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Home My WebLink About5152-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.ti.~3?l ....... Date ............ .AUg ....3.]... , 19. THIS CERTIFIES that the building located at t/!!h§e L~ .. Street Map No..Vtll, ~ Block No ........ Lot No.. 6 . . ~$$~k...N~Y., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Ma~ . ~., 19.. 71 pursuant to which Building Permit No. .~! ~ dated ..... ~c~.. ~.. , 19.. 7.] was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P~IFat~..O~e..f~l. tX ~911~I ............................ The certificate is issued to . .~e~ge ~at~ .... ~er ................... (owner, lessee or tenant) of the Moresaid building. Suffolk County Department of Health Approv~ A~...~,..i97~...by. ~ V$ll~ .... ...... I~;~e~tor TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT CfHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) .Permissio~ is hereby granted to: ............. ~ ...... tl;~'Z ~ ................................... at premises located at ..........:~[l~"6""~e"~ ................................................................. pursuc~t to ?pplication doted ........................... ~ ....... ~ .......... , 19....~1~ and approved by the Building Inspector. ~i~Jl ~~ tall m~S~l Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. ~---'~/~"'~c~ TO WHOM IT MAY CONCERN: The seyage disposal facilities for a structure located <Gi~ deed loca~io~)~ have been inspected by this department and found to be satisfactory. Chief of General Engineering Services i~OWN OF SOUTHOLD BUILDING DEPARTMENT ~/~/~ ~ T~N CLERK'S OFFICE SOUTHOLD, N. Y. .......... ~mapra~ed ~/~ ............... ~ ............ ~ ......... ~.....~ ............................................................................. ~ .......... ~ ................ .............. ............... INSTRUCTIONS ~ o. This application must be completely filled in by typewriter or in ink and 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 detailed description of layout of property must be drawn on the diagram which is port 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 perm t 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 hove been granted by the Building Inspector. : APPLICATION IS HEREBY MADE to the Building Dep~rtment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South01d, Suffolk County, New York, and other apj>licable 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 and regulations. r~m~ Tn ...... ~e~..~ ....... ~ ..... ~/.. ............................................... (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. ~_~: .~O~{~dt,Cl~.O~ ............... , ., ~'-~ A- "rt-,~-~ ....................... Name of owner of premises ................ .~.Q3~...~'.~.~.~. ............................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. location of land on which proposed work will be done. Map No.: ..~'.~,~,~.~...~[~13,~1~ ....... Lot No.: ....~ ................. Street and Numbej' ........... ~.. ................ .~..~.~fi~,.~.~,g~;.t...]~ ............. ~ ......... :. ............................... [~ ~) _~ I/I LAAC E- .LA Municipelity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a~ Existing use and occupancy ..................................................................................... ; ............................................. b. Intended use and occupancy ............................... ~..~.~P~,~....~I,~.~,~j~. ....................................................... 3. Nature of work (check which applicable): New Building .......... ~C ..... Addition .................. Alteration ..~...-, ........... Repair .................. Removal .................. Demolition ................ .. Other Work (Describe) ........................................ 4. Estimated Cost .... ~;.~,.~.,.0.0..0.~..0.Q ........................... ~...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 ar 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 additi.o.ns: Front .................................... Rear ............................ Depth ................................ Height .......................... :.Numbed'of Stories ................................ 8. Dimensions of entire new construction: Front ........ ~.~!. ..................... Rear ......... .~..~. ........... Depth ..... ;~.~;~.9. ...... Height ....... .~.! ...... Number of Stories ..............], ...................................................................................................... 9. Size of lot: Front ....... .~..~. .............. Rear ........... .~.~,5. ................. Depth ...~t.,,~..~.Q.,G. ....... ~.. '160 10. Date of Purchase ........................................................ Name of Former Owner ......... ,,~.e.~'. ............................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed congtruction violate any zoning law, ordinance or regulation? ............................ ~D. .......................... 13. Name of Owner of premises .D. eD~e...GZ'.Ci~J~.e~....Address ..Unt;.l~'i.~.tZCjC ...... ~ ....... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~3,~,..];[f~e~...,TJ3~,.~.~ ....... Address ...~.~-..]~.i.~l]_e..D,..,l~:~hone No.~.~2.~..1.~.~.. 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 corner lot. ~ STATE OF NEW YORK. COUNTY OF ..~.1,L(',~.9,~,~. ............ $ ~-~. ........... ~.9.~.~.~.~...~n..,~,],~, ................. ~ .......................... ,..being duly sworn, d~oses and says t~¢ he is the applicant (Name of individual signing application) above named. He is the ......... ~.g~.~...~.~......~......[D.]_~.~n~_~...~G~ ...... ,. ..................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~:ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swor~o before me this ~ ~ day of ~n ~.~ ........ ............................... ,~ , ..-~-~..-.~.~.~ .......... ~oun~ [~ignature of~f appl~nta I nt)