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Home My WebLink About5204-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~ J+395 Date Bel~t 21+ 19 THIS CERTIFIES that the building ]ocated at &~et. ~e ........... Street Map No. ~ ..... Block No.~ ..... Lot No. .~...Oreenpo~t . ~.,Y, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~p~.. 2. , 19 ~$. pursuit to which Building Permit No... dated ...... Apri~ · .2 .. , 19.71., was issued, and conforms to all of the req~re- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....~ly~. ~ .~lY. ~e!l~g .................................. The certificate is issued to .~...B~ ..... ~ .......................... (owner, lessee or tenant) of ~e afores~d building. S~olk County Dep~tment of HeMth Approval ~ S [ ~ 7 [ ~ Building I~spee~or TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 520 Z Permission is hereby granted to: ................................................... ii~eJi~d~..r .......... l**l,~..li,Z, ................................................... ,pursucu~t to application doted ........................... ...~.~ ......... ~ ........ , 19.,~..~..., and approved by the BuiJding Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at <//J/~~~a i'f)O~ have been inspected by this department and found to be satisfactory. SEP $ Ohief of Gsneral ~.gtmserin~ Services 1971 Examined .......~.........~........, 19.~..../.. Approved I[ 19../..!... Permit No. APPLICATION FOR BUILDING PERMIT C> Date ...~...m~, ........................... :., 19..--/.I. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showin.g, location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detaded description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may nat 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 occupied or used in whole 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 a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with alt applicable Jaws, ordinances: ibuilding code, housing code, and regulations. ~0 {Signature of opplicont, or nome, if a corporotion) ......... ......... .......... (Address of ppplecant) Nome of owner of premises ....~..'.....~.~.~..~... .................................................................................................................. Street and Number ........................... .~.....~ .................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................... b. Intended use .{..g"~..~,..., J.~' ' ....~..~.. ~'J~.,{....~q ......................... and occupancy ......... ... ......... ../ ...................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: 3. Nature of work (check which applicable): New Building ............ ~ ..... Addition .................. Alterotion .................. Repair ................ .l~Removal .................. DemolJtio~.../.;f....~...... Other Work (Describe) ........................................ 4. Est mated Cost ....... ~.~'.j..~.. .......................... ~.....~.....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 oors. ............................................................................................................................................ 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 olterations 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 ...?.......~-,.i[. ..................... pth....J...o.....r...j .............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 ]. Zone or use district in which premis~ are situated ................................................. ~ ................................................ ]2. Does proposed construction yiolote any zoning law, ordinance or regulation? ........ .~.~ ............................................. la. Name of Owner of ................... ^ddress ............. '.... pbe Name of Controctor~=~......U.~...~.s..T~...~'~.'.....(..~....i.~.~i.~.tLR~....Address ............ '"~"...~..~.~['.~. '"""'"'"'"'"' Phone No.~ .~...'..~...°.?..~... Locate clearly and property lines. Give whether interior or lot. and block number or descripti. PLOT DIAGIGa~ ,ing or proposed, and indicate all set-back dimensions from ~n according to deed, and show street names and indicate o, STATE OF NEW c~OP, K~, .~ (c ~ ........... ~~.~,.....~.1[[~ .............. : ........... ~ing duly sworn, d~s and says ~ he is t~ applicant (Name of individual signing ~ati~n) above named. He is the ..................... ~..~.~].~ ................... ~ ........................................................................... -- (~tmctor, ~t, co~rate officer, ~c.) of said ~ner or ~nem, and is duly authorized to ~orm or ~ve perfo~ the said work a~ to ~e ~d file this application; that all statements contajn~ in this appliCati~ am tree to the best 0f his ~l~ge and ~lief; and that the ~rk will be perfprmed in the manner ~t fo~h in the ~plic~i~ fil~ ~ith. Sworn to ~fore me this J I II ~ ~/