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Home My WebLink About5247-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~+3 29 .. Date THIS CERTIFIES that the building located at $/8 Map No. xx Block No. Ix Lot No. xxx .... Aug 10 , 19 7.1 Peconic Bay Blwa Street Latlre. 1 N,Y, conforms substantially to the Application for Building Permit heretofore filed in this office dated .&p!qil 19 , 19 71 pursuant to which Building Permit No. dated .. April 19 , 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 . .Private one family..(.sur~:er cottage). ~welltl~g ............. The certificate is issued to Ke!e~ l',ql,ls!ty.. D'~ner ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. J.u!y 15, .197.~.. by k, Villa Underwritcrs Cert ~ N892316 /~(~,,.~..,/...,/..:q .~.,! House ~ 160 Peco Lay Blv..d .... / ; ~uilding Inspector / ? TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5247 Z Permission is hereby granted to: ................................... ~...~...~ ....... ..=..,..z...,. ............................................................................................. pursuant to application dated ................................... ~l~..;.JJl.., 19...~.~, and approved by the Building Inspector. jjjjj~jjj JJhl~ llJ~j~ ~ ~l~ll~l~&~lt li'lll'~tt~'~' ~l~l~,t4i~l~tl ~ ~ $...~ ........ Building Inspector/ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: at ~e sewage dis po sal fac il it i es for a structure located (~ve deed location) / have been inspected by this department and found to be satisfactory. JOt 1 5 fg7f Chief of General Engineering Servtoes ¢. J. ~-~NUL T Y '~$ TA TE NO, I T~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMI'I ate ............. ............................... ,19...z.../.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in c~upJicate to the Bu~ldi Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicati. c. The work covered by this application may not be commenced bafore issuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such per~ 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 Occupa, 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterahons, or for removal or demolition, as herein clescrib The applicant agrees to comply with all applicable laws, ordinances, building co~, h~.gJ~,sJng code, and regulations. ( 'g e c app 'cant, or name, if o corporation) (Address of applicant) State whether applicant is owne~_.lessee, agent, architect, engineer, general contractor, electrician, plumber or bull, Narne of owner of premises 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 dane Map No,: ........................................ Lot No.: ................... 2. State existing use and occupancy o~ premises and intended use and occupancy of propos~ construction' a. Existing use and occupancy ............................................................................................................................. b. Intended use and occupan:, ~4.~'.~.,..~1~'.....~...~.. ~/~='/~/~ Nature of wo~k (check which apphcable). New Budding .................. Addit,on ................. Alteration ...... Repa,r .................. Removal .................. Demolit,on .................. Other Work (Describe) .~.//~.~'//~/~..~..~..~.~,~'./O. 4 t, .oted Cost ......... .................................... Fee .................................................... .. (to be pa~d on filing this apphcat~on) 5. If dwelling, number of dwelhng umts ........... /.. .............. Number of dwelling umts on each floor ....................... If garage, number of cars .......................................................................................................................................... 6. If business, commercml or mixed occupancy, specify nature and extent of aa.ch 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 Stones ............................. 8. Dimensions of entire new construchon: Front .................................... Rear ............................ Depth .................... Height .................... Number of Stones ................................................................................... 9. Size of lot: Front ......... ...~.../...~... ....... Rear ......... ..~....~....O.. ............. Depth ~-/~'~ 10 Date of Purchase ...................................................... Name of Former Owner .................................................... ] 1. Z~one or use district in v, hich premises are situated .................................................................................................. 12 Does proposed construct,on ~iolate any zoning law, ordinance or regu. lahon;~ ...... ../~..~ .......................................... 13 Name of Owner of premises . ..~..'...~... ......... ~.. ............... dd s .... ~ .................... ./... Phone No~'.~.~. .......... .~. Name of Architect ...................................................... Address ............................................ Phone No ................ Name of Contractor .................................................... Address ............................................ Phone No ................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and red,cate all set-back dimensions fr, property lines. Give street and block number or descriphon according to deed, and show street names and indic- v~hether interior or corner lot. STATE OF NEW~O~(,/;~ tSS COUNTY ............ / ............................. .'..~ ...... ~,.C~..~..~'~.....~.~.../'~.~..~.~,. ...... being duly sworn, deposes and says that he ,s the appho (Name of individual signing applicahon) above named. He ~s the ............................................ ~ ........................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and this application; that all statements contained in this apphcation are true to the best of h~s knowledge and belief, , that the work will be performed in the manner set forth in the applicgti~n filed ther~wit~ Sworn to before me this ~-~. ? ........ . ............... ry ' · ......... ('g opp'ca ) '"'NOTARY PUBLIC, State of New York No 52-81.25850, Suffolk Term £xp~re~ March 30,