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Home My WebLink About4861-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~1~16~ ...... Date ............. Ifarch.. 1~. ..... , 19.71. THIS CERTIFIES that the building located at . 'Cil~l~" La .&. Deer. Dr .... Street Map No. Daer. Park. Block No ........... Lot No..6 ...... 14a.tt i tll~k.. N...][, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... gttty. · 16, 19.70 pursuant to which Building Permit No.. dated .......... Jut. y.-..1.6., 19 70 ', 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 . lq. rivage, one. family. ~healLlng ...................................... The certificate is issued to . Pl~ed. ¥.~er[~.s .&. W. ife. l~mer ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ' De~" '$7,' ' -$9?0...by R., Deer Dr . .~.~a.. i., ! ' Building Inspector FOltM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NV 4861 Z Permission is hereby granted to: · .J~me~.~..,~.eem~-.,...~g.-.l~,eA..'JGmj~je ..... ........... 4~t4>tt, v,~ .............................................. at premises located at .......... ;..~t~..l~....Jlt~...l~ ........................................................................ ................................................. JLlJ~..~..&. J~l~..ZJl~lt ........... ~l~tt~llal~ ..................... .pursuant to application dated ............................ ~ ......... 1.~ ........ , 19..~0., and approved by the Building Inspector. S-9 SCHD RECEIVED I:~OCT29 I~HIO: I~, BEPARTMEN1 OF HF~AL IH RI/ERHEAD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date 12 -/?-7o Bldg. Permit TO WHOM IT MAY CONCERN: The sewage disposal facilities fo~r~ structure located (Give d/eed location)/ have been inspected by thi department and found to be satisfactory. Chief of General Engineering Services District Engineer (Building Inlpector) / Application No .............. Z. ......... ~ r~ APPLICATION FOR BUILDING PERMIT Dote ......... l.~ ................. ./. ....................... , 19...., INSTRUCTIONS a. This apPlication must be completely filled In by typewriter or in ink and submitted In duplicate to the B~lldlng Inepoctor. b. Plat plan showing location of lot and of buildings on ipremlses, relationship to adjoining pmmlselM _lrabllc Itreeti area~, and giving a detailed de~riptlon of layout of property must be drown on the diagram wh'lc)~ I! part ef ~Jl applleatle~;-~, c. The work covered bY this application may not be commenced before iuuonce of Building Permit. d. Upon approval of this aapllcatlon, the Building Inspector will I~lue a Building Perm t to the applicant. the ~hall be kept on premlie$ available for Inepection throughout the progre~ of the work.. e. No building shall be occupied or used In whole or In part for any purpose whatever until a Certlflcato of O~u~an~ shall have been granted by the Building In~poctor. . APPLICATION IS HEREBY MADE to the Building Department for, the Issuance of o Building Permit pu~muont to the ,Build!n~.. Zone, O~lnonce. of the To,.~ of Southold, Suffolk County, New Y, ork, and other appllcob · I.aw~, Ordlnenem m .~l~mat~..ons, ,mr me co. nstructl,on o.t..au!!dlngl.: a,dd. ltl,ons or a!.terations, or ?or removal or demolition, al he, In dsecrlbed. · app.cant agrees to comply With all appllccole law~, oramance~, building cod~, housing code, and regulatienl. .... ............ ............................................. ' ............. . " (S gnature of~611¢ant, or nome, If a coq~mtlen) / ,, '. ............... .................. .............. , ...... (Addres~ of applicant) State whether applicant Is owner, leaee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,om.o, own'ro, ....... applicant Is a corporate, signature of duly authorized/ ("/bfflcer. ~, If 1, Location of land on Which proposed work will be done. AAa p r~o.: ................................. ...... Lot No.: ....................... ,.~ Street and Number ~.r. Az...~.....a.~......~..'~..~..//....~r~f.~....~,~..~.,... ~)~: ~...~.....~..~....~.. ~ ~.~..~./.'..~,~e_/~__ ~0 ~ ~/,~ ,~1 Munlclpal~ .......... 2. State existing use a.nd occupancy of premises and Intended use and occupancy of prapMed comtru~tlon: a. Existing use and occupancy . A/'~ ~/~ b. Intended use and occupancy' ~. ~ S ~..~...~ ..~:....e.~.. .............. .............................................. 3. Nature of work (check which applicable): New Building ~ ................. Addition .................. Alteration .................. Repair ............ ~. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~...~.,,~.~..~.. ................................... Fee .......................................................................................... (to be paid on fi!ing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars .....~....~..~ .......~..'7~E..~;~,~ J ...............................i; ............... L ......... 6. If business, commercial or mixed occupancy, speciYy nature and extent of each type of use ............................ 7. Dimensions of existing s~ructures, 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 ...~..~...~..7...'~.....~ ............. Rear ...~.~...~.?...~ ........... Depth ...~..~.~.Z..: ........ Height ...~.~... .......... Number of Stories 2~ 9. Size of lot: Front ..../~..~....~. .............. Rear ' ' ...I..~..~.. ........................ Depth .../..~....~.. ....... : ............ 10. Date of Purchase . .~....~...~...~.. ....... ~/.~...~....o.. ...................... Nome of Former Owner.~..e.~e~,.~x .............. '/,~-~'~. .......................... .~'e~-lEasJ~'~ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..~..~..'~.....~r.. ............................... 13. Name of Owner of premises .~.E...~......~.~..~.~...~..~......Address ............................................ Phone No Name of ArChitect ...................................................... Address ............ ................................ Phone No ..................... Name of Contractor .~...~"./...~...~.~'.......~..:...~-~..~...~.~......Address ..~'~.~...-..~..~ ............. Phone No...~..~.~...~...'~....~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back d mensions from property tines, Give street and block number or description according to deed, and show street names and indicat'e cornqr Iot.~_ .. 13 ~. ' ~" -- . STATE OF Nb'~I~YOR~,. ~ t$,~. ............ : .................. ~'/' ....... "~"~".~u.~..~ ............. ~'ng duly sworn, d~es and says ,~t he is the applicant above n~med. He is the .............. ~ ........ ~.~ ....~, ................. '~ .................................... ~ ~ - ~ ~ ~'~ (~ntmctor, og~t, co~orate officer, et~:~ ............... of said owner or owners, and is duly authorized to pe~orm or have pe~fo~ the said work a~ to ~ke ~d file this application; that all statements contained in this application am tree to ~e ~t of his ~ledge and belief; and ~a~ the ~o~ will be performe~n th~manner set fo~h in the opplicati~ fil~ ~r~lth. ~. _ ~ A~ ~ ~ .... .~...~-~....~.:.....~.~ ........................... ~LO~O CHAPMAN N~ PUBL~, S~te of New Yo~ u~ , ~. ~2-06181~ Suffolk ~un~