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Home My WebLink About5170-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 ~ ~.e~i~ ~*~?"'- IP.~ Street MapNo..K BlockNo..~ Lotto. X .~~~ .~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ~ & /.7, ~9 7.f p~suant to which Building Permit No. ~/ 7 0 ~ dated .... ~r~ /~ , 19 ~/, was issued, ~d conforms to M1 of the require- ments of the applicable provisions of the law. The occup~cy for which this certificate is The certificate is issued to ~~ ..~ ........... ~'.... (owner, lessee or tenant) of the afores~d building. ~ ~ Suffolk County Department of Health ApprovM .... ~P ~; ...... ~'.. ~' TOWN 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) 5170 Z Permission is hereby granted to: at premises located at .......... ~/~i,.-C-;ell~--J~ -~e~l~--[~ .............................................................. ................................ ~ ......... : ...... F.~t;.t,;,~,.~ ....... ~,3:,,, ......................................................................... pursucu~t to application .dgted .......... ~ ............... ~...~..JiJ~l'~JJ ....... .'i~K..., 19.~.., and approved by the Building Inspector t S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located eed location) // have been inspected by this department and found to be satisfactory. Chief of General Engineering Servicem JUN $ 0 1971 Examined ........................... , I . . ^aproved ........................................ , ........ Pe- t Disapproved a/c ...............................................................~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S O~lCE ~D, N. Y. APPUCATIO~! FOR BUILDING PE~I~ Date ~ I 7 19..~../ ..... INSTRUCTIONS a. This application must I~e 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 a~'eas, and giving o detailed description of layout of property must be drawn on the diagram wh ch 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 occupi..ed or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted b~} the Budding Inspector. ' - APPLICATION IS HEREBY MADE to the Building Department for the issuance of a j~u d ng Permit p!~rsuant to the Building Zone Ordinance of the To~n of Southold, Suffolk County, 'New York; and other alpp cab · Laws/' Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal, or demo t on, as herein described. The applicant agrees to comply with all applicable lows, ordinances,... ~'"'~' i'~ '~"'~building code, housing code, ond r~ulotions.~.. (SignCa~ure Of appli'~t;';i';'~'me, if a'~:'~'~porotio~')'""~ .... ........ ...... .................... State whether applicant is owner, lessee, agent, arc..hitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... ~ ...... .~...~ ............................................................................................... I f app~co~gnature of .~J~.~_~horized of ficer. .... ...... ; : . . . . -; ;4 .; ;. ;;.; ; ; ;. . .; ; ; ; i ................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ ~, Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy .................................................... ",~-'-:' ............................................................................ Intended use and occupancy ............................... ~...~ ............................................... 3. Nature of work (check which applicable): New Building..................~/ Addition .................. Alteration .................. Repair ................. ,. Removal Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost /6~,~.od~ ~ ...................... ! ........ : ........................... 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 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 ........ !...C-r~... ................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............ ..~. ..................................................................................... 12. Does proposed construction vkflbte any zoning law, ordinance or regulation? ....... ...,~...q ......... : .................................... 13. Name of Owner of premises ....../~..f~!~...~..¥.e~ ............. Address ..2.~.9...~.~...~.n...~..~.......~.~'~.n..~... Phone No..~-.~./.... ,~..~./. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~..,~.~..~.../~.,~.....~.W./..e/.e.f..d-..h~...Address ...Z..S~...~..~...~....C.~.~...~.~.?...~.. Phone No..2.~..~.:~.(~... 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. STATE OF NEW' YORK, ~,ee COU N-FY OF,~. ................. ;;~ j~j~...: ~'~'~' ................. · ,~'..~......~ ....................................... being duly sworn, deposes and says that he is the applicant (Narned~individUal signing applLcatio.~,, Z~,~(~-,D~ J~; · , - · above named. He is the ........................... ..-~w..z.v.r.~.: .................................................... ~ ................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rnoke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...... 1'.~-'-~.... do~ of ....~~. ........ : ......... , 19.7/. ~ .... ~ _ _ , ll' 11_ _ ; llq . .. : ..... ............................................................. ~ ELIZABLq'H' AHN NEVILLE ~/ ¥' NOTARy PUBLIC, ~tate of N~w York No, 52-8125850, Suffolk Cbt~atv Term Expires Msrch 30, 1~