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Home My WebLink About5462-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certific8te Of Occupnncy No.~.~.~.~l~ ....... Date .............. .D. eO...29 ....., 19..~! THIS CERTIFIES that the building located at . ¢lear~rl.®w. Ave ........... Street Map No.l~0 ....... Block No ........... Lot No.. 29 ..... l~Olktho~[ .... N,.~., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... &.il~ .....!2.., 19~.!.. pursuant to which Building Permit No..~...~... dated ............ &t~..~.2..., 19~r~.., 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' one · family- dwet.lir~g .................................... The certificate is issued to ... F.~&l~k..P.&F~ .... Ow~®l'. ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... Dea.. 27. . .19~i..]~/. House ~ Building Inspector 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) 5462 Z Permission is hereby granted to: at premises located at ....... J~j-...-J~.-.-t~ltp- Jll, t~{) ........................................................................... ................................... · tJ!,J~e~..,l,,~. ........... ~ttl, ....... ~.~. ............................................ pursucu~t to application dated .................................. A~ .......'~':J' ...... , 19...~j~r, and approved by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH ~,:~, '~ ~ 1971 Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed l~ca~Con)'' have been inspected by this department and found to be satisfactory. DEC ~ ? ~971 Chief of FO~M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Pemit No .................................. Application No......~......~.....~'...f~. ...... Disapproved a/c ............................................................................................ (Bui ding nspector) (~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ....... ~.../...~. ................... ,19..~.../...... ~ 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 layout ofproperty must be drawn on the diagram which is part of 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 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 buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordi nonces, building code, housing code, and regulations. (Signat~e of applicant, or name, if a corporation) ............................... '(',~l~ress of applicant) State whether appl cant is owner, lessee, agent, architect, engine.erA general contractor, electrician, plumber or builder. Name of owner of premises ....................... ......... ..~..~.~ ..........T ......... ....................................................... off icer. If applica t is a corporate, i ature of'duly authorized ......... ......... .......... ........... (Nd~e and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...... ..~...2..~...~-..,~ ......... /)...~ l~pt No.....~.~ ............... Street and Number ....... ~...~ ............................................ ...~...~ .............. : ................... [ ~> ~ ~ ,~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy i ,j),~ Intended use and occupancy .......................................................................................................... 3. Nature of work (check which applicable): New Building................../ Addition .................. Alteration .................. Repair .................. Removal .................. DemoHtiar .................. Other Work (Describe) ........................................ 4. Estimated Cost ................... ..~...~'.~.~.......c~.. ............... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .............. ./. ............ Number of dwelling units on each floor: ......... Z ................ If garage, number of cars / 6. If business, commercial or mixed occupancy, specify nature and extent of each h/pe 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 constrb~{i6~-i Front ............ ~..~..~.. ............... Rear ..... .~....6..~.. .............. Depth ....~'...?. ............. Height ....... /.....~.. Number of Stories / . . 9. Size of lot: Front .......... ./...Z..~. ......... Rear ............... ~.~.~.. ............. Depth ......... ..~../...~. ............... ,~...U.~. /? 70 Nome ]0. Date of Purchose ...................................................... of Former Owner ........................................................ ] ]. Zone or use district in which premises ore situated ........................... ~, ....... 12. Does proposed construction violate any zoning law, ordinance or regulation:~ .4/'~ 13. Name of Owner of premises ...~..~.~.....~..~..~..~.?. ............ Address ..~.~P...~.~...~....~..~..M~..~'.. .......... Phone No...o...~..~.......~.?..~ Name of Architect ..~....~.f/.~....~..~'..~.).~ ........................ Address .~?....~...~./.~...~....~..~.~....~..Y..,~....~. Phone--~" No../~...~....Z..o~,/./ Name of Contractor .....~.......~..,~../.e£~..~.~/~..~.~. ~....o. Address .....Z..~'?....~..o..~./~..~....~.~...~..~...... Phone No...~.~..~.....-~..~.../6 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, and show street names and indicate whether interior or corner lot. ~-0 / ~> STATE OF NEV~'~:)J~J~,. I.~ t¢c ....................... ~ .......................................................... ~infl duly ~wom, d~ ond ~y~ t~t h~ i~ t~ ~ppliconl (Name of i~ividual signing application) above named. He is the ....................................................................... ~ ....................................... (~ntmctor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or ~e peffo~ed the ~id work and to ~ke and file this application; that all statements contained ~in this application am~tme- to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the ~plJcatJ~. fil~ therewith. Swom~o ~ore me this ~ ~. o, .... · . :. ......... ........ ......... ........................... [LIZAB~H ANN ~EV1LL[ NOTARY PUBLIC, ~ate of New No. 52-8125~ Suffolk Term Expires ~rch ~, ~