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Home My WebLink About5569-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ZI~.5 Date . ~.U;1. y . 2.0 THIS CERTIFIES that the building located at ¥itlage. I~ne Map No. Vii. ~an~Block No. . .Lot No...~ .... Mattit~c~ ,19 ?~ Street conforms substantially to the Application for Building Permit heretofore filed in this office dated .0ct 15.., 19 ~ pursuant to which Building Permit No. dated . 0~,~i; 1~..., 19 r/i, was issued, and conforms to all of the require- ments of the ~applicable provisions of the law. The occupancy for which this certificate is ·.. O;¢ne~. ......... (owner, lessee or tenant) issued is .P~iva~e one · family· dwet t.ing. The certificate is issued to . Frank J~icnel~. of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No...pe~... ttOUSE NUMBER ~ Street ¥il!s. ge L~e .I4a~r 3~..~972 by B. Villa .. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5569 Z Dote ........................... .~..~.~ ~.~.~ ~......~. ~.., 19....~.~J "Permission is hereby granted to: .......... ~aa.a..~l~..~....~..~¢~ at premises located at ......... ~t,..~-..~'. ......... ~g~..~tl~ll~ ......................................................... ................................. .,V.~.~.e....~.e.. ................ ~.t...t.~..,R:~.,. ............................................. pursuo~t to application dated ..................... ..,07..,~. ......... .?.,~.. ................ . 19...,.~..., and approved by the Building Inspector. Fee $...10..011 ........ Building nspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH MAY~ ~ 0 1972 Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. Exam,ned ..... ~..!.~ .......... Approved ...................................... , FOPoM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ 19 ........ Pemit No .............................. Disapproved a/c ......... ~'":" APPLICATION FOR BUILDING PERMIT Date ................... INSTRUCTIONS a Th~s application must be completely filled ~n by typewriter or ~n mk and submitted in duphcate to the Buildin Inspector. b. Plot plan showing location of lot and of buddings on premises, relohonsh~p to adlommg premises or public streets, areas, and g~wng a detaded description of layout ofproperty must be drown on the diagram which ~s part of this applicatio, c The work covered by this opphcotlon may not be commenced before issuance of Building Permit. d Upon approval of th~s apphcat~on, the Building Inspector w~ll ~ssue a Building Permit to the apphcant. Such perm shall be kept on the premises ovadable for ~nspect~on throughout the progress of the work. e No budding shall be occupied or used m whole or ~n part for any purpose whatever untda Certificate of Occupanc shall have been granted by the Buildmg Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to tk Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Lows, Ordinances, Regulations, for the construction of buildings, addmons or alterahons, or for removal or demolition, as herein describe, The apphcant agrees to comply w~th all apphcable laws, ordinances, building code, housing code, and regulations. (S~gnoture of app~dont, or name, if a corporation) / (Address of optM'lcont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electnoan, plumber or bullde If opphcant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Location of land on wh,ch proposed work w,II be done. Map No.' .... ~..~...~..~.. ............ Lot No.....~.... ............ Street and Number ........... ..~../....'~'....~...."~....~......,~.......~....~...'~.....~... ..................... ...~.~..~...~.Z...z~....~..~ ................... Munic~pahty State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a Ex,smag use and occupancy ....... ~,,~~ ..; .~. .......................................................... b Intended use and occupancy ....... ~..~.......t~..~~ .............................................. 3. Nalure of work (check which applicable)' New Building .................. Addition .................. Alteration ............... Repair .................. Removal ........-z~z-.. Demolitior .................. Other Work (Describe) ..................................... 4 Estimated Cost ...~...~.~.~,..~ .............................. ~- Fee ...................................................................................... (to be pa~d on filing th~s application) 5. If dwelling, number of dwelhng units ......~...~7.......2,X..Nu~mber of dwelhng umts on each floor ........................ If garage, number of cars .........~ .............................................................................................. ~. 6. If business, commercial or mixed occupancy, specify nature and extent of each t~pe of use .......................... 7 Dimensions of existing structures, ~f any: Front ........................... Rear ................................ Depth .................... Height ........................ Number of Stones ............................................................................................................. D~mens~ons of same structure with alterations or additions. Front .................................... Rear ......................... Depth ................................ Height ........................ Number of Stories .............................. 8. Dimensions of entire new construction: Front ........ .~-~. ................... Rear ...~.~..~ .............. Depth ~-~..~.......--...~...f Height .................... Number of Stories ....... ~ .............................................................................................. 9 Size of lot: Front .~...~.,Z'.,..~...~.. ...... Rear....~.~.~...-- ................ Depth .~.....~..~Z .~.~....--:.......~ 10 Date of Purchase ................................................... Name of Former Owner ...................................................... 11. Zone or use district in which premises are situated ................................................................................................. 12 Does proposed construction wolate an,/ zomng law, ordinance or regulat~on~ ......................................................... 13. Name of Owner of premises ..~.~...~...~....~.~¢'~..Address--~-- .~...~.~...~.,.7~., Phone~ No.~...~...~.~...~ Name of Architect ........................................... ,* ....... Address ............................................ Phone No .................. Name of Contract ~. .... Address Phone No.~..~....~.~....~...,(..f PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back d~mensions fror property lines. Give street and block number or description according to deed, and show street names and indicat whether interior or corner lot ' STATE OF NEW YORK, ~ c c cou~w o~ .............................. ~_~'~ ' ....... ~.~...~.....~...~..~Y~...~....~..~.~....~.....'~.. .......................... being duly sworn, d~oses and says t~t he is the apphcan (Name of ,nd~vidual~g~plicot~) above named. He ,s the ..... ~~~ ............................................................................................................. (ContractoD agar, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and ill: this apphcation, that all statements contained in this apphcation are true to the best of his knowledge and belief, an, tha~ the work will be performed ~n the manner set foffh Jn the applicati~ filed therewith. Sw~ before ~e th~ ~ ~ ~ ..... ...... ............... , ...... ~_~ ..~ ..... ~.. _ ............. NOTARY PUBLI~, State af ~ew Yarh Bo ~ 81~5850. Suffol~ C0u~tv