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Home My WebLink About5198-zFOF, M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~'. /"/..~ .O..3. Date· THIS CERTIFIES that the building located at ~o.f~~'x/~block No. Lot ~¢o.'--X't ! J p.T Map conforms substantially to the Application for Building Permit heretofore filed in this office dated . . .~. ~ -,~ O. , 19 ? ./pursuant to which Building Permit No. ~' dated ~ , 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 (~~t.~%.,,~ .'~ ...~..~ .. ~~ ~- ..... The certificate is issued to~..~"~....~~ .... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval~ ./~. ! ~ ?. ! ....~. ~ ~ .~ 3 ~ .... Building In''~-/-spee~or~ , 19 ~'' Street l~Ol~ NO, ~ 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) N? 5198 Z Permission is hereby granted to: Dote ....................... .A,~Z*.~L ....... ~ .......... , 19....~.$ ............. gat~ ............................................ to "~ "~e~r "~me '-~'a~lT'-a~t~'~l-~ .................................................................................. at premises located at .......... ~L~...~.~..~..]F~;...~....~0]~t~el~t~..]~]l: ............ : ............................ .................................... Ze~;eet~..JO~1~r~ .............. ~ ..................................................... pursuant to application dated '-t ........................ )~h ....... '~ ........ , 19....~..~, and approved by the Building Inspector. J:ee $-...:10,~00. ....... Building Inspecto~ SCRD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewase disposal faci~ities for a structure located ? /// (Give deed location) / have been inspected by this department and found to be satisfactory. Ohief of General Engineering Services JUL I ~ 197! --. IPOB~ NO. I TOWN OF soUT,oLD BUILDING DEPARTMENT · TOWN CLERK'S OFFICE Examined ..... .~........c~......, 19.2/. Approved ........................................ , 19 ........ Permit No .......... (Buildi~ng Inspector)/ ~ APPLICATION FOR BUILDING PIRMI1 INSTRUCTIONS a: TRIS application mus~''be 'complet&lY 'filled in by typewr~r or 'ih ihk dnd submffted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premleec or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which I$ part of ~hle 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 uppllcant. Such permit~-'~ shall be kept on the premises available for inspection throughout the progress of the work. e. No b Idi~hall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been groFi~. ~- ~ ~'~_.._ APPLICATION IS HEREBY/Vg~DE to the Building Department for the issuance e~ a Building Permit pureuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, mhd other applicable Laws, Ordinances or Regulations, for the constructionH~uild~ng~, addi~lqrjs or al, te~al:ions or for ,removal.od demolition, al herein d~crlbed. The applicant agrees to comply ~itl~afl ~bJ~4ej~,-er~i.~:ml)~e~-~ulb:J~q:a~ ]~u~ ~ng code, and re~atlon$. i , : .......................... ...... 9" ................ State whether applicant is ownerl lessee, ogent~arch!feqt~ ,_n.g!neer~ o_en_er_a_!.~c~n~tact_gr, electrician, plumber or builder. Name of owner of prem,,, ...... 1.....-~..~ , · .................. ~. ~,~ ................................................... (NamUe and title'of ~orPorate 0ffT~er) -' \'.~ .~ ..~- - ~~- .~/....~ .~...-.~.s. I. Location of land on which proposed work will be done. Map No,: .......... L4'.......-:1....:..u..../... ...... Lot No.; Street and Numaer ............ /c..~:.~.-.~ .......... ~....; ............................................................................................................ ~_~ ~ ~ . ~ ~ Munlclpallh/ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy .......................................... ~ ................................................................. 3. Nature of wo~k (check which applicable): New Building / Addition Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ....................... .~ ........ : ....................... ~ee .......................................................................................... (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 ............ ./.~..~.~.~.~ ..... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 !. Zone or use district in which ~pre,~ises are situated .......................... ~ ....................................................................... i2. Does proposed constructi°~ violate any zoning law, ordinance or regulation? ..... ~.~. ............................................... 13. Name of Owner of premises .l~.e..~.~......~.~..~.v.!.~..~.~l ......... Address ...~..1'...~...~..~...~...C..u.._~..:.... Phone No...?.~.~'....~..?..6..? Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor .~....fig...~..~/..e[..~.....~.~..~...~....-/.~p.....Address .~,~..~....C..c~....Z...~......C.~..~.. ..... Phone No..?.~....~...O../!. PLOT DIAGRAM Locate clearly and distinctly oll 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~//~, ! S.S. ' ................... ~.i~.-.'..'.-.,-~ .................................... I:~iBg duly ~om, ~es ond ~y~ t~ h~ i~ th~ ~pplicont (Name ~ individual signing a~licotion) above named. He is the ................................................................................................ ~ '~ ........................................................ (Contractor, agar, co~orate officer, ~c.) of said ~ner or owners, and is duly authorized to perform or have pe~o~ed the said work and to ~ke ~d file this application; that all statements contained in this ~pplication are true to the ~ of his knowl~ge and belief; and tha~ the work will ~ perfo~ed in the ma~ set fo~h tin the applicatJ~ fil~ therein. Swam to ~fore ~ ~is ~ ~,' ....... ......., ............................. No. 52-8t25850, ~otk ~ ~ . Term Expires Ma~h ~,