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Home My WebLink About5221-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~..b~97. ..... Date ........... .~.e.p.~.. 2l+ , 19.. THIS CERTIFIES that the building located at . Clea~i~ & Br&itsta~ltSC&et Map No. S~tthf. iOl~Bl~k No .......... Lot No~0 ...... $~h~l~..~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~ .8., 19~.1.. pursuant to which Building Permit No. dated ......... A~tl. ~.. , 19 .7~, was issued, ~d confoms to all of the require- ments of the applicable provisions of ~e law. The occupancy for which this certificate is issued is P~iV~ .~9..~!Y. gw~$~.~ ...................................... The certificate is issued to .. ~~. Pillea · · ~e~ ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Dep~tment of Health Approval A~ . 2Q,. ~ . D~.R~. V$~i~ .... Building Inspecto~ 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) No. 5221 Z Permission is hereby granted to: -.-g-,,,..e~le~ml~-:l:.....,~./~- at premises located at .......~J~lJ~..~JlJ....~JJ~t~:;J~la...~.L~aJ~ ............................................................. ................................................ g:Lel~rlea~..&we.&..;l~~..~ .......................................... pursuant to application dated ........................... ,-".dJ:J)~' ...... ~ ....... , 19.~/.J..., and approved by Building Inspector. Fee $.-*J, JJe~.: ...... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located · ,/ /,J- J (Giv~Zdeed location) J ! have been inspected by this department and found to be satisfactory. AUG P, 0 1971 Chief of General Engineering Services TOWN OF SOUTHOLD BUILDING DEPAgTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ~/~.....~... ...... ,19.7Z " " " ^pproved ........................................ , I~ ........ Permit No ....... ^p,,=t,o. No Disapproved a/c ............... ~ ................. ................. (Building Insp~r-~--~'~ ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildir~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets ak_ areas, and g v'ng a data'led descr'pt'on of layoutof property must be drown on the d'agram which's port of this apphcation. 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 permj 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 Occupanc 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances a Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinanc~¥i~ingcod~n~code, and regulations. State whether applicant is owj~e.r, lessee, agent,~r, chitect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) 1. Location of land on which proposed work will be done. Map N°.'~.:~.,~,.. ,~¢~, Lot No.:/...~,.....! ............ State existing use and occupancy of pr~mises on~ ~d~d use and occdpancy of propos~:l eonst~Ction: b. Intended 3. Nature of work (check which applicable): New Building ,..~ .......... Addition .................. Alterotion .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ ....... .................. Fee ......... .............................................................. 4. Estimated Cost (to be paid on filing this application) $. 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 ......................... i.. 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 ....~.~..o.....~. ..................... Rear ...... ~..~.~...~ ........... Depth .~..~.. ............... Height ...~......~ ....... Number of Stories '.......'~...4~.......-. ............................................ 9. Size of lot: Front ...... ~...~...~.._.~. ...... Rear .......... /~...~.~....~. ............ Depth ...,/.~.~.~./....,~....~...~..~j0,~ ~ 10. Date of Purchase ......~...(...~.....~./. ....................N,~me of Former Owner ~.~..~.,...~.~.....,r~..,q,e~ .......... 11. Zone or use d str ct r~h ch prem sas ares tuated .....k~.~ ...................................... ! ........... 12. Does proposed construction~j~lat~enany nzojgj)ng law, ordinance or_..r,egulation? ...... ..~.......'. ........................................... 13. Name of Owner of premise~,~,,~:~K...~?,,~....Address ~~, L~,.~.. · Phone No Name of Architect .~).[.~.~..~ ......................... Address i~[ii[i[[ Phone No ..................... Name of Contractor~.~~ ........... Address Phone No. PLOT DIAGRAM Locate clearly and distinctly oil 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 lot. STATE OF NEW(~. P~.~/]~ .............. ~..~.'~.~. ....................... bein~ duly sworn deposes and says tho, he is the app icant (Name of.individual signing application) above named. He is the ......... ~ ! ...... ~....} .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rr~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to be$ore me this /,~ , ,e -- ....... ....... ,,..7/.. Notary Publio~,r~~~ County ~iSignatu re of NOTARY PUBUC, StJto of New York No. 52-8125850, Suffolk Term Expires Merch 30,