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Home My WebLink About5180-zFO~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .Three. W~t~rs..La ....... Street Map No.O~.~e~.t..bY. f~ock No.. ~ ..... Lot No. i 6 ..... O~ien.t ~. N,~, ...... confo~s subst~tially to the Application for B~lding Permit heretofore filed in this office dated ........... March..~ 197.] . pursuant to which Building Permit No.. ~]~. dated ...... P~¢h. 2~. , 19.~ , was issued, and conforms to all of the require- ments of the applicable pro~sions of the taw. The occupancy ~or which this certificate is ~sued is ~%V~9 .~ .¢~$~. ~W9%~ng ................................... The certificate is issued to . ~illi~ ~enbnrg.. ~e~ ................... (owner, lessee or tenant) of the Mores~d building. Suffolk County Department of Health Approval Sept ~. ~971 · - b~ .R.. E~la. Under,rets Cert ~ ~ 8~689 l~ . . ' ~ , TO~A'N OF SOUTHOLD BU.ILDiNG DEPARTMENT TOWN GLERK'$ OFFIGE SOUTJ. fi~LD, N~ Y. ~- BUILDING PERMIT O'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMpLETION OF THE. WORK AUTHORIZED) N? ' Z Permission Is herel~y granted ~o:, --~ ~ ........ ...... i' ........................... _' ..................... : ............. ~~. ........ ,-e~m~: ....... ~,.:; ....... : ......... : ..................... pursuant to ~p'li?ation ~ed ............. ::: ........... ::~:.....~. ...... , 19..:.~, and app~ by the Uildi-u"-'ngI'nspector. ' '~* '"/ ~ ' ' -' *' $-~ SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date 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. Chief of Gaueral Engineer~m~ uarvieem TOWN OF SOUTHOLD BUILDING DEPART/CENT TOWN CLERK'S OFFICE/--. SOu"mOLD, N.Y. m,.ed ...... ......................... ,,, ........ .¢. Bisappraved ~/c ....... ; ........ ~ ................. ~ ...... ~ .......... 0 APPLIC~.TION FOR BUILDING PER~I'T ~, 19 ...... 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 pmmtem er I~bllc streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whlch I~ ~rt of c. The work covered by this application may not be f:ommenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspe~ot .will Issue a Bu_lldlng Permit to the al~lcant. Such permit ;~: shall be kept on thel>remisss available for inspection t~.roughobt .the progress of tho work. V1 e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate Of Occupancy- shalJ hovq been granted by the Building Inspector. , APPLICATION IS HEREBY MADE to the Building Department for. the .is~ance .of .a Bulldl?g .Permit Building zone Ordinance of the Town of Southold, Suffolk County, New forK, ana other alii;came ~ Oral .~anc.~. RegulatiOns, 'for the.coeistr~cti0n of buildings, additions or alterations, or for removal or demoll~'ion, q~flemm esecrmea. The applicant agrees to compl'y with all applicable lows, ordinances, building code, housing code, and regdatlonl. ' · (Slgnature:~f applicant, or name, Hlra ~)qNIraflon) (Address of appllcard') State whether applicant is owner, lessee, agent, architect, englneer,.generol contractor, electrician, plumber ar builder. Name of owner of premises ....;.'.~..~..~ ............................................................................ If applicant is a corporate, signature of duly authorized attic, er. (Name and title 'of corporate officer) ~ 1. Location of land on which proposed work will be done. Map No,: ....~..,~.,.,~,~.,~"~ "' "-' '~' ................ Lot No.: ....~.~. ............ .~'~ Street and Number .~.¢~...~ ........... :'"¢~'"'"~;;i~i'";li' c~ ........................................ / " 2.State existing use a.nd occupancy of premises and intended use and occupancy of propaeed comtructlon: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupan:', 3. Nature of work (check which applicable): New Building ,./~.. ........ Addition .................. Alteration .............. Repair ............... ~ Removal .................. Demolition .................. Other Work (Describe) ...................................... ,. tmotedCost ' . (to be paid on filing this application) 5. If dwelling, number of dwelling uni~ ....... ~ ...... ~Number of d~lling units on ~ch flor ............................ If garage, number of ~ ............ ~.~...~...~.: 6. If busine=, comme~ial or mixed ~cu~ncy, sp~i~ nature and extent of ~ch ~pe of u~ ............................ 7. Dim~sions of existing structures, if any: Front ............................ Rear ................................ Depth .................. Height ........................ Numar of Stori~ ............................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................R~r ............................ Depth ................................ Height ............................ Number of Stories ................................. 8. Dimensions of ent re new construct on Front ~ ~ .~ Rear ~ ~ D~ ~ -~ He ght. ~.~.~. ~. Number of Sro, es ~. . ~ ...... ~ ....................................... ~ ..................... ~ .............................. 9. Size of lot: Front ......L~. ............Rear ....... Z.~ .................... Depth .....~ .................. ~ ~0. ~te Purchase ........................................................ Name of Former ~ner ~..~~. Zone district ~hic~ premis~ are situated ......... ~...~ ........................... ~ ..................................... in 12. D~s propas~ construction Violat~ any. zoning~w, ordinance or regulation? ..~..~ .................. '3. Name of ~ner of p~em'is&s ..~.~~ddress .-.-~~Phon. No. ~;~ Name of Arch t~t ~( .............. ~..A~ress ~ Phnn~ N- I ~ Name of Contractor .................................................... A~ress ............................................ P~ne No .................... 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. 12e' AoT ='t7 -- STATE OF NEW YORK, ! ee COUNTY OF .......................... ~/~' // ............. '~/X~~.~ ........... :'.being duly sworn, depose and says that he is the applicant (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and t° make 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 perfo_[rmed in the manner set forth in the application filed thergwith Sworn to before me this '-}, . ( _ /) - -- I [ II ri I-I i-J- L~ 'E::)W ~ ,, CONTI~ACTOq TO CiqF C W AND VERI DISCq{r','.,,r,JCi?!, :,'~ ~, ::, .~e,7~l I':C1 -J '1 4 CONTR,\C~ ,";l~ TO C:-:; C[~. AND VERI~ FY ALL C!q4~;!-~rCr'~S RND DIMEN. 0 o 1 CONTRACTOR TO CHECK AND VERt- SIOF!S,L, ~:I : . DI'3C,~i,.,~, ~ , ,- , ,, , 4 4'- 4.' (,l) ::!1 0.8 4.-/ Electrical (~antron"r ,,. ' ' ~ nomply wiffi I5,c~r,-~ ~.,~ i-ha '