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Home My WebLink About5502-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .l~O~t,~X*~ ~]Jl~ ........... Street Map No.&~M~.. ~,~...l~lock No ........... Lot No... ~ ..... .~.~-~.~;. ~.~-~'~.t- .~. *~-* ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... .~.e~... ]~..., 19 ~.. pursuant to which Building Permit No.. ~.~. dated .......... ~.ap~ .... ~.3.., 19..~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...~$~..~1~. ~LI~..~¥~1,~.1~ ..................................... The certificate is issued to . ]~$Olm~. &. ]~w. Ka~k~. ..... 01~*[ ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~.~.~.. ~..~.~....~..~., .~,l& ...... UNDERWRITERS CERTIFICAT£ No ..... Il..~....~ ...... . .............................. HOUSE NUMBER... ~05 ...... Street .....~l~t,~e~*~, ~l~. ............................. 7 ..... Building Inspector / 1~0~ NO. Z TOWN OF SOUTHOLD 'BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDIHG PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FOLL COMPLETION OF THE WORK AUTHORIZED) No. 5502 Z Da~e ................................. JJJ~j$ ....... t~., 19--~t~. Permission is hereby granted to: .......... JJ%....34t~ t....ti~..ll~ ....................... at premises located at ......... ~i"~j ......... JJJl~"~l~ .......................................................................... ...................................... ~/J-..-~Jt~m..lt%~t .............. ~Jm~t"l~rJmi"tl~T~ ....................... pursucm¢ to application dated .................................. ...J~.~.....]~ ....... , 19...~J~J., and approved by the Buikting Inspector. Bui Iding S-9 $CHD SUFFOLK COUNTY DEPARTMENT OF HEALTH JAN ? 1§72 Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. Chief of G~r_e~'al t~ir_oer[~ S~,~vlce~ District Engineer JAM ? Ig7~ lrOl~-Re NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT ~prav~ ............. .~ ........... ~ ........... , 19..~. P~it No..~..~..~ ..................... ................................................................................. ...................... .......................... (Building Ink,tar) / INSTRUCTIONS must be completely filled in by typewriter or in ink and submitted in dupli¢~,te to the Building This application 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 ofpraperty muSt be drawn on the diagram which is p~rt of this app ication. c. The work covered by this application may not be commenc~l before issuance of Building Permit. d. upon approval of this application, ~ne Building Inspector will issue a Building Permit to the ~o~li¢~nt. ~u~h pea'mit shall be kept on the premises available for inspection throughout th~ 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. APPL CATION 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, Suffo k COunty, New York, and other applicable Laws, Ordinances or Regulat OhS, for the construct on of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bui ding 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. ............. .......................................................................................................................................... Name of owner of premiSes'-'~l~-~iq',,I~...~...:...'~.CLI k.c'~-''''CLlr~'''''''~'t~'''''~':' ...J,,~.OL.I~C.~.I~ ...................... If applicant is a co~orate, signature of duly authoriz~ officer. ~ ............ ~ and tit{~";~"~;';~;;~'~";~'~ ......... ~ ~ -- ~ ~ l. C~otion o{ I~nd on which pr~o~od work will be done. Mop ~o.: .. .~.~.1 .................. ~t ~o ...... ~ ............... are t ona .... ....... ........................... ~0 ~ ~ Mun~ipali~ 2. State existing u~ a~ ~upancy .of premises and intended use and ~cu~y of p~ c~gmcti~: a. ~isiting use ~ ~c~ancy .......... ~.~ .................................................................................................... b. Intend~ use and ,~cu~ncy ...... ~....~ ....................................................................................... 3. Nature of work (check which applicable): New Building / Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ Estimated 4. Cost ........ ~.(~..~..f~.~,,~.(~ ........................... Fee ... /.~).; I~./~ ............................................ (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 ..~..~.,,~., .Z-?.~.. ......... 7. Dimensions of existing structures, if any: Front ..... ~.O.A~,,~', ........ Root .....~.J~.,~. ............ Depth .J~.~'..~.. Height .~.~./~...~. ...... Number of Stories ............/~'..¢2~.~. ............ . Dimensions of same structure with alterations or additions: Front ......~...O....A(....&::.. ................ Rear ....~..~..~1~.~.. ...... Depth ..J.~..{IZ~.~~. ............. Height ......~..~..../~....~T.......Number of Stories ...~.~/.~. ............ 8. Dimensions of, entire new construction: Front ....... ...~..'7..../. .................. Rear ...... ~..~...~ ............ Depth .....'~ ........... Height .....J..~. .......... Number of Stories ................. J. .......... i ............ 9. Size of lot: Front ....I.~.~.~. ............. Rear ....I ~ ~.:..L~..[ ......... Depth ......~. ~.- ~.~ ]0. D,~'~z Purcha~ '~,~ ~, ~ .-.,.'*-~t.w-~.....~+..~..z..LI .............. r~ome or former uwner ..t~,%~,~.~....l~..-~.~..e~l.~.u~e~.k.t 11. Zone or use district in which premises are situated ...]~.~--,~..~..~.~,~.Jl:.l.~! ............................................................... 12. Does proposed construction violate any zon ng aw, ordnance or renu at on;~ N~. -I~c __..ch~cL o. %/~lk. ele- -° ..................................................... 13. Name of Owner of ~remises'~..]:~ke~/~/R~Y~/~t~t~c~t~e`~Address~.~.~.~:~.~..ftP`~.~.~t~:~¥Ph~ne N o.NL.'J.'Z .~.J .~..~...~ Name of ArchitectJ~.t.~,...-~.:.~).~.,~..~. j.<...~...~g..~%~....Addres~)~.L~.~.~.~...-Jj~...:~.~).~-~:L~..~.Ph~ner'" '1' Name of ContractorJ~J~.~,.~....~."~)2~ .~.~).~.~J~{....Addres~C~.¥..~.:.J~.~....~r~J&~).~hone NoH.'Z.~..-..]~.~S..~. 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. VA. cf~ L V^cA T STATE OF NEW YO~/(,/~ above named, lie is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements cont~3ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth Jn the application filed therewith. Sworn to be, fore me this ...... day of ........ , Notary Public, ........~...~...~.~..~L..~.. ............................... Count~' "}~ignature of~a~plicant) 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 8~uth~. 2~ ............ Street Map No.&qua .~.e~ .p~lock No ........... Lot No.. 3 ... ][.&#~;. ~a.r~. ![,.Y., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... .8.$p~...]3.., 1~... pursuant to which Building Permit No..~0~. dated ............ Se~t...~,., 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~$vat~. ~1~. fa~ly, d~e 1 lSn[. ..................................... The certificate is issued to .H~.chard. F, Dray .A. ~.alker ...... o~®rs ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval l~ou~e ~ ~0~ .Jan. · ?,..~97'2 · .lay. It.. Villa ..... / / / /, -- . · ' '/'t/ ..................... F' ........... Building Insp~/t~r