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Home My WebLink About5461-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~ ...... Date ........... l~®~.. 20 ........ , 19.~rl. THIS CERTIFIES that the building located at .Inle.~ .Pol~ .14 ........... Street Map No~.a~.~; .$b, .... Block No ........... Lot No..128 ....... Greenport;. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~1~ - · 12. ~, 19. ~1. pursuant to which Building Permit No..~1[ dated ......... &lig...12 ..... , 19~.1. ., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....Private. o~e. f~t]Ly, dw®l-~.$t~g .................................... The certificate is issued to .~ho~. [$]L.] ~.~n .... Owner ............................ of the aforesaid building. Suffolk County Department of Health Approval lo15 (owner, lessee or tenant) Inlet 8c~d Rd Green Hill Rd ./.~f,~.4/~.-.~. ~ ..... .k? .. Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5461 Z Permission is hereby granted to: ~ to ....~..~..~...~...~....s~. ................................................................................ at premises located at ..... ~1~...~....~1~..~i~ ............ i~.]1~'.~3 ..................................... ............................................ ;li~e~..Pe~...~ ............. ~e~l~e~l~ ................ .~ ............................... pursuo~t to ~pplication dotted ................................ ~t~ ......... .~ ...... , 19.~.., and approved by the Building Inspector. ~e ~...te~.~ .......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date NOV 23 lg71 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Giv~ deed locat~ n) ~ have been inspected by this department and found to be satisfactory. Chief of General Er~iueerir~g Servtcee NOV 2 $197! "/ ~~- ~ BUILDING DE~*RTMENT ~ - / ~-~ TOWN CLERK'S OFFICE ~ ~ SOUTHOLD, N. Y. Examined ~;'~ ~]~ , ] g ........ ,,ro od ........ ........... , ,, ........ Disapproved a/c ............................................................................................ (Building Inspector) {f APPLICATION FOR BUILDING PERMIT 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 o areas, and giving a detailed description of layout ofproperty must be drown on the diagram which is port of this opplication.r- 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 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 HEREB~Y MADE to the Building Deportment for the issuance of a Building Permit pursuant to the 'Building Zone Ordinance of the Town ¢)f Southold, Su}folk 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, ordi nances, building code, housing code, and regulations. (Signature of Vapplicant, or name, if a corporation) ................. ............ (Address of applicant) ~/ State whether applicant] is owner, lessee, agent, ~ngineer,_., general contractor, electrician, plumber or builder. ~l'~e of owner of premises ....... ~ ........ ~ ............................................................................................ If applicant is a corporate,, signature of duly authorized officer. (l~lame and title of corporate officer) . 1. Location of land on which propo,~ed wg,rk wiJI be doj~e.^Map No,: ......... .~;;.~ ............... Lgt No.../...z,....~.. ............ Street and Number ...~......~...~ ........ ..'~...~. .............................. ~ .................................. / -'q YS'- ~ ~E:E-A/ /4 (~ L L~- Munic~ality and occupancy of premises an.d::~/ntended use and occupancy of proposed construction: State existing use 1~1~,.' - . a. Exisiting use and occupancy ................................................................................................................................ b. Intendod use and occupancy .............................................................................................................................. 0~ 3. Nature of work (check which applicable): New Building................../ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............ ~.~..~.~:...4~.. ......................... 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 ................................ 8. Dimensions of entire new construction: Front ............ .~..~.. ................ Rear ...... ./...~..[...~...~ ....... Depth ...... ..~'...~. ............ Height 1~' Number of Stories ! 0. Size of lot: Front .......... ././...6.~. ........... Rear ......... ./../..5..~.~....~. ............. Depth ..../..~3'...~.;.°....2~.. ........... 10. Date of Purchase ............... ..O...c,...7~.......~..o......../.~.?.~. ...... Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated .......................................... ~ ....................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;) ..~....~.. ........................................... 13. Name of Owner of premises .~'~,o,,m,,~.~ ...... ~,~,/.~.~..~. ........ Address .~..(,.~,..~,,~.~.~.,~,,~,,~,,~.~..,,~/,~,,. Phone No..~.~,~.~..5..~'. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor..~..e'.,....~,~/~f,3,...~.?,;./~/.~.~..~.'.~-'X~.....Address ..2~.~,?..,~.,.o.x...~.,%,.,C~,...~...,~.~ Phone No....~..~,,~...~q?..d PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~3ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y~)R~. t ~ ~ ,.. . , ............. ~ ........ ~ ......................................... ~ing duly ~om, d~mes ond s~ys t~t he is the oPplicant (Nam~ of individual signing a~lication~ ..~ above named. He Js the ................................... ~.~ ............................................................................................. (Contractor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e perfo~ed the ~id wore and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the ~plicati~ fil~ therewith. .S..~.~l~.~r.; d~;'~;' .....~ ......... : ........ , 19.~/... ~ ~m Nota~ Term Expire~ ~ ~, tg~