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Home My WebLink About5620-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 A~t..l:$.a...Ro. a.d Street Map No.14atio E,~; Block No ......... Lot No.. 1~ 14attltuck, N,Y, .. conforms substantially to the Application for Building Permit heretofore filed ~n this office dated . NQ~' I0 , 19 ~rt. pursuant to which Building Permit No. dated NOV ......~l 0 , 19 .... ~T[ , 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~te, one family. ~wetlJ4~ The certificate is issued to Edwa .;~d of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No... HOUSE NUMBER~ Street Cm~er ........ (owner, lessee or tenant) pe~d~g .... · zalia Road Villa.. Building Inspector / i TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5620 Z Permission is hereby granted to: ]~dW~ A~)~, ..................... ~.La..~.U;.t~O; ..................................... to . ~,~.6.. ~...mm.. ~Ir..~m~;:~l~ll .................................................................................. at premises located at .......-~....i~. .................. .l~l~;~t~l~.~]~;~&~ ....................................... ........................................... ~a..~a~ ................ ~t~.~k .......~,-~-, .................................. pursucrn~' to application dated ~llYet~;~Z, t0 19.~.?..., and approved by the Building Inspector. Fee $..tFe~O0 .......... --Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date 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. Chzef of General EnEineerir~ S@rvios~ TOWN OF SOUTHOLD OI <. BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ................................ Disapproved a/c - APPLICATION FOR BUILDING PERMIT Dote ........... ........... , INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building~j~, 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 part 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 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. .................. ......... 2. State existing use and occupancy of premises and intended use and ~cupancy of proposed const~ction: a. Exisiting use and ~cupancy ...... ~.~.~.: ................................................................................................. ,. ,n,..,.,use.n" ........... ........................................................... 3. Nature of work (check which applicable): New Building .... Z~..~... Addition ..................Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........,~.~....~ .......................... Fee (to be paid on filing this application) 5. If dwel!.!ng,,number of dwelling units ...... ~...Number of dwelling units on each floor ............................ If garage, number of cars ........ ..'~.......c~..~.. ~:"~' .......... .~ ................... 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 .. ~...~.. .... Height .................... Number of Stories ....... ~ ................................................................................ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ....................................................... Nome of~l:orrr~er Owner ......................................... ~cz~ ~ ~ ........ 11. Zone or use district in which premises are situated ...Z~. ....... ...................................................................... ]2. Does proposed construction v~l~e..a~ ny~n~ ordinance or r~a~o~ ................................................ 13. Name of Owner of premises .~....-c~.......~...~......~ ........ Address ......z..:..~.~......~.:~.~ .......... Phone No ..................... Name of Architect ...... ,.~ ............................................ Address ....... ~ ................................... Phone No ..................... Name of Contractor ............................. Address /'¢ ......................... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~k 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. STATE Of NEW~I~/ ~- . tcc ........................ ~...c~;.........~l ......................... I~ing duly sworn, cleposes end soys thor he is the opplicont (Nome of individuol signing opplic'~tien) above named. He 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 end file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thaz the work will be performed in the manner set forth in the applicatien, filed therewith. No. 52-8125850, Suffolk County