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Home My WebLink About5138-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerli[icale Of Occupancy No. Z~269.. .. Date JA.m.e 23 , 19 71 THIS CERTIFIES that the building located at B/S ~o~;]~ ~ ~ Ba~le~ Street Map No. ~ Block No. . ~ Lot No. ~ 8~thel~ N conforms substantially to the Application for Building Permit heretofore filed in this office dated . Feb 18 , 19 7~ pursuit to which Building Permit No. dated Feb ]~ , 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~l~a~e .~nz f~ly ~ell~g ......................... The certificate is issued to ~l~l~-~ A~e~.. ~s~... (owner, lessee or ten,t) of the afores~d b-i~ding. Suffolk County Department of Health Approval ~le 2~. ~97] .by ~, Yil!a ~.~se , 1580 ./~ Building Inspector l~OR~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°, 5138 Z Permission is hereby granted to: , , .................... :..7; ................. ~,~ ................................. ....... ~ ...... .&~..L.~...~. ........ ~..~...~..,..~...s...~ ..........................- i ........................ ~ i ............................ ~.z..~....i~:,,,-~. ............................................... ........ ..... ~CZ' .......... ~';'~ ....................................... ;' ................................................................................ pursuant to c~p~lication dated ................................... L..~......./~....~....~....., 19..;.7./, and approved by the J:ee~ ..... L..~.. ........... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: at The sewage disposal f~for a structure (~ve deed location) located have been inspected by this department and found to be satisfactory. Chief of General Engineering Services dUN :~ ! 197I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ' - ^ppllcation No ............................. (Building Inspector) APPLI~.ATION FOR BUILDING FERMI1 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building 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 de,ailed description of layout of property must be drawn an the diagram whlch Is part of thle application. c. The work covered by this application may not be commenced bafore iseuance of Building Permit. d. Upon approval of this application, the Building Inspector will luue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the pragre~l 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, end other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or al!erations, or f.or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building cede, housing code, and regulations. (Slgna~re of applicant, or name, If a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~//~......~ .................... ............... (Name and title 'of corporate .......... offlce,,,,~~ ~ ...... 1. LocatiOn of land on which prOposed work will be done. Mala. b~.:~.~., ............ Lot No.: ...~.. ............. Street and Number. " " ........... ~i~l'~ii~' ...................................... 2. State existing use and occupc~,ncy of pm, raises and intended use and occupancy of pmpoeed coratructlon: a. Ex~st~ng use and occupancy ....~ ............................................................................................... b. Intended use and occupan:, ...~i~f~l~ ............................................................................................... 3. Nature of work (check which applicable): New Building ~ ................. Addition .................. Alteration Repair .................. Removal ................ Demolition .................. Other Work (Describe) .................................. ~... (to be paid on filing this application) 5. If dwelling, nu~ber~ of dwelling units ...... ~ ............ Number of dwelling units on each floor -)".Z,.'. ................... _ ~ garage, number of cars ..... .~. ~~ ...................... ~. I~ business, commercial c~r mixed occupancy, specify nature and extent of each type of use ............................ 7 ~,Di~ions of existing structures, f any' Front .......... Rear ... Death ~?igHt .;.../.~...~ ........... Number of Stories ...... ~ ........................................................................................... ~imensions of same structure with olteratioos or additions: Front ......... ~.....~. ............... Rear .~.. .................. D~pth ...~ .................. Height ../~.... .................. Number of Stories ..~ .............. 8. Dimensions o~f, enhre new c~r~struction: Front ...... .~.~.-~...~.. ................... Rear ...;~...~... ............. Depth~[~. .................. 9. Size of lot: Front ..../.......~.. ............. Rear ....... /..~....~.. .................. Depth .~.~....~. ................. 10. Date of Purchos~e ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... .../~....~..~.~.'.~...~...~.~...~.. ................................................................. 12. Does proposed construction violat/e any.zgning law, ordinance or regulation? .....~....~.. ................................................ 13. Name of Owner of premises ~.~.. Address ~.~.....~..'~1~ .... Phone No ............... Name of Architect .................................................... Address ............................................ Phone No ................... Name of Contractor ..4..:...~l/..:.~.~.~....Address ~ .............. Phone No .................... PLOT DIAGRAM Locate clearly and distinctl~ldings,_~h.e.r existing or proposed, and ind cate all set-back dimens ohs from properly lines. Give street ar~r I~lock rlmnt~For de~¢r'~ to j~jed, and show street names and indicate whether interior or comer lot.~ ~ STATE OF N~ YORK, t S~ cou. .......... .............................. ~...~..~.c..: .................. ~ing duly sworn, d~ andsays is t~ applicant (Name o~dividual signing applicati~~ above name. He is the .................................................................................~ ;~. ................................................................... (~tmctor, ~t, co~rate officer, ~c.) ~ .... of said ~ner or owners, and is duly authorized to pe~orm or ~e pedaled t~ ~id work a~ ~ ~e ~d file this ~pli~tion; that all statements contained in this applic~on are tree to ~e ~ of his ~wl~ ~hef; and that the work will ~ performed in the manner set fo~h in the a~licatt~ fll~ ~e~i~. Swam to ~m ~is ~~~~~~. ........................ day of ............................................ , 19 ....... Nota~ Public, . ........................................................... Coun~ (SignOre of applicant)