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Home My WebLink About5196-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificafe Of Occupancy No. 2;1~9.0 ..... Date ............... ~pt.. 22..., 19. 7.1 THIS CERTIFIES that the building located at ~l]~o .l~r~'~ · · Street Map No. X~ ........ Block No.. ~ .Lot No.. ~.. Lall~e;t.. · .N oY., .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ l~az'eh L:~., 19. ?$ pursuant to which Building Permit No... dated ....... l~rclr~.1 ..... , 197~[., 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.~,~ra~;~..one..family .~l~.e~Ll~-'~g .................................... The certificate is issued to . ~[$l~J~u~ .Seho~av~l~[ .... Oul~ .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~1~...2! ~..1.97~[...by. t{, FORM NO. 2 TOWN OF $OUTHOLD 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) 'O N. 5196 Z Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date SEP 2 1 1971 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage, disposal facilities for a structure located (Give de~d location) have been inspected by this department and found to be satisfactory. Chief of General Engineering Services SEP P, ~ 1971 BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~...~ 3f, ?/ Examined ................................... , .9 ........ ^pproved ............. P,,m,, ...... Disapproved a/c ........................................................... ' ^pp,,=,,on ........... APPLICATION FOR BUILDING PERMIT Date ~ ~-/-' 19 2/ INSTRUCTIONS I" This application must be completely filled in by typewriter at in ink und submitted in duplicate to the Building ~ Inspector. b? Plot plan showing location of lot and of bu.ildings on premises, relationship to adjoining premises or public streets or , areas, and giving a detailed description of layout ot proparty must be drawn on the diagram whlch is part of thle application. ~7 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 o Building Permit to the applicant. Such permit/' bekept on the premises available for inspection throughout the progress of the work. shall e. No building shall be occupied or used in whale or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit I~reuont to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or f.or removal or demolition, al herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hough code, and reg lotions. , (Slgnatu~ af applicant, or nome, if a corporation) ............. · ....... ....... .............. i ddre;, of a~'~'-~' ............... State whether applicant is owner, lessee, agent, architect, eng_ln, qer, general contractor, electrician, plumber or builder. , hr' rem, '~'"~ ~c~L~-~ ~) ' If applicant Is a~?rate, s~ of dul~uthorized officer. .................... ; ~......~.....~, .............. 1. L~ation of land on ~lch p~m~ ~ill ~ dane. Mpp No.: ....................................... ~t No.: .-. ...................... Munlcl~ll~ 2. State exi~lng u~ and ~cu~ncy of premiss and intended use and ~cupancy of Oo Existing use and occupancy ................................ ~ ............................................................................... Intended use and occupant-, ...... ................. ~ ............. ~ ............................................................................. Locate clearly and property lines. Give street whether interior or comer lot. 3. Nature of wo~k (check which applicable): New Building ........ ..~...... Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estim. ated Cost ........................ ~ ................................ Fee ......................................................................................... (to be paid on fi~ing this application) 5. If dwelllng, number of dwelling units ............... .~t ........... 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 ....... ~.Gt ....... Number of Stories .................. ./......~..~ ............................................................................................ 9. Size of lot: Front .......... ./...~ ............ Rear ............. ./..,~.(r...Z..~.. ....... Depth ................ ./..~'./,~..~ I(~. Date of Purchase .............~.....?..~...~._/.7./ ...................... Name of Former Owner ......... ..7'.q.~4..*.J./. ............................. 11. Zone or use district in vYhich premises are situated ............................ ~.. ................................................................... 12. Does proposed construction viol~c~e any zoning law, ordinance or regulation? ....... ~ .............................................. 13. Name of Owner of prem ses .J~.......~/~g.*x¢...~...~./..~.....Address .....L~..~,/~./~...../..?~ .~./..~...c..~.. Phone No..~..~'...~../.~.?. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~.....~. .... ..~.g/. ..~..~.?......Address .....1,.~.~....~...~.~..~...~ ....... .ePhone No..2.~.~...~..~.¢..~. PLOT DIAGRAM Idings, whether existing or proposed, and indicate all set-back dimensions from to deed, and show street names and indicate 16~ t~ STATE OF N~ le~ .................... .~.;'t~rn~....-~rS-~ ........................................ being duly swo~rn, deposes ond sey~ t~t h~ i~ th* opplic~nt (Name of i~ividu~signing application) ~ ,,. ~ a~ve named. He is the ...;;'.~ .................................................... ~.~..: .......... ~ ....................................................... (Contractor, ag~t, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke ~d file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will ~ performe~ in the manner set fo~h in t~e application filed therein. Swo~ ~fom ~ ~is ~ )~'*~' 7/ ..................... y of ....................... '. 19 ........ ~otoe/ ~ubli~ ................................. ~ ................ Coun~~- /~ ' ' ~ ~$1~nomr~ o{ ~pplieont) ...................... ELIZAB~H A~N ~EV[LLE -- NOTARY PUBLIC. State of New York ,o. su,o, ~m ~pi~ ~rch ~,