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Home My WebLink About5453-zFOl~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Of{ice Southold, N. Y. Certificate Of Occupancy No. ~.~3~ ..... Date ....... Zlkla... 27 ., 19 ~/~ THIS CERTIFIES that the building located at 'Rtt~h Rioa~ ........ Street Map No.&~, ~OlZ. Block No.. ~. Lot No. 7 ...~tit~ ~,~, ... conforms substantially to the Application for Building Permit heretofore filed in this off,ce dated ....... ~g..~0 .... , 19 ~. pursuit to which B~lding Permit No. ~.. dated ...... ~,.. ~.Q... , 19 ~ , was issued, and conforms to all of the requ~e- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... ~i~ .e~e ~ily. ~ll~g ............................. The certificate is issued to ~ .~a~ ..... ~e: ................ (owner, lessee or tenant) of the afores~d b~lding. Suffolk Co~ty Department of Health Approval ga~ · .~ i · · -]9~2 · Dy .R.. Villa. ..... · :-t ........ Building Inspecto~ FOI[M NO. ~ TOWH OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5t53 Z Permissiol~ is hereby granted to: ....... .i~3Jt .:..~ ..gea~t~.. ~ .............. .......... · .~. ~..../~i~;.~ ......................................... at premises located at .... ~....~t/~..,~......~J~J~..~..-.-J~-..?~J.....JJl~..~ ................................................ pursuant to application clc~ed ................................... ilJlJJJl ....... Je ..... , 19~j..., and approved by the Building Inspector. Fee $.~.ij~ ........... c S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date JAN 1. 1. 1972 TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located "/~ / / (Give deed 1-6c~ation) J have been inspected by this department and found to be satisfactory. Chief of Gene cai ~EnEineer~n~ Servloes JAN 1 1 1972 TOWN OF SOUTNOLD .,/~ "BUI~ING DEpART~NT/~/~ TOWN CLERK'S OFFI~ ~....:LA ...... , ,~.~/. ~ ~ ~,~ ~ ...~- ~amined ~pr~ ~ 19.~L Pemit 'No. ........................................ , .......... ,..~.....: ....... /~ ~: , (Bui~i~ Ins~tor) ,- . APPLICATION FOR: BUILDING PERMIT , 'o/ .,., Date .: ..... ,,,..., ...... ,...., ....... ~ 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 orb areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part at 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 Inspecto~ wi!l issue a Buil,di.ng Pe .r~.it to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress or me worK. e. No building shall be occupied or, used in whole or in part for any purpose whatever until a Certificate ~f .Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department ~r the issuance of a Building Permit pursuant to the Building Zone Ordln~_~, of the Town of Southol,d/ Suffolk .County, New york, ond ,other.oppl!.c..able Lc~s., O. rdl.nanc..es or Regulations, for the ~onstructio~ of. buildings' add:tlons or alterations,, .o,r,?r re .mo?~ o.r aem~.ntion,, al n.em_.m aescrlana. The applie~l' egmel to eam~ly with~al! applicable la~, ordinances, ou.amg coae, nous~ng'coae, arm re~LllatlOl~. (Signature of applicant, or name, a coq~ora onl (Addre~ of applicant) If applicant is,~,~corpa~,e, sipnature of duly authorized officer; '! ......... ..................... ......... - (Name anc~ title of corporate officer) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~.~....~. C~ ~ v~ T'~_.~ ¢ "/-g rz ,,i., : ............................. :...,: ........................................... Name of owner of premisese-.~ -~-~__~_.~.~:~.~....~w..~,~,: ...... .~~,,:...~ ......,......;,~'~m~ ...................... Location of land on which proposed work will be done. Map No.: ...... ~.~"'~..."~ .............. Lot No..~....:. ............ ~ ~...~.' . .......... St~t and, Nu~r ..~....~.~.~...., ........ ~-~ ..... ~., .......... :~...' ," ': ............................ S~e existi~ u~ o~ ~cu~ of p~i~ u~ intend u~ o~ ~u~ M'P~ ~: ~,,~ ~ o~ ~,~.:....A~.~...~.~ ...... : ....... :.-~..-**....-:. ........................................ O, b, i~ uM o~ ~y ...,...-.,. .~. ,~ / ~ . $, Nature of work (check which applicable): New Building ,~!~.~,.., Addition .................. Alteration ................... Repair .................. Removal .................. Derdi~lition,.,.,~ ............ Other Work (Describe) ........................................ ,. ~,t~mote,~ Ca, t ......... i ....... ,~.~.~..'...'.,.~-- -' ................... F, ............... ~...e.....'.~ ............................................................ (to be paid an filing this application) 5. If dwelling, number of dwelling units ........................... N mbe of dwelling units on each floor ............................ If garage, number of cars .................. ./. ........................................................................................................................ 6. If businr~s, commercial or mixed occupancy, specify nature and extent of ec~h type of use ....; ....................... 7. Dimensions of ~xJ~tJl~ ~'ructur~, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Frant .................................... Rea~' ............................ Depth'. ............................... Height ..................... ~Number of Stories ................ 8. Dimensions of enhm new construchon: Front ..... ~ ....................... Rear ...... ~g,~...., ......Depth ...~. ............. Height .....~b ........ Number Of Stories ....... :...~.. .............................. ~ ............ ~' ........... i ............... i ....................... Size of lot. Front ..../~..~ ............... Rear ...... '/.~ .................. Depth ..~.~. ...... : ..... Date of Purchase .......... .~.~.~....~.. ................................. Name o~ Former Owner ....................................................... Zone or use district in which premises are situated ................................... ; ................................................................. Does proposed construction violate any zonirig law, ordinance or regulation? ....~....(J..; ......................................... ,om, of O~,r of p,m~,s [*.~e~.~..~'...~, ~..~.~.~-~r~.~,.~;...~r~' Pbem ~o. Name of Architect ..................................... ~ ................ Address ............................................ Phone No ..................... 10. 11. 12. 13. PLOT DIAGRAM Locat,e clearly and distinctly all buildings, whether existing or p..mposed, and indicate all set-back dimensions .from property, lines. Gi~e street and block number a~ descri~ion aocording.to .deed, and ~ ~met ~mmes and ind;cote whethe~ Intori~ ar earner I~'. Y~RKg ~ 1~ STATE OF NEW I S S ..;,...~..,~r...~......'=~... .................................. being duly swam, deposes a~ s~ t~ ~ is t~ ~pllcant (Na~ of I~lvidual signing a~llcati~ . _ ,I J . ~ · . .................. L(~.~.~..~.~ ...~..~.E..~. /~ ~ o~e name. He is the ..~ ........... ~ ..... ~ ............................................ (~mc~r, ~t, co~mte officer~ ~c.) of'~id'~r or ~ne~, a~ Is duly aut~riz~ to ~fform or ~ ~ ~e ~ld ~ aM ~ ~e a~ file · this application; 'that all state~s c~n~ in th*s a~li~t~ am t~ ~ ~e ~ ofhll ~e ~ ~llef; ~ ~m the ~rk will ~ ~ in t~ ~mr ~ ~h In ~e ~11~ fil~ ~. ~m,~m~thll ~ __ ~, . -- '__ ~ ..... ........ , ,,Z.L' .