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Home My WebLink About5475-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .%i./.S...I~..~.t.l.m...N.? .~...R~..~. .... Street Map No ....~ ....... Block No. ~ ....... Lot No....XX...Cu..t.e.h.o. gg..?~...N.o.~.: ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Au.g,..1.8.I ..... , 19 ?.l.. pursuant to which Building Permit No....~?..~.Z. dated ........ A~g.,..],.8, ...... , 19..~.., was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Pr~..v~;e. one. f.a~.].y..4W.e~.l..~.g ...................................... The certificate is issued to . ]~,..&...K,7. ~.,..K.,..D.e..Lc. ~.~.s..~.$ .... ~..~..e~. ............... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) · .~ep~;....~2,..1~7~ .b~. R,..~.~ .~.... UNDERWRITERS CERTIFICATE No..P..~..~ ................................... HOUSE NUMBER .. ~31.0 ....... Street .... . .L,_~..t.t.~.e...N.~..k...R.o..a~. .................. ................................................. ~.~?.h.o.~..e ..................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. BUILDING PERMIT CT'HIS ~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5175 Z Dote ............................ ~,.P, JJ.~....~...., 19..2t. Permission is hereby grant:ed to: at premises located at ......... '~J~"~l.1~'~"~"~ll!~ ..... ~J~l~"lll~"t~lr~'~ ............. ............................................. ~ ............ ~'z~ ....................................................................... pursuan¢ to application dated .......................... ~ ....... '~6 .............. , 19...~, and approved by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed loca~'ion) ~' have been inspected by this department and found to be satisfactory. Chief of General Engineering Services $£P 1 2 197~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TEPlPOI~R~ Certificate Of Occupancy No..Z~I~ ..... Date .............. Sept; .... ] 2..., 19. ~ THIS CERTIFIES that the building located at . ii,/~. Lt.ttle..l~®ek. Rd ..... Street Map No.. ~ ....... Block No.X~ ........ Lot No.. Xat..C~ttehogtlo... It.Y, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ,~llt~... 1;~, 19.. ~ pursuant to which Building Permit No .... ~I~7~Z dated ............ ,~... ~-~., 19. ~1., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. l~T~.~ate, or~® .fala~.~.~r. dwel].~ng ...................................... The certificate is issued to .141'. & .Mrs. K.. D~Lo'-s~l,lg .... Owaer~ ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval l~ept...12...~9~2...by. I~o .¥~.~],a... UNDERWRITERS CI~RTIFICATE No .... .pOIld~'lg ..................................... IIOU$I~ NUMBklR.. ~3~0 ...... Strcc't ........ L~.tt,&e. lqe~k .Ro&~ ...................... Building Inspector · Approved ....................... ..%.. ............. , 19...~.~. Pemit No ............................ Disapproved a/c ~ ................ APPLICATION FOR BUILDING PERMIT Applicotion No. ~r_{ 7 ~-~' ~ INSTRUCTIONS This application must be completely filled in by typewriter or in ink end submitted in duplicote to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to ad oining 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 app ication. 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 usedJn'Whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted bythe Building InSpector· APPLICATION 15 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. * (Signature of applicant, or name, if a corporation) ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. ........... (Name and title or corporate officer; ~ '7//-5' ~,~' 1. Location of land on which proposed work will be done. Map No.: ...~;)~..~'~.3 ....... ,7..~..~.~--4.~~ ............ · <~..:' "S~b~e existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ................................................................................................................................. Intended use and occupancy ......... ..~.....~..../..'~'~.../-~.~.(~.~'.~. ............................................................................. 3. Nature of work (check which applicable): New Building..................~'/ Addition .................. Alteroti~n' ....~..:-.!.~ .... Repair ........... : ...... Removal .................. Demolition .................. Other Work (Describe) ................................. ~. ...... 4. Estimated Cost .........~...~-?~--v~,....~.. ......................... Fee /O, (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 c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... Height ........................ NUmber of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ............................ j ....... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new c6nstruction: Front ...... ~.....~. ......... i .......... Reor ...... ~...O....~ ............ Depth .....~.~ ....... Height ....~.~..~ ..... Number of Stories 9. Size of lot: Front ...~.~...~...~.. .......... Rear ........ ~...°..°..~ .~T.. ............. Depth .....~'~.....1;~......-7... 10. Date of Purchase ......... .~. ............................................ Name of Former Owner ........................................................ 1 i.' Zone or use district ih which premises are situated ...~.~..~;;h~.~'.~.~.~. ...................................................... 12. Does proposed construction.violate any zoning law, ordinance or regulation? ..~...O.....-~.. ................................. 13. Name of Owner of premis~ ~.~...~.~..~.~,~.C--~...~...Address ..~--~a~.~.~..~......~:~..... Phone No~.~.?...~.~.?../. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~x'-~z:;~-~Z~..~,[~.'~t.....~Z~.~[..~.,..Address .s.~.~Z~.....~z~:/Phone No. ~..~.~.~..~...?.~.~-~ PLOT DIAGRAM Locate clearly end distinctly all buildings, whether existing or proposed, ond indicate oil setJo~ck dimensions from property lines. Give street and block number or description according to deed, and show street nomes and indicate whether interior or corner lot. I STATE OF N~~, ~-ee ~ ~ ' COUNTY OF .... ....... .;;...;.~~....~~'~...: ....... '~ ng duly swOm, d~, 'a~d says t~ he is the applicant (Name of individual signing application) above nomed. He is the .~ ....... ~~ ............................................................................................. ; ....... ~ .... (~ntmctor, agar, co,orate officer, etc.) of said owner or owners, and is duly authori~d to perform or h~e pe~ormed the said work and to ~ke ond file this.application; that all statements contoined in this applic~ion-am tree to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the ~plic~i~. fil~ therewith. Sw~0re me this~~~ ~' '~' ~ 1~/~~~ ~~. .... ~..~.~....~y of ...~.~ ............... , ~TARY PU~. ~tafe ot New ~o~ No. 52-81258~, S~ffolk Coup9 T~rm Ex~ir~ ~eh 30, 19~