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HomeMy WebLinkAbout5171-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. No.. Certificnte Of Occupnncy Date ..... THIS CERTIFIES that the building located at . l~rt R~! -~ .B/$ ~v~ld A~,~ Street Map No. ~ .... Block No~ Lot No... ~ B~$~I. O. ld. · .N. :.~., ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... l~al'...18., 19 7% · pursuant to which Building Permit No. dated ........... Nal~ ]~ , 19..~.., 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 ...Pr,i.~.-a%e. on, £~ily dwe.~.~ing The certificate is issued to Roger 14cCal'v.l. tl of the aforesaid building. 0wl~e~, .................... (owner, lessee or tenant) Suffolk County Department of Health Approval ltcuse ~ 7~ ~ou~ View ~ · -.~ .~¥ .$972. by R~ ·Villa . Building Inspectfr FOI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5171 Z Dote l~re~ ~ 8 , 19. 7'J Permission is hereby granted to: ............ ~.~c~.~...~,.$....--,.~.~. ............................... to ~ ~atl4 laeW olde fa.~ily ~welling pu~uant to opplicotion dated .............................. .?!.a...~. ....... ~..~. .......... , ]9.~..~...., ond opproved by the Building Inspector. $..'1..0.,..09... ........... ouilding ~nspecror ~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date MAR 3 1972 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. I~AR 3 BUILDING DEFARTMEHT~' SOUTHOLD, N.Y. - --/~ .,< ~_ -r/~' ~.~ '~- ,~,~ .................................. .~, ........ Perm, ~a....~C.7../. .......... ....... ~.~ ~.~ ............................................. INTRUSIONS a. ~ls ~pllcQtl~ mu~ be c~ple~ly flll~ In by ~ewrlter or in ink and ~ubmitt~ In ~pllca~ ~ the Buildi~ In~r. b. Pl~ plan ~wi~ I~lon of I~ Q~ of ~ldi~s ~ pmm~m~ mlQtl~lp a~s, a~ glvl~ a ~fl~ ~rl~l~ ~ I~ of p~ mutt c. ~ ~ cM~ ~ ~ls a~ll~l~ ~ ~t ~ com~nc~ balm luu~e of Bulldl~ Permit. d. U~ G~I of ~ls ~llc~l~, ~ Bulldl~ I~ctor ~111 I~ ~ Bulldl~ Pe~it ~ t~ Q~llcont ~h ~it ~all ~ ~t m h p~lm ~lleble ~r ~tl~ ~hout e. No bulldl~ ~11 ~ ~cupl~ or u~ In whole or In pQ, for any pu~e whaler until a Ce~iflc~ of ~all hM ~ gmn~ by the Building In~K~r. APPLICATION IS HEREBY MADE to the Building Department for the issuance of Q Building Permit pursuant to the .Bulld!ng Zofl~. OKI. Inonca of the Town of Southold, Suffolk County, New York, and other CV)pllcobla I.QWl, Ordinances or .~.h~Ulatl?s, tar tl~a conctructlon of building!, additions or altemtionj, or for removal or demo$1tlon, oc herein described. · appllcg,nt ogmel to co~nply wlth~ll aplollc~aj~le/~Qw8, ordlnan, o~, building code, houtlr~16cle, and regulations. ~,7~-/~ /~'." ,~1,¥"- -z,¢%----, '-- -eL---,'4 -'~ .... ,-% · ' //' ri / (Addnlu of applfc~nt) ' State whether applicant Ii owner, lellil, agent, Qr~hltcct, anglnNr, glfltrcl contractor, electrician, plumber or builder. blame of owner of premllel ........ ~. ...................................... ~ .............................................................................. If applicant Is · corl~mte, ilgnature of duly autherlzed officer, 1. Location of land on which pmpueed week will be done. Map No.: ..............; ......................... Lot No.: .............. ;.. - Street oncl Number ~ ............. ~d~.. ..... ~Munlclpallty 2. State existing u# and occupancy of Premls# and Intended use and occupancy of prepared comtmctlon: o. ........... ........... .................. ............................................... b. tended u# and occuoanc . ............................. ~ ..... 3. Nature of work (check which applicable): New Building ~........~... ..... Addition .................. Alteration .................. Repair .......... ~. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estirn. oted C~../~ ......... ~ .................................. Fee .......................................................................................... (to be paid on fi!lng 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 ../...~..~..~.. ......... Denth Dt ..... ........ · ........... 10. a · of Purchase ~.~,../..~...~..~.. Nome of Former Owne~'~..e. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction va ate anvzonino law ordinance or re ~ ~-~ -. .., . .~ gu at on ........... ~ ............................... 13. Name of Owner of premises ~...~...~ddress ./..~.~.~...d~.~..~....l~..~.~..~/~on~e/'~o~' ..~....~'..~.. .......... Name of Architect ....~..~ .................................Address ............................................ Phone No ..................... Nome of Contractor ~.~..../~2 Addres~J~..~...~..~... Phnne ~1~1~ Locate clearly and distinctly oil 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. · ../".-~...~'~...~ ~--...~'..~'. ~...~' being duly sworn, deposes and sa s that he is the a licant ...................... . ..: .... ............................... y pp ( Nam~i~tYe~'~i~,ng al~cation) _~ o~ve named e ~ ~~ ' H s the ....... . ........................................... (~ractor, ag~t, co~rote officer, ~c.) of said owner or owners, and is duly authorized to pe~orm or hav~pe~o~ed the said work and to ~ke ~d file this application; that all statements contained in this application~, to the ~st of h s ~owled~e a~ belief; and that the work will be performed in the manner set fo~h in the app~ fd~r~ith. Swam to ~for. ~ ~i, ~ ................ .......... ......