith. Sworn ~o before me this ~ .~. day of .~ ,,. , ...................... .............. . ....... ................................ Notary Public~-~J~F,e~..L.~ ....... Coun~'~'~"--"~'~ignature of applicant) .... (~ ELIZAIJ~TH ANN NE.VI?~. NOTARY PUBLIC, State at r~ew ~u No. 52-8t25850, Suffotk Cou~tY~ Term Expires March 30, 19~