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Home My WebLink About5206-zFOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southola, N. Y. Certificate Of Occupancy Date ........ .OCt; . 28 ..., 19..~ THIS CERTIFIES that the building located at . D~atact' Ave..(.Cor, lclin ~St) Street Map No. Gardan l~ts Block No ........ Lot No..19~20~2~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ lpl'i3~.. ~., 19 7]. pursuant to which Building Permit No..5206Z. dated ........ gIl~':~ . % ..., 19 71., 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 . .Priltal;o..ol~e. f. amil~, dw~.lling ................................. The certificate is issued to ]~dw&rd &.Alt, hea .8icl~r .. Owners ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approvai Ileuse 200 Building Inspector FOI~M 2/0. ~ 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 AUTH~)RIZED) 5206 Z Permission is hereby granted to: . ...~...~.......a..~.......m...~.. ~...$.. :~.~ ..... pursuant' to application dated ........................ &p~ ....... ~ ............. , 19....~J, and approved by the Building Inspector. Building Inspectol S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da~e 00T27 1971 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located / / (Give ~eed location)' have been inspected by this d~p~rtment and found to be satisfactory. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Yo 'Approved // 19.~I. ..... Permit No. .~c~ O (~ ~ DL~apprcw~t a/c ........................................................................ APFLIGATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plat plan showing location of lat and of buildings on premises, relationship to adjoining premiees or public streets or areas, and giving a detailed 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 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 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 a~terations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. - (Signature cf applica~, or name, if a corporation) .............. ........... (Addrqss oVapplicant) Stote whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ............................................................................................................................................................ If applicant is a corporate, signature of duly authorized officer. .................. ...................Lq 1. Location of land on which proposed work will be done. Map No.: ..~..~.~...~.~...~.....~.....~..Z..~... Lot No.:/.~..-..~..~.~../......~ Street and Number ....~..~....~...~.. ...................... ~...., ........ .~...~./. ................................................................................ e,~ 0 0 ~.~.~,~ ~ / Municipalih/ 2. State existing use and occupancy of Premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupant/. ........ ~...~.~.~..~.......~../.~...: ............................................................................................ 3. Nature of work (check which applicable): New Building J Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost~-,~5'~ ~.~ o ...... ;/ ................................................ Fee ................................... .... (to be paid on fi!ing 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 some structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Star ~J'-~..; ........... : ............... D~menslons of entire new construct on: Front ~..~. Rear ...~..~'.. .......... ~ ................ ; ~e,~'~ .a~-~,e-;~ Height .................... Number of Stories ....~m ................................ . 9. Size of lot? Front ,.~ ~ ............ Rear Z ~ . .... XoT .............................. 10. uate or ~urcnase ~.~ · .~.9..~..~ ........ Nome of Former Owner ~,~./::~..'/./ -- ~,~ ~. ,~, 11. ' .......... · ............... .."E; ............. .~...... ~ Zone or use district in which premises are situated .......................................................................... ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation:? ........... 13. Name of Owner of premises ,~..~..~,.~;~...~.[~...~/..o...~.. ........ Address ~,~.~.....;..T.' ..c./..~ ~ ~ ........... ~-.. Phone No ..................... Name of Architect ....... ~...~.~.sz~...F.. ......................... ;.Address ........ ; ................................... Phon~ No ..................... Name of Contractor ,~...~.,V. SJ'...?-.......~...,...:~...,J....~.J'......Address ..x~.~..Z~../..~...~,.~...~. ........... Pbene 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. STATE OF NEV~'~'O~,~ 4 tee C0UNTY, = ............ ................. : .... ~F,~,-,~,~ .......................... oemg duly Bworn, deposes and soys that he is the applicant (Name of ndw~dual~lgning applicat on) above named. He is the ................................... ~ ................... ~ ......... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly author zed to perform or have performed the said work and to make and file J~his application; that all statements contained in this application are true to the best of his knowledge end belief; and /t~,ar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ,-. .... ~ ........ d~ of ......... ~ .................. , 19./Z./...~...~ ...... I.'_ ,'Y') ...... .................... ...... Cou ty ' .................... NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk Coup. t~ Term Expires Ma~.-h 30,