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Home My WebLink About4866-zFOEM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icate O[ Occupancy No. ~4~9 ...... Date .............. ~..a~l~.. ?~.. ~., 19. ~0 THIS CERTIFIES that the building located at . W®st. Cl, e®k..&. D~eks. P~ !~redet Map No. XXX ........ Block No...~ .... Lot No ..... xx ....¢~t~hogue ... ~I,¥. .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... July. 20.., 19.70. pursuant to which Building Permit No..~866Z · dated ............ July.. 20., 19.70, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. F~iva~t~. one .family. ~elling ..................................... The certificate is issued to .//a~.X~r. &. P/lrl'a. ~ase ....... Owner ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~/a~,-6,-197~l...by. Ro .¥illa ...... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4866 Z Permission is hereby granted to: ....... ,~ ,,.. ~t~.....,~.¢.... ~ ~"'~.~. ~..~,a.. ~a se to ....... ]~x~.:~L..~m~...or~ .. ~at~$;~.y.. ~;~.trag ................... i ......................................................... at premises located at ............. .g~k~-~..gt~t,..~..~.'~..~Ep~k...J~,~ ........................................... ........................................ F~,e~..~ok~.....¢~o~ol~ ............... ~q.,.~'-~ ......................................... pursuan¢ to application doted ................................ ~ ......... ~:'~J~..., 19..~)., and approved by the Building Inspector. Building Inspecto[ $-9 $CHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WltOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to ~hlef of General ~h~gineering Services ~'~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ....... , 19~ Approved ~..~' ........... ; ................... ,19 ........Permit No. ~..~.._{9.......~... Disapproved a/c .............................................................................................. Application No.....~..~....~......~.. ....... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio-~ 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 perm',,. shall be kept on the premises available for inspection throughout the progress of the work. e. No building sba. II 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 o Building Permit pursuant to tl~ 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 herein described. The applicant agrees to comply with all applicable laws, ordioances, building code and regulations./~ (Signature of applicant, or name, if a corporation) (Name and title of corporate officer) 1. Location of land on which proposed work will be,done. Map No.: ....... ~ ............... ,~. Lot No · ~ ~ Street and Number ..~/,~'.....~~ ........................ ~,..,~///'~.~ ~' ....... ....... ...... 2. State ex'st' g use a d occupancy of pr,~rnises anc['Tnten,ded use and occupancy of proposed constructloh': b. Intended use and occupancy ....... ~. .............. - ................................................................................ 3. Nature of work (check which applicable): New Building ....... ...~.. ...... Addition .................. Alteration .................. Repair .................. Removal .................. :Demolition ........ ; ........ ; Other Work (Describe) ........................................ ........ ./..C2..;....... ............................................................... 4. Estimated Cost ...~ ............... ~ .................... :.....Fee ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... /.i .............. ~....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 ................................ 8. Dimensions of entire new construction: Front ......~.....~... ..................... Rear ....... .~...~J~. ........... Depth .~......~.... ............ Height .~..~.. ........... Number of Stories ...... ;..../.. ........................................................................................................ 9. Size of lot: Front .....~....~'.... ........ .,... Rear ........ ..~../.. .................... Depth ......7~....~.....~.~...._......~_,,.s ~ 10. Date of Purchase ......... ~...~......~......~.. ........................... Nome of Former Owner ...~..~~ ............. 11. Zone or use district in which premises are situated ........ ~. ...................................................................................... 12~ Does pr~pased ¢ohstructlOn violate any zoning law, ordinance o~on? ..... ~ ............................................ 13. Name of Owner of premises~.......~.....'.~..~ ....... .Address~ ....... Phone No.'7..~..7.'../....~....~.../ Name of Architect i.,....~... .................... .~-..-. ......... ~....Address ...... ~-~. ...... ,~...~...~.......~.~ ..... P~hone No ..................... Name of Contractor ~..~....~...Address .~ ..... Phone No~...~....~-..~.~' PLOT DIAGRAM STATE OF NEW ~,~ tS S ' , /I/~-- J' /~.7 %,.~.f'~. ~ ~, ben da sworn d os s bnd sd t~t he is the a cant ......... ~.' ........ '."..~...~'.'...,.".'"'"'~'"~'~'~'~"~'. .'g Y - , ~ e ys pp (Nam~ 6f indivi~al ~gning o~) . above named. He is the ....................... ~~..~..~..,~ ............................................. ......................... (Cont~Ctor, ag~t, corporate officer, etc.) of said owner or owners, and is dulyauthorized to perform or have ~rformed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be perform~ in the manner set fo~h in 'the application' filed therewith. Sworn to before me this~- ~ ~ ~ ................ ............. a~pl~cant) ~R~ P~B[I~, ~lt~ o~ ~ York ~o. ~-$2~a120 Su~lk County Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. ,