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Home My WebLink About5588-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~[~7.1 .... Date ......... /[l$1aO . ~ .., 19. THIS CERTIFIES that the building located at . {l~l.l~a~l~W I~ ....... Street Map No. tJlut&l~ ][t~&i~lol~kc No ...... Lot No. P.~ ~0. . .8011~J~0111[. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~t .~ , 19 7¶ pursuant to which Building Permit No. dated ........ 0~ ~ , 19 7'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 issued is l~i~ta~. Ot~ .:~Utly ~[~11t~1[ ............................... The certificate is issued to l~Ob~'t 1~ ..... ~3~ ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ]~' ~ '~ 97~ · .]0~ R, .¥i~&. UNDERWRITERS CERTIFICATE No.. ~[. ~:...&. ][ .220~.~ ................... HOUSE NUMBER · · ~0 . .. Street . . .~lea~rl~ Roati ..................... ~ Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? 5588 Z :';~::':~'~Vi~'"~;"~'"~ .............. ~'~'"~:':'~: ...... ~~: .............. pursucm~: to application dated ...................... ~..~.?.. ................. , 19.*~...!..., and approved by the Building Inspector. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ ~ ~-~ ,,...~, 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 Ct~arview. Road. Street Map No. cedar Beaql~l[~l~k No ...... Lot No.. pt 50 Sot~thold N.Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... (]Ct 2~' . , 19 75 pursuant to which Building Permit No.. ~;~ dated .. .0~.~;. 27. .., 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 Pr£vate. one Zan~3~y .d;ce:~lJmg ........................ The certificate is issued to Ro13~3~t Ma,,ta ....... ~zner ............. (owner, lessee or tenant) of the aforesaid building. .~et~r.. 23. 1.972..by. R. Vi~a. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No l~2~!t & Ig 2fi99 . [-lOUSE NUMBER 14-~0 .. Street ~lear~e~ R~ Btuldmg Inspector / S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date MAY 23 1972 Bldg. Permit No. TO WHOM IT MAY CONCERN: at ~~ g~Th:ewage-~~~~dipp°sal facilitiesy~for a~.~~dstructure located ~/ l/ (Give deed location) have been inspected by this department and found to be satisfactory. Chief of General Engineering Services MAY 2 S 1972 BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ ................. ~proved ' 19 ........ ~emit No..~.~..~.~.. ............ APPLICATION FOR BUILDING PERMI · Dote ..... ~......C,,~.... _..g...~. ...................... , 19..Z/.. ..... INSTRUCTIONS ~t.~(./~ . ¢/~Z. ~'m a. This application must be completely filled in by typewriter or in inE and submitted in duplicate to the Buildings. 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 pa~ 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 remqval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building cede~ housing code, and regulations. .................. ........ ~_~..--- I I 7 / O (Address of applicant) State whether applicant is owner, lessee, agent, archit:~,_~ general contractor, electrician, plumber or builder. If applic~t is o corporat%~gnature of duly~uthorized officer. ( me and title o' o o,ate 1. L~ation of land onwhich ~~be done. ~o.: ................. ~~No..~.~.~.~ ...... Street and Number ........ ~~ ............... .......................... ~'=Municipali~ .................................................... 2. State existing use and ~cupancy of premises and intended use and ~cupancy of proposed construction: Exisiting use and occupancy ............................................................................................................................... lntended use and occupancy ..................................................................................................... 3. Nature of work (check which applicable): New Building ........ .~....... Addition .................. Alteration ....~ ............. Repair .................. Removal .................. Demolitiar .................. Other Work (Describe) ........................................ Estimated Cost ...... ~.~1~,..~....~.....: ..................... Fee ......................................................... ~ ................................ 4. ~-~/' ~ (to be paid on filing this application) .5. If dwelling, number of dwelling'"~4 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 ............................ 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 construction: Front ............ ..~..~.. ................ Rear ...... ..~....~.. .............. Depth ...~L~. ............... Height ....... ~:~,.~ ...... Number of Stories .................... ~ ........................................................ :.,. ...... ~..~... 9. Size of lot: Front ......~..3..~.. .............. Rear ............... .?.~..'~. ............ Depth ........ .~...~..~. ............... 10..: Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. 12. 13. Zone or use district in which premises are situated ......................... ~ .................................................... Does proposed construction violate any zoning law, ordinance or regulation? ..... ~ ................................................ Name of Owner of premises ..~..e.~..~..~........~....~..~ ............. Address .~,e'~....~.~¢G Name of Architect ............................................ i ......... Address ................................... ; ........ Phone No ..................... Name of Contractor ......~....'~'.....~../..~..~...~..~..~../~..~..~r~ddress ...~..~.~.~.......~..o...~...~..~.. ............... ..~.~.'~c/~'. Phone No...?..~.~....~..~.../.~. 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 nu~mber or descriptic~ according to deed show street, names and indicate whether interior or comer Iot.~-~ STATE OF N~EW_YORI~ . - J ~ ¢ .............. ?~....~......~.....~ ........................................... ~.~ing duly ~worn, d~es and say~ t~t he is the applicanl (Nam~ of individual signing application) above named. He is the ......................................................................................................................................................... ~~ (~ntmctor, agent, co~rate officer, etc.) of Said owner or owners, and is duly authorized to perform or have pe~o~ed the said work and to ~ke and file thi~ application; that all statements contoined in this application am t~ to the best of his knowledge and belief; and tha~ the work will ~ performed in the manner ~t fo~h in the ~plic~i~ filed ther~ith. Swam t~ ~Jore me this . ........ :. ...... ELIZAB~H ANN N~IL~ NOTARY PUBLIC, State of New York Te~ Expiree M~h