The URL can be used to link to this page

Home My WebLink About5488-zFORM NO. 4 TOWN OF $OUTHOLD BUN,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificele Of Occupnncy No. Z.~7.~3 .... Date ........... ,~e.n.u..a~....~ .~...., 19..~.~. THIS CERTIFIES that the building located at ~b~.e~. Road ............. Street Map No. T..e.r..~.. ~.a.t.e.r~lock No ........... Lot No..~.l. t .... ~o..u..~.o.~..d...~ :.Y.: ........ conforms substantially to the Application for Building Pemit heretofore filed in this office dated .........Sept. · .7 .... , 19.?1. pursuant to which Building Permit No... dated .........Sept .... ? .... , 19. ?.1., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pr.~.va~;~. ona .f~.y.d.~e~[Lu$ ..................................... The certificate is issued to ..E~..1. &. Ca thel, irm..$ber~.n~ ...... 0~nero ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ]~.v..;~P...~. 97.2....by..R. :..V.i.1..1.a ..... UNDERWRITERS CERTIFICATE No.. N~.GO .... Aug .8...¶.972 ................... HOUSE NUMBER ..... .S~2~ .... Street . .P, amb~i.er, l~,~ad .......................... ..... ......... FOI~,M NO. ~- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 'F N? 5~s$ z ....... ~ ............................ ,,~..~/ pursuan¢ to application dated .................. .~.-..~..: ................. 19.....,.., and approved by the Building Inspector. Fee $ ........................ Building Inspector FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .... Itat~lOl'..ltoa~[ ......... Street Map No..T.e.r..ry..~.t..~.~lock No ........... Lot No..1.$ ....... 8o.tlthold..lq.o.I, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 8apt. · · .7-., 19.75 pursuant to which Building Permit No.. dated .......... 8o~i;.. ~ ..... , 19. '7¶, 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 . P~Lv~te. om .fa~:i. ly. d~ell~ng ....................................... The certificate is issued to ... F,~tl. Sebl,.~n~n~.. & .lg~Lfe. Otmel,, ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .]~o~ .. 2~ · .¶~..by. ~i,. T~I3~ .... UNDERWRITERS CERTIFICATE No.. ~ .3~.~OO.. ~[11~.8. '~.9~ ......................... HOUSE NUMBER .... ~]~,~ .... Street.. ~lllb~.Ol'..l~t~, ................................ Building Inspector SCHD SUFFOLK COUNTY DEPARTMENT Date Bld$. OF HEALTH NOV 2 9 197~ Fer. it .o. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located - ~/ (Give de~ed locatiot) ~ have been inspected by this department and found to be satisfactory. ~hiof of General h~gineering Services NOV 2 9 Examined Approved ........................................ , 19..~ ....Pemit No....~....~...?..~.~ .......... Disapproved a/c .......................................................................................... :. TOWN OF ~UTHOLD ~ ~ ~ ~ ~; BUILDING DEPARTMENT ~ TOWN GLERK~ OFFI~ ~/,z/~ ~- ~ ~ ~UTH~D, N.Y. ~ ~. ~. ~ ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT ~ Date .............. ~....Z ....... ,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 o detailed description of layout ofproperty must be drown on the diagram which is p~rt of this application. c. The work covered by this application rn~y not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the ~ppHcont. 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 o 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 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 6pp~icant, or name, if a corporahon) ./...6...o../ £ (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. '~'~'r~' ~"~;~er of premises ..~.....~....~ ........ ~ ................. i::i:ii..:ii.~: If applicant is a corporate, signature of duly authorized officer. '~-~'- 9 [ .................. ......... / 1. Location of land on which r-'work illbedone ManNa ~:.~.~.....~.. I~tNo'~ P 'rzz': .......................... Street and Number ............. ~rm~..~..~..,~.~r~ ............. ..~_..~...7...~....~.~....-~c..-;:.~m.. ........................................... MuniCiPality 2. State existing use and occupancy, of prepfises and intended use an~ occupancy of proposed construction: a.b. Exis~inglnte ded u~, andand occupancy '" "~""~"~'~"~.~ ~,. ~(~r_ ......................................................................... use occupancy .........~..~..=................~...,,-,,,'~.....~ ....................................... ~ ..................... 3. Nature of work (check which applicable): New Building ....~......~. ...... Addition .................. Alteration ...:..L..~.....u.. Repair .................. Removal .................. DemOlition .................. Other Work (Describe) ........................................ 4. timated ........................ ~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 .........~ ........................................................ ......................... 5. 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 ................................. / ' n= .... ion' ~' entire n~ -*nstruction' Fr*nt ~'~o o .... Height .................... Number of Stories ....~ .................................. ............................................................... 9. Size of lot: Front ...~.~ .............. Rear .................................... Depth ......./....~'...~...~ ......... 10. Date of Purchase ..../....~..~....~'.. .................................... Ntamef,,, .,{'~ ~t.°f_Former Owner ~..~.'. ................................. Zone or use district in which premises are situated ...... 12. Does proposed construction vioLate~anv zoning¢..~__ - 'la-w' ordinance or regulation? ...... ~....¢. ......................................... 13. Name of Owner of prem ses ~. .~ddress ............................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........ ..~::~',~ .......................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly ond distinctly all buildings, whether existing or proposed, ond indicate oil set-back dimensions from property lines. Give street and block number or description occording to deed, and show street names ond indicate whether interior or comer lot. STATE OF NE-~t~Y(:;~I~,~ cou. ........................... VZ..~..~..GZ~Z.;.~ ........ being duly sworn, d~o~s and says t~t he is t~ applicant (Name of individual signing a~lication) above named. He is the .......... ~.~ .............................................................................................................. (Contractor, agent, co~orate officer, etc.) of said ~ner or owners, and Js duly authorized to perform or h~e performed the said work and to ~ke ~d file this application; that all statements contoined in this application are true to the best of his knowledge and belief; and that the ~rk will be performed in the manner set fo~h in the application fil~ therewith. Swam to ~f~_/me this .......... : ...... ''-'-'~ ----'-~~ ~ ~' JUDITH T BOKEN Nota~ Public, State o~ New York No. 52-0344963 Suffolk County