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Home My WebLink About5349-zFORM NO. ¢ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~' ~'~'Z'¢' Date ............ ~.../~/A .~ ..... , lg.~.~. THIS CERTIFIES that the building located at ~,~.. ~. ~D. ~'7' Street Map No .... ~,, ...... Block No .... ~. ......Lot No ...... ,~. .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ /¥~]W~tE ..... , 19~ pursuant to which Building Permit No. ~7~.~, ~ / dated ........ /¥ o'tt~: .... , ~ff.,., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .... -,JO -. ~ ~tM .... ~,~ ti 1., I t~f-'-~./'/.t~/, .~. ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Appr0.val if~/~.T& ..... ~.~.~.T....~.. ~./A~-~ / UNDERWRITERS CERTIFICATE No ........ ~V' ....Y',~ 'a/g ~;d ..... ,__'..~ .................. HOUSE NUMBER..~ ~ 9t2~....Street...~¢6tCg,,r .~ .... .-j~t~.~, .'[..~,.'~. ............... ...................... iZ, ..... ..,, . .......................... Building Inspector FOiI, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5349 z Permission is hereby granted to~o' /4/~'A/ ~'~J¥ ~, J ~' ~ H/~ LT-..-~ .... ............ at premises located at ....................................................................... ~' ....................... .~.:/ ............. pursuor~t to ~ppli¢~tion doted ] ~[ ~M~ 19~.~., ~nd approv~ by th~ Building I n.~. Fee $ ........................ Building Inspector S-9 > SCHD -- SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. TO WHOM IT MAY CONCERN: at The sewage disposal facilities f/~r a structure located (Give dee6 locati&n~ I / have been inspected by this department and found to be satisfactory. ~ef of ~nsral Engineeri~Z Services APBI 1972 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE ~proved ............................. :: ......... , " ~ gO Z Disopproved o/c .......... ~. .................................... : ........................................... ........................ ....................................... .............. ................... :.:.re,g;} ...... Dat~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building~;~ Inspector. b. Ptot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or"~ areas, and giving a detailed description of layout ofproperty 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 t° the applicant. Such perm 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 Lawsi Ordinances or 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, ordi nances, building code, housing code, and regulations. "k/,7 ... State whether applican~ is owner, esse~//~ge~t, architect, Name of owner of premises .................................................................................................................................................... (Address of applicant) engineer, general contractor, electrician, plumber or builder~ '.~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... ........................ ~ ............................................................... ~'aTi'gi~g~i'~ ........... 7 ........................ State existing use and ~cupancy of premises and intended use and ~cupancy of pr~osed construction: a. Exisiting use b. Intended u~e 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Remo~l ..................Demolitior .................. Other.Work (Describe) ........................................ 4. Est mated Cost ~' /.~ O0 C7 ~ Fee /.0~ . (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ..~..,./~....~...C ........ Number of dwelling units on each floor ............................ If garage, number of c~rs ............................................................................................................................................. 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 ............................ Depth .....~....~... ........... Height I.~ Number of Stories ............... ._. ............................................................. ~....~.. ~. 9. S ze of at Front ~.../~..: .~.~ Rear ...~..-.~...~ Depth ~.?... ?~"'? ....... ~'~'~"-'~-J ................................................................ : ......... 7 ' 16y Date of Purchase Name of Former Owner .~..' .~.~'..A~.. ~ S ~;r~-*, 11. Zone or use district in which premises are situated . ...~....~...'~.../..'~... . . 12. Does proposed construction violate any zoning law, ordinance or r~gulation? ..... ~ ........................... Name of Owner of remses~/~)')~//A/ ~'~'h~/JE..~..~...~re ~.o ~(. /f~/~?~,~ B~.~ · __._' ....... 13. p ....................................... ~aaress ............................................ Phone ~o ..................... 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 indicate oil 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 NEW,,~O~i,~ J¢¢ cou ,v OF ........... ' ........ ¢ .... ......................................................................... ~ au~y ~om, d~oses and says t~t he is the applicant (Name of individual signing a~lication) above named. He is the ...................... ~.~.~.~. .......................................................................................................... (Contm~or, ag~t, co,rate officer, ~c.) of said owner or owners, and is duly authorized to perform or h~e peffo~ed the said work and to ~ke and file this application; that all statements contained Jn this applic~ion am tree to the best of his ~owledge and belief; and that the work will be perfor~d in the manner set fo~h in the ~pllc~i~ fil~ ther~ith. Swam to before me this ................... ........ . Nota~ Publ'c, " m,,~'~:. _. . ...... Coun~ ~ (J (SignOre of applicant) ~ ..................... ~0. 52-812~ S~ t r York . . MAP oF LAND