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Home My WebLink About5628-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building Ohe family dwelling erty 570 Hippodrome Road Southold, N.Y. Location of Prop flJ~s~ ~ .................... trot Hamlet 066 O~ 12 County Tax Map No. 1000 Section ........... ;Block ............... Lot ................. Subdivision M/o Bie.x.e.don Ests. Filed Map No. .1.~ 7.2. .LotNo. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...~lp.v.e.n~l~?..1Qj ..... 19 7J. pursuant to which Building Permit No. . 5628z dated ...~ .oy.e.m.b..e.r..1.5. ! ........... 19..7.~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... One family dwelling Roger Roth The certificate is issued to ..................................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ...,T.q ~. 2.7. ,. ~L9.7. 2....b.y...R....V.i..1.1.a. ........ N18024 UNDERWRITERS CERTIFICATE NO .................................................. Corrects CO z4707 Building Inspector Rw. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 50UTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5628 Z Permission is hereby granted to: ' .... .... -:.:..~ .............................. ~. .................. pursuar~ to application dated ........................... ~rjl~': ....... 1~ .......... , 19....',~jl~ and approved by the Building Inspector. FORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No../;.~707 ... Date ....... fl.uly. 12, THIS CERTIFIES that the building located at t~2. Rd · off. Itippadrol~e RdStreet Map No. Yoeixeden E~.ock No...~ . . .Lot No..9 & ~O... /~.,.. ~'. . . conforms substantially to the Application for Building Permit hdf~ this office dated Now'~ 10., 19. ?I pursuant to which Building Permit No. 5628Z dated ....... };or 1 5 , 19. 7.~, was issued, and conforms to all o£ the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is 9~iv~.te or~e family dl;e.l.l, ir~-g ............................ The certificate is issued to ~oggr lqozix .... 0'~rx~o~' ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No pe~dctng ............. HOUSE NUMBER '5'~0 Hipp~$~e .Ed Braiding Inspector , S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed loc~ion) ' have been inspected by this department and found to be satisfactory. r TOWN OF SOUTHOLD ~ ~'~"~/- BUILDING DEPARTMENT71vh/ - - TOWH CLERK'S OFFICE ~ ~ ~- SOUTHOLD, N.Y. r/~ ~7~ ~'.0 ~~ Applicot No ............ ~,~. ............ Approved ........................................ , 19 ........ Pemit No .................................... Disapproved a/c .......................... -- ~u~lmng Inspecto[; APPLICATION FOR BUILDING PERMIT Date ........ ..'~......../...~. ....................... , 19...?.~. ..... t . .. , INSTRUCTIONS ' " a, This application must be completely filled in by typewriter or in ink and submitted in duplicote to the Building - Inspectbr.." ' ~ ~' "~' 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 ofproperh/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 shalLbe, occupied or used n whole or in part for any purPDse_whatever until a Certificate of Occupancy shall have been. granted by the Building Inspector. APPLICATION IS.HEREBY MADE,~o the Building Department far 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, ordi nances( building code, housing code, and regulations. ,: ....... ., ...., .. _ .... ~ddress of applicanY) State whether applicant is owner, lessee, agent, architec~/~~eneral contractor, electrician, plumber or builder. Name of owner ~f premises ....................................................................................................................... If applicanVs a icorpo~/~n, ature of ~)y authorized officer. 2. State existing use and occupancy of premises and iptended use and occupancy of proposed construction: o. £xisiting use and occupancy ............................................................................... ....................................... * ..... b. Intended use and occupancy ................. 3. Nature of work (check which applicable): New Building ..... ~ ...... Addition .................. Alteration .................. Repair .................. Removal .................. DemolitiOn .................. Other Work (Describe) ........................................ 4. Estimated Cost ................. .~...G~./.~:..~... ...................... 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 ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each t~pe 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 constructj0n: Front ............ .~..~. ................. Rear ........ .~...~ .............. Depth .....~4~. .............. Height ......... .~...[.... Number of Stories I ... 9. Size of lot: Front .............. .~....~'.. ....... Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated . ...~.. . 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ,.4/.~. ......................................... 13. Name of Owner of premises ..~P~..cT...~.?...~.. .................... Address ~..,~'~/~¢$/' Cc~ C~,~, .......................................... ~none No...~.~.~.....~..~ Name of Architect ...................................................... Address ............................................ Phone No ..................... ....................... '/"9/'~'T' · "'/" '~"" 'Add ress !~ ...... ~'~......~.~., Phone No. Name of Contractor .~..eo ..~.~.~.~. ~u, ' ~.~ dx ~ ....... ?..~..~...6..~.~..~. 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 comer lot. ~3"' ' STATE OF NEW.,~ORIC.-_ ,. ! ~ _' ................. · .~..~--~ ...... ~ ........................................ being duly ~wom, deposes and sa~s that he is the applicam (Name o~ individual signing application) 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 rr~ke and file this application; that all statements contained in this applicatibn are true to the best of his knowledge and belief; and thaz the work will be performed in the manner set forth in the applicatiort filed thereWith. 'S' ' ':i'?' '~'f' 'c 'r-~ t h° ~s ~'. ~'~' · ' :' '~ ~', 19'~''/'' ~OTARY PUBLIC, State of New York NO. 52-8~25850, Suffolk Coup,.. Term ExP!res MI~II 30,