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Home My WebLink About5350-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy N°I~252 ....... Date ............. Jl~e' ' '~0 ...... , 19~3. THIS CERTIFIES that the building located at .11/8. ~ .lid. ,{0~,~.) ... Street Map No...xX ........ Block Nou ........ Lot N~O[... Hatt~l,tl~C...1~,~.... ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J~p_a..$1~.., 19 ~.1. pursuant to which Building Permit No. dated .......... J~...~1~..., 19.~¶., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .. P~$v~ .01~..£me~.~]r. dV~,l~J~ ..................................... The certificate is issued to RIIdl. · .Seht~. ~ ....... 0iole~. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · · 'Ja~ 'I~. · '¶'~3' · ~' 1~..V~... UNDERWRITERS CERTIFICATE No. '!1' ~01~' ................. 'iI .................... HOUSE NUMBER.. ~ ...... Street .... ]~g~,a],~. aO~. ~!~)...! ..................... Building Inspector. FOElVl NO. 3 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) N? 5350 ranted hereby .... /' '] '~"~ ' '~'~' "/' ' "'"~; ": '" ' '~: ' 'C~' ' "~' ~ ~' ~ ' '~" i~ ~ ! ///~:~,0~ r' ~ h") ~z~/~:'~,· ~-7 ' at premises located at ................................. J(~......'.."...~......: ............ ~..~.....~....; ......... :.,.'. ...... ;....~ ................ ............................................................................................ ~J.~.::7:(~zz.~z~ .............................. ...................................................................................................... : ...... ~C..~.:: ........................................ pursuam to application dated .................................... ......'.....:sJ.t..~...~., ]9~., and approv~ by the Building Inspector. Fee $...,g ................... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH J^~ 2 9 Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. O~ie~ of 0eneral E~ineering ~ervices JAN 29 197'3 TOWN OF SOUTHOLD BUILDING DE PA RTMENT//~_ TOWN CLERK'S OFFICE SOUTHOLD, ". Y. ..... ......... , ........................... ........................................ , 19 ........ Pemit No ..................................... Disapproved a/c ....... ~ ................................................. :. ................................. ................ ..................................................... ............................................ ~ ~. /~ . '-I ........ ........................................................ (Building Inspector) / - APPLICATION FOR BUILDING PERMIT ..................... .., I~STRHCTIO~S o. This application mu*t be complotel~ fillod in by ~powriter or in ink and submitted in duplicat~ to th~ Buildin~~ Inspactor. b. ?lot plan showino I~ation of lat and o{ buildinos on premises rol~tionship to ~dloinin~ premi~o~ or public stre*ts o~ ~re~s, ~nd oivin~ o det~ilod description of l~yout o{propo~ must be drown on the dioomm which i* ~ o{ thi~ ~pplication. c. lbo ~ork ear, rod by this application m~ not b~ comme~ed borate issuonc~ o~ Buildino P*rmit. d. ~pon opprowl o{ this application, ~e Build n~ In~p*ctor will issue o Buildin~ ~ermit to th~ ~plicont. Such permit shaft b~ kept on the pr~mises ~wilabl~ for inspection throughout th~ pr~r~* of th~ work. e. ~o buildin~ shall bo occupiod or u~d in whole or in pa~ for any pa~os~ whatever until ~ Ce~ificat~ of ~eupancy shall h~v~ bo~ omnt~d by th~ ~uildino 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 applicc~le Laws, 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, ordinances, building code, housing code, and regulations. ( i,i,i~/~ure of applico ,r~r nome, if o corporation) ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 1. location of land on which proposed wor~ill be done. Map No.: ~ ....................................... Lot No ........ Street and Number ......................... .~....~..~'. ....... ..~/../...~..~..l.....~........~....~.~.........~...~..~.~.....~....7. , ....~....~...~.~i~.~.'.'~i.~ 2. State existing use and occupa~y 'of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ..............................................~.. ...................................................................... 3. Nature of work (check which opplicable):'New Building .................. A~dition .................. Alteration .................. Repair .................. Removal ................. : Demolition .................. Other~ork (Describe) ........................................ 4. t moted Cost .................... Fe, (to be paid on filing this application) 5. If dwelling, number of dwelling units............................~/J/~,~ Number of dwelling units on each floor ............................ If garage, number of cars .......................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of e~ch t3/pe 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 ................................ new cons'traction: Front .............. ...-~.....~.. ............ Rear ............................ Depth ..... ..~...~... .......... 8. Dimensions of entire Heght ~.~ Number of Stores ~,..A~...~...'~... 9. Size of lot: Front 10. Date of Purchase .................................................... Name of Former Owner ....~.,.....,~...)r~..,~/.,..,,-~,,..,,~,,.,,~,.~.,.Z.~-- ...... 11. Zone or use district in which premises are situated 12. - - ' 'R. ............... ~ ................................ Does proposed construction violate any zonine aw ord nonce or reaulation> ' 13. Name of Owner of premises .~...~..~../.......~....H...L. !..E...~...H..0..L..~ress ~.~.: .~..1~.~.~.:.....~....~... 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 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. COU~4'v,-; "7~ o,~..b STATE OF NE~Y~,R~J~ ! e e COUNTY Of ~ ................. ~.~ ................ '" '.JfiuE's M SEV4 · ................................................. ~.. -~.. ........................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named He s the . .~.. ~' E ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make 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 applicatiow filed therewith. Swam to before me this _ ~, ~ of ..... '- :, ......... mo ary 'c, ..__ ~ IL[£ ....... Count,/ /// (Si~-(;~l~ii~';;~;)' ...........................