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Home My WebLink About4878-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No ............. Date ................ THIS CERTIFIES that the building located at (~D... '~'~¢./~ .... '~, U~' .... Street Map No ............. Block No ........... Lot No .................................. conforms subs}~tially to the Application for Building Permit heretofore flied in t~s office dated . ./ ~ ..... , 19 .... pursuant to which B~lding Permit No. dated ........... ~ .0..~/.~ ~, 19~ ~ was issued, ~d conforms to ~1 of the require- ments of the applicable pro~sions of the law. The occupancy for which this certificate is issued is ..... ff~ ...... ~.~/./. }. }(.... ~.~( ~'.4.~.4 ~.~ .................. The certificate is issued to L ~ fi/~ ~ ~ I~ ~ A ~ / ~ (owner, lessee or tenant) of the afores~d b~lding. / Suffolk Co~ty Dep~tment of Health Approval . ~..,. ........... ~ ........... Building Inspector FORM NO. ~ 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) 4878 Z Permission is hereby granted to: to ...... ~.. ae,~ .. me...f~,at,l, lr...~t~;I,~ ~ ............................................................................. ~t premises l<oted m ................ ~..~..&~ ............................................................................. ........................................................... ~~ ....... ~.X.. .............................................................. pursuon¢ to application dated ....................... Building Inspector, Fee $ JIQo(:J~ ........... -- Building Inspector ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ^ppraved 19 ........ Permit No ...... Disapproved a/c~ (Buildin~nspector) Application No ............................. APPLICATION FOR BUILDING PERMIT I~ate ...................................................... , 19 ............ 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 premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of Ica/out of property must be drawn on the diagram which is port of this application. c. The work, covered by this appli{:ation may not be commenced before issuance of Building Permit. d. Upon ap >roval of this apphcatlon, the Budding Inspector wdl ~ssue a Building Permit to the applicant. Such permit shall be kept or the premises available for inspection throughout the progress of the work. e. No build shall hav· been APPLIC-~TI~ Building Zone P. egulations, fo~ The applicant c ~g shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy the Inspector. , ;~ rant~.e~by Building N IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~rdinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or the construction of buildings, additions or alterations, or for removal or demolition, os herein described. rees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Sl~hature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gene~'al contractor, electrician, plumber or builder. ........................ ............................................................... ~J~,/.,.~....e. ~ - Name of owner of premises .................. ..C~....r73..?.?:1. ...................................................... If appl~:~Trpo~,~L/~ure of du~.~thorized officer. (Nd~e and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No~i ........................ Street and Number .......... .~'..~./~..~.~. ........ ~..v...~... ..C~....~.~.Cd...~.....o~.,de Muni.cipalJt~,' .................. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......................................... ; ........................................................................................ b. Intended use and occupancy ................... ~.....~...~.X/~./. ~.~ ............................................................... Y-' ................. 3. Nature of work (check which applicable): New Building ......... ~. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....J..~.l.~..~;~.,.~. ..................................... 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 ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ............'/'"~'l ............ 8. Dimensions of entire new construction: Front ~.~. ~ Rear .~.~/~; ... Depth ....~.l~.. ............ Height ....... ?..~. ......... Number of Stories ............~ ........................................................................................................ 9. Size of lot: Front .......... .~../~. ............ Rear ........... ~.../.~.. .................. Depth ......... ..'~....~...O. ............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regul._ation? ........ ...~...O. ........................ 13. Name of Owner of ~rem S~s' ..~...q-~. ~/..~/.4.~.~ Address~..~...~.'..~...~.!~..~'.~....t.V..~...a(.PhoneN~'~.'~::i:~.'i~.' Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........... ! .................. Address ...Z.~.~...~:~....~.....C.f~.~'..c.~. ....... Phone No..~...~..~...6.~.°..."..O PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed~l~nd show street names and indicate whether interior or corner lot. STATE OF NEW~/~ tee COUNTY ~F. 2~ ,'~~:['~" '''~ '~'~' .............. .,'~.di~K~'~..~,..~ .............................................. being duly sworn, deposes and says that he is the applicant (Nart~J of individual signing application) .~ ... ~~:. above named. He is the ................................................................... i.....~. ................. ~ ........................................ (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 that the work Will be performed in the manner set forth Jn the application filed therewith. Swam to before me this ......of ................... ,.. No. 52-8~.25850, Suffolk CoLJ~t~ Term Expires March 30, S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Date Eldg. Permit No. ~/fgf TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) ~ have been inspected by this department and found to be satisfactory. Chief of General Engineering Services District Engineer