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Home My WebLink About5222-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~.~.3.6. ....... Date .......... F,~.l~.~r ~ . , 19. THIS CERTIFIES that the building located at WateI'S. Edg~..W~y. Street Map No. ~ . Block No.. ;i~ . Lot No... XXX... l~cruthold N,¥~ ... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Ma.r.¢h . .10, 19. ~ pursuant to which Building Permit No. dated .......... .M&t'.ch .$.0 , 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 . .Pl, iv~te c~e-ff~lly..dwelq.~,~g ............................. The certificate is issued to Arthur..B~t~nows~.~. of the aforesaid building. Suffolk County Department of Health Approval House ~ 136~ Underwriters ~ N92~;291 (owner, lessee or tenant) Jaa · a6. · '~972. · .by. R. Villa - · .... .. Building Inspector FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON-THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) lq? 5222 Z Permission is hereby granted to: ........ · T.,,...;~e~,.... ~.. A.~.*,~1~'r. ............. ~q~-.-1~,~...9~.~ ........................................ .......... .~t~,~mt,~ ..... lll.~'~ .............................. to ....~..~*~...~n~., ~ !~..~ 11~.~ ................................................................................ at premises located at .......... ~,~.~...~f.~...$.~ ..~....j~&~lt~et..]~&,~..1~F-~.~..~ ....... ...................................... ~..~e~t~e2~t, ...... ;~.~t. .................................................................................. pursuan~ to application dated ........................... ]~,~'~ .......].0. ........ , 19.7..~.,, and approved by the Building Inspector. ]Zee $..11~t~t .......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~ld~. P~mit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give de~d location) ' have been inspected by this department and found to be satisfactory. ~tef of ~ener~ Exomined ~ ~' /0 19.,~ / pp d ......... ~ ................. , 19 ........ Permit No ............................. ........................................................................................................-- ~ : .... Oc-c~ .....J/--~ ................. .................... APPLIGATION 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. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premiees or pub c streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is pert of thie application. c. The work covered by this application may not be commenced before issuanCe of Building Permit. · d.... Upon appr.~al of .this application, the Building Inspector will issue a Building Permit to the applicant. Such permit sna, ~e kept on the premtses 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 Perm t pureuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicab · Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remova or demolition, as here n described. The applicant agrees to comply with all applicable laws, ordin~es, building code, h~lng code, and regulations. ~/ (Sig~'ature cf applicant, or name, if a corporation) ..................................................................... ~.~~.. (Address of applicant) / State whether applicant is awner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ~.,.i ../.~e~ ............................................................................................................................................................ Name of owner of premises .. ~ ......................................... If applicant is a corporate, signature of duly authorized officer. ................................................................................................ ~7. ~.z ~/~ (Name and title 'of corporate officer) 1. Lacation of a d on Which proposed work will be done. Map Ne.:~./,~,~.~.z.c~.#.~..~... ..... Lot No.: ........................ st,,. and ...~ ....... ~ ........ '/. ............................... ~ ...... /~.~. ..................... ~.~ .......... . ...................... Municipality 2. State existing use and occupancy of Premises and intended use and occupancy of proposed cormtruction: a. Existing use and occupancy ......~/.~..~..~9..~...-~... .......................................................................................................... occupanc.,.' 0-~ ~'~"/'._( _V._ -- /~.,~/~ ~,'~ ~ b. Intended use and ............................... 7'"' ............ ............... ~ .............. .................................... ~ 3. Nature of work (check which applj lie): New Building ~.....~... ....... Additir~. ................ Alteration ......; ........... · Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost '~c>~'/X'.~ ~ .......... ~ ............................................... rea .......................................................................................... (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 same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... .~. ...................... Rear .~......~...r...~.. ........... Depth ....~....~...'~..~..?..~ Height..~.....~...~ ...... Number of Stories ........ ~ ....................................................................................................... 9.Size of lot: Front .../..~..~. ................ Rear /. n o De t /~..,,2 ~.~ ~ /~ ~. ,/2. . .~.~. ............... ~.,Narne of Former Owner ~...~..~/~..~ 10. Date of Purchbse .9.~. ........ ./.J..~. .~...~....~...~...$.. .,. .... /~.~,. ..... 11. Zone or use district n wh ch prem sas are situated ...'iz~...::.....~./i'~....~. ....................................................................... 12. Does proposed construction v olote any zon ng law, ordnance or regulatio, n;~ ..... .~....~..,,~. -- . .~.~..~ ~ 13. Name of Owner of premisest~..~'~t.~.t~...~.:..~..q~.*.~,~6~ddr,ss Name of Archtect/~.~;.~..~..~.~. ~..X~xl~..~.~. Address .~,.t.~e~'~°/ .. Phone oZ."~.. Contractor ~/R~.~/I~....~..~.'~..'~.~'.~.~.~..,~i ........ Address ~....~'.~..~.r..~..~$.~.~.~~ -- ............. Phone NoT.~..?..T~..~..~./... Name of PLOT DIAGRAM , t Locate clearly end distinctly all buildings, whether existing or proposed, and ind cate al set-I~k] d mansions from PwhrOePt~ert~r inl~erl~r GoirVcL~emreltotTnd block number or ~escription accc~g~ to d~/,~de;h$o~4:~eeet [nc~L~ .and indicate STATE OF NEW~OP-.,Ka /y~ lee .,PCet~,'c /~-/$x'" COUNTY~OF_i%.,..,__/,...r.,~_/...:',,Ifd;/~-~/./~ ...... f. '~' . ............ · .v.....~..~...T~.....~...M.~.d[~.A~L£*~.~...~..!. ....................... being duly sworn, deposes and says that he is the applicant (Nart~e of individua/signin,g application) above named. He is the ....~/,~.~./..'./.~.e~, ................................................................. ':: ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make ~nd file this application; that all statements contained in this application are true to the best of his knowledge and belief; and ti,at the work will be performed in the manner set forth in the application filed Sworn to before me this ......... ,~../~, ........ day of ....../~.~-.z~. ,C/~ ........... .o,o ...... .................. ........... NOTARY PUBLIC, State of New No. 52-3130400 Suffollc Count Term [xpire~ March 30,