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HomeMy WebLinkAbout5159-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z~+~.92... Date .......... Sept. 2~.t I97.] 19... THIS CERTIFIES that the building located at .. Three W~%ers · ~t~n® .. Street Map No.0~ieng .by. ~ck No. . I ..... Lot No..]7 · 0r~n%. ~,Y, ....... conforms subst~tiaHy to the Application ~or Building Permit heretofore filed in this office dated ....... ~ .9 , 19~ ~ pursuant to which Building Permit No. ~.~ . dated ..... ~e~ ..~$.. , 19 ~., was issued, and conforms to all o~ the req~re- merits o~ the applicable provisions o~ the law. The occupancy ~or which this certificate is issued is ~tva~ .eh, fa~.ily, d~e!t~g ................................... The certificate is issued to . Wttl~a~ ,~e~em~g. · - ~e~ ..................... (owner, lessee or tenant) of the a~oresaid b~lding. Suffolk Co~ty Department o~ Health Approval 8~p~ ~. t9~' - b~ ,R,- V~ ..... ~de~ters Cert ~ ~892798 /./ ~ ~ ~. ~ ~0 ........... [.~ ~-~--~ ~-m. Building Inspec%or TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT m-ilS PERMIT MUST BE KEI~,, O1~ THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5159 Z Permission is hereby granted to:, to ~t" ~e~" mm'-fm~r · ~m~-;~ iai: ................................................................................... at premises located at ...[ ....... ~ipl~..~J~t....~l~:~..~y...t,]~..~tl~..~...~ ............................................. pursuon¢ to application doted ............................ ~,l~ll~ .......~..:...., 19...~J., and approved by the 'Building Inspector. ~F~e ,~.tO~O~ ........... Building Inspector SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH SEP 2 3 197t Date Bldg. Permit No. 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. Chief of General Engineering Services SEP .P, S 197~ 3 Nature of wo~k (check which applicable): New Building ...... ~ ...... Addition .................. Alterohon ... Repair ................. Removal .................. Demolition .................. Other Work (Describe) ............................. 4 Estimated Cost .... . .~....~'..~.£.~.~ .................................... Fee ................................................................................ (to be paid on f(mg thru apphcat~on) 5 If dwelUng, number of dwelhng umts ............ i ............... Number of dwelling units on each floor ....... ~. ............... If garage, number of cars ......... ..2= .............................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........................ 7 Dimensions of e>.ist,ng structures, Jf any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories .............................................................................................................. D~menmons of same structure with alterations or additions: Front .................................. Rear ........................ Depth ................................Height ........................... Number of Stones ........................... 8. Dimensions of entire new construction: Front ...~..?.. ....... ~ .................. Rear .......................... ~.~..z ~ '~ Depth .......... 5-~ .~.... Height .... /..~..(. ....... Number of Stories ............. ../..././.~.. .............................................................................. 9. S~ze of lot: Frc,nt ...... /.~£..'. ............ Rear ........ ./..~...c.: .................. Depth ...... ../..z..f~..' ............. 10 Date of Purch'~se ...,~....u...~......~.../..../..~..7. ........................ Name of Former Owner~.~.'?.~..'./:..~.~..]~...Z.~../f.f/..~.H....~.:.....~..~...'~/. 1 1. Zone or use district in which premises are situated ................. ~ ..... ..~..F...~(..~Z. ........................................................ 12 Does proposed construct;on viot~te any zoning law, ordinance or regulahon~ ..... .~...~ ....................................... ~;, /~ccZ~-~4~', A/~,~, 13 Name of Owner of nremises~/~. /~= ~Z~^~ ~/,~f~ Ad,~re~ (,~r~,/~ ¢ r. -- No ,~ Y".~- 9'~ ~ ~ ....................................................................................... Phone ................ Name of Architect ..................................................... Address .......................................... Phone No ................. Name of Contractor .................................................... Address ............................................ Phone No ................. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and indicate all set-back d~mensions fro ~cr;~.erty lines Give street and block number ar descriphon according to deed, and show street names and indica rior or corner Jot. 1 oo, 0 STATE OF NEW s COUNTY OF ..-,,~-~~~f .... ................ ~~~~~~__~... being duly sworn, d~oses and says that he is the appJlcai (Name of indw~dual signing applicat~n} above n~med He ,s the .............................. ~~~ .~~ ............................................................... (Contractor, agent, comorate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fi thru application; that all statements contained m thru apphcation are true to the best of his knowledge and behef; ar that the work wdl be performed m the manner set fo~h m the application filed~here~th Swam ~o before me this ~ ...... ..... ...... ........... , '" ....................... ~ Ho 39-7~712 : ~mm~ssmn ~p~re~ March 30, 1~, ~:_ FFL, 12 6, INSULATION IN CEILING 16" O. Co LIB, F?OOF SI INGLES--"*' s/¢ PLYWOOD , INSULATION : .?~/~" PLYWO0 D IG X4 2 7L 4" 4x6 Hf ~, 2,,e 2xe P,.P,' L_ , 3 ~2,x 8 C,B, 16 O,C, _¸% i 4Xt2 CON OCT 3-7 PO,ST LIGHT 4×12 ~Lro'r Ol 2_7--8 824" GS-8 gT-- 4. .! 2-8X I-4 8 POU~'ED CONC. F©UNDATION WALL$ IGXf3 ,~ FOOTING 2x_ i~o.._ F.~, ~6; ac. CELLAR' 4" ~ONC. FLOOR 4,-4. CONC WALL,! WITH FRAME _24×24, X L L I ~ _ _ ¥ ¢*[:)A F'F_ "' 2 71 8 ' - 24x 2.4, x 12 II 'EON(;. 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