The URL can be used to link to this page

Home My WebLink About4865-z FORM NO. 4 TOWN OF $OUTHOL~ BUILDING DEPARTMENT Town Clerk's Office : Southold, N. Y. No.Z~09~ ...... Certificate Of Occupancy Date ~I)~.C...2] ...... , 1970. THIS CERTIFIES that the building located at .YSee]J~ .I)~17/e ............. Street Map No. 1,loc?se C. cW9 Block No .......... Lot No..2]. ..... C%%lChog~e. ,~ ........ t!74 · ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Jtl]L~J .. ~7. · , 19.7.0 pursuant to which Building Permit No. dated ............ j~j[y ....~(~ 19~.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 . ~va.to. on~. famf~.y. [twe].:l.~.n~ ......... ............................. The certificate is issued to . Jnseph .HataJ. e:~ ...... 0.w.n,e~. ........................ (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . D.ae.. ~ ~. ~ .9.~0.. b.y..k~.. ~illa .... Building Insl~e~tor TOWN OF SOUTHOLD BUILDING DEPARTMENT' TOWN CLERK'S OFFICE SOUTHOLD, N. Y'. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISKS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4865 Z Permission is hereby granted to: ...G~..~1~l~'~..~,/.C..Zosepl~. ~ta. te~, ...... ............... C~e ........................................... to ...... ~'~, · *aec, · o3~. *, ~:~ * .~'~1~.~.~ ~ .................... ' ......................................................... at premises located at .......... .~...~.~ .......... ~][~*~e"~O~ ........ ! ......................................................... ................................................ ~ / ~ . , . . .~e be . - ~ ~ ~. ~e .............. ~t,*e t~o g ~e ..................................... pursuan,t to application dated ............................. ,~ ....... .~/........., 19....~iI~, and approved by the Building Inspector. Fee $,.$0e00 .......... Building Inspector / S-9 SCHD 'SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. q~_~-j TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure (Give deed location) located have been inspected by this department and fbund to be satisfactory. ~hSef of General ~ngineoring Services D~strict Engineer Approved~Z. .................................... , 19.(] .... Permit No. BUILDING DEPARTMENT Disapproved O/C .......~.....~ .......... ~ APPLICATION F~R BUILDIN~ PERMI'r 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 pn premises, relationship to adjoining premises or public streets or ureas, and giving a detailed de~ription of layout of prol~r~ must be drawn on the diagram which is lm~rt of this application· ~, c. The work covered by this application may not, be commenced before issuance of Building Permit.'~J 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 bud ngs, add t OhS or alterations, or for removal or demolition, as herein described. The applicant agrees to comply Witl~ all applicable laws, ordinances, building code, housing code, ond~ons__ (SignatUre of applicant, or name, if a corporation) (Address of applicant) If opplica~, is._o corpor~.e,j/~i~nc!ture of~l~lY authorized officer. ~ (N~e end title of co~orate officer) 1. L~ation of land on which prdp~ed work will ~pone. Map No .......... ~.~. ~. ~ LotNo' . .~.~. ~ .................. . / Munici~li~ V 2. State exi~ing use and ~cu~ncy of premises and intended use and ~cu~ncy of pr~os~ construction: a. ~isting use and ~cupancy ............................................ ~ .................................................................................... b. Intended us~ ond ~cup~nc~ ........... : ......................................................................................... 9. 10. 11. 12. 13. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exist, iH~raposed, and property lines. Give street and block number or de~ccording to deed whether interior or corner lot. 3. Nature of work (check which applicable): New ~Building ....... ~... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................. ~,.~.~9....¢~.....~.0..~...O. ................. Fee (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 ............ Z .................. 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 ....~.~. ............... I~eight ...... ./..~.. ......... Number of Stories .................. i ................................................................................................... Size of lot: Front ....... /....~..~. ............ Rear ........... /...~...~. ................ Depth .......... .~....~...~. ............. Date of Purchase ...... .~....°t.~...~... ....... ./..?...~.~. ................. Name of Former Owner ........................................................ Zone or use district in which premises are situated ...................~ .............................................................................. Does proposed construction violate any zoning law, ordinance or regulation.;> ......... ...'~.~. .......................................... · Name of Owner of prem,ses .~J.~ ..~../~,~ Address ~'~.'~fi (~...~(.~.~,,~. PhoneNo Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~...~......~../~..~..f~......~....//..~..c.(..~..~.~..Address ....~,~.~.......~....~......4. e......~'~,... Phone No....~..~.~......~-..~..~ ndicate all set-back dimensions from and show street names and indicate STATE OF NEW YORK, JS.S / COUNTY 0,~^ '~'~-'~'~ .......... ............... ~,~...,~r,4~....~,f~: ........................................................ being duly sworn deposes and says that he is the applicant (Name (~ !ndividual 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 ti,ar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..... ....... .~ day of ...... ........ ............................. MARION k. REGENT ~J NOTARY PUSLIC, State of New York No. 52-3233120 Suffolk County Term Expires I~rch 30, 19-)1