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Home My WebLink About5259-zFORM NO. ~ TOWN OF SOUTHOLD BUTLBING DEPARTM~.NT Town ~erk's Office Southold, N. Y. Certificate Of Occupancy No. Zt/2 77 ~ 7 ~97 ~ Datlt" . ~J '~/~ /~l~,[ Street THIS CErTIfIES that the b~d~g loca%ed ~' ~''' 'j ......... ' ........ .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....~. ?..~'.~..~....~..~...., 19~..! . pursuant to which Building Permit N .o-~...~..~. ..~' dated .................. ~)~'~ ~' .~.~ , 19'7. .... ~ , 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 .(~.~..~ ?..'~..'~..~.' .'~...~...~..C.'~.. ~.~.~.~ ~ ~... ~.~ .~.~.l..~..~............ The certificate is ~su~ to ~.~.$.~.. ~ ~( ~ ...... ~ ~.~ .~ .......... (owner, lessee or ten,t) of ~e Mores~d b~d~g. S~olk Co~ty Dep~tment of He~ Approv~ ~. ~ ~ ~ ~ ..... ~.~'~. ]~: .~[.~ ~ ~ B~ld~g Inspector FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMEN'I 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? Z Permission is hereby granted to: .. ~..~',~L;;z.~ .....5Z¢.....~ e~.~r.~.. ~ &e LI~ .... ................. ~ .¥.:~...~ ~.~;~.e. ......................................... to .. ~,.....~.,~...~...£~,,~_~....~,~.~ ~.:L,..~ ....................... , .......................................................... ................................................. O~h~u~ .............. ~ .~., ........................................................... pursuon,t to opplicotion doted ............................... ~L*~'*~*~ ....... .~...., 19!~:~..., ond opproved by the Buildin§ Inspector. Fee $..1~.~0 ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date September 2, 1971 Bldg. P~rmit No. 5259Z TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located Right of Way~ 26~' N/Main Rd., 400' E/Laurel Avenue, Cutchogue (Give deed location) ~ have been inspected by this department and found to be satisfactory. SEP 197'1 Chief of General Engineering Services TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUI'HOLD, No t'. Approved ........................................ , 19 Permit No. ^pp,,=t,on s Disapproved a/c ......................................................... '. · APPLIGATION FOR BUILDING PERMIT Dat. .......... ................................ , INSTRUCTIONS ~ a. ~This application must be coml~letely filled in by typewriter or in ink und submi~ed In duplicate to the Building Inspector. b. PI.at .l~n showing I.oc.ation of lot ,a.nd of buildings on premises, rnlationship to adjoining premlees or public streets or areas, arc gwmg a detanea aescriptlon at ~ayout at property must be drawn on the diagram whlch is part of this 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 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 af Occupancy shall have been granted by the Building Inspector. ' ' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perm t pursuant to the ~Build!ng Zone. O~inance of t.he Town of Southold, Suffolk County, New York and other appllcGble Laws, Ordinances or ~egu~ati..ons, tar the construction of ~uildings, additions or alterations, or for removal ar demo t an, as heroin described. ~ne apphcant agrees to comply with all applicable laws, ordinanc~es, building code, housing code, and regulat~lon$. .....-.-. . . . (Slgnature~df applicant, or name/f a comorat on) (Addrese of: ap State whether applicant is owner, lessee, agent, architect, ~glnlm~,~l?erol contractor, electrician, plumber er builder. cor~orot~ title 'of officer) · 1. Location of land on which propc~ed work wil! be done. Map No.: ....................................... Lot No.' ................. Street and Number ....... ~.~...~.......~..~.. ............... ...c~.. ~ ~ .~ ......... i...ii.i' .... 2. State existing use and occupancy of premises and intended use and occupancy of propaeed construction: a. Existing use and occupancy,. .................... ~.~ .................................................................................. b. Intended use and occupan:' ..................................... ~ ........................................................ 3. Nature of walk (check which applicable): New Building / Addition ....~ ............ Alteration Repair .................. Removal ................. -. Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost ............. .~..~./....O~....~..:...G~.~ ........................ Fee ......................................................................................... (to be paid on filing this application) §. If dweIHng, number of dwelling units ........ ./. ................. Number of dwelling units on each floor ............................ If garage, number of cars ........................... ./. ............................................................................................................... 6. If busine~, 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 ............. .6.../. .................. Rear ........ ..~.../. .............. Depth .....3.~.1...~.. ......... Height ........ ./....~.. ..... Number of Stories ............... ./. ..................................................................................................... 9. Size o~: lot: t /./~ ~' /~ 6" :3 ! ~ ~e Fron ........................... Rear .................................... Depth ............................... 10. Date of Purchase ........................................................ Name of Former Owner ..... ..~....%~.~.~/. ............................ 11. Zone or use district in which p~,~e~ses are situated ...................... ..~... .......................................................................... ~* 12. Does proposed co~ns{;uctio~ vi0~te any zoning, law, ordinance or regulation? ......... ...'~...~. ............................................ 13. Name of Owner of premises ..~..e....~.......~..~..e.~.q ............ Address .../..L...-~..~..~....~...~.~....~?..~..~...~Phone No. ~...Z.~.....~...3..~.~.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~....e~......~..~/.~'~...._J~.~.>.../..~.e'.£ ........ Address ..~.~..~.....~...°.?/...~..~.......C..u..~...~E~'.~Phone No. 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 NEWj~OP~,~ ,, ~ ............... =..""~'...'~4~.....-'~..-~.~'r~..~...,.'..,.~:;: ............ )-'.4 .......... :.b~hg dul~-swor~ d~and says t~ he is th~ applicant above named. He is the ..................................................... ~4~ ...................... ~ ........................................................ (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to pe~orm or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this ~pplicat~ are true to the best of his knowledge and belief; and that the work will ~ performed in the manner set ~h In~,~e a~lication fil~ therewith. Swam to ~fore ~ this , .......... o, .......... .......... . ,/ / .............. ..................................... Notort Public,~....~--L--~~?: ~.~, . ~igna~re Of applicant) Nota~ Public, StYe of New Yo~ rio. 52,03~4963, Suffolk Cou~ ~0fil~lon Expires M~rc~ 30,