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Home My WebLink About5378-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.8147~l,. ...... Date ............. $111~r' "'20: '- ', 19 ?2' · Street THIS CERTIFIES that the building located at . ¥~.. ~,. &~ ...... ..... Map No. ':llJ: ......... Block No. ~ ...... Lot No. ~.. '~1~110~' ' I~i, ........ conforms substantially to the Application for Building Permit heretofore filed ihi this office dated ......... i~l~0' ' 2~' '" 19.?~. pursuant to which Building Permit/'No..,..' . dated ............ ~I1~ · '2~" ' 10.~,~., was issued, and conforms to all/0~ the require- ments of the applicable provisions of the law. The occupancy for which thisleertificate is issued is '1~'[~'8~0' '~,0' l'~lt.~.l~" '51~'01.'~tlit ........................... ~ ........... The certificate is issued to .. '~'!~'~'' ~1~'~. ....... 0~ ......... ~ ............ (owner, lessee or teI~ant) of the aforesaid building. Suffolk County Department of Health Approval . M~. ~ .¶ 9r~ .. 1~ .11,'~,. ~',~lJ.& ...... UNDERWRITERS CERTIFICATE No.. '~.1~' · · ~ ..... ' '' .......... HOUSE NUMBER... ~[~ ..... Street .... ~1,~' '~I1'~ ......................... ! ' · ......... Bu'ldmg I?)eCt0! FOR~ NO, 3 TOWN OF SOU'THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 5378 Z Building Inspector. Fee $,...~.~.~..~. ......... Permission is hereby granted to: ............... ~'~g.e~l ~e...~].~epme~ak~[.i ................. ...................... ~'ateh~gje .................. : ................. to ,~,~.. ~e.w...e~L £eaX~...~'~1 Lts~ ......................... ~ ......................................................... at premises located at ........... ~'/t~"~/'"$t~'e ...................................................................................... ....................................................................... .~u~l~ ....... ~.~.. .................................................. pursuan~t to application dated .............................. ~t~lll.....~-~..-.~...--, 19..~.J., and approved by the Building Inspectf FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at....M.../~...~..~.~ ............. Street Map No... ~ ....... Block No...~.. ...... Lot No..X~......C...~e...~...Z~....[~ ........ confoms substantially to the Application for B~lding Permit heretofore filed in this office dated ........... ~.. ~., 19. ~. pursuant to which Building Permit No. ~.. dated ......... ~...~ ..... , 19~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~..~? .[~. ~ ........................................ The certificate is issued to . ~. ~$~ ...... ~$ ........................ (owner, lessee or tenant) of the aforesaid building. S~olk Co~ty Department of He~th Approv~ .. ~...~....~...~. ~.~. Building InspectOr S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for (give deed l~cation/) a structure located have been inspected by this department and found to be satisfactory. Ch~_'ef of Ceneral ~?~nsc,,, rln'F~ Sezwlces 'row~ OF Sou'r. OLO ~ ~'~ ~-'-~--- ~ TOWN CLERK'S OFFICE - ~.,~c- SOUTHOLD, N.Y. .-/-/~ ~ ~ ~ / '/ ~' ~ ........ Exomined ............................ , 19 ~ [ Application No ................................ ~ ~proved ................... ~ .................. , 19..~.~.... it No ..................................... ,op ro ed .......................................... ....................................................................................................................~~ ~ ~ ~~d .~' ~ ~ ~ ......./_ ......... INSTRU~IONS ' ' ".' ~ a. This application must be Inspector. b. Plot plan showing location areas, and giving a detailed descri c. The work covered by this d. Upon approval of this c shall be kept on the premises avail e. ~1o building shall be shall hdve been granted by the filled in by typewriter or in' iok and submitted in duplicate to the Building lot and of buildings on premises, relationship to adjoining premises or public streets or of layout ofproperty must be drawn on the diagram which is part of this application. >lication may not be commenced before issuance of Building Permit. ~tion, the Building Inspector will issue a Building Permit to the applicant. Such permit le for inspection throughout the progress of the work. used in whoJe or in part for any purpose whatever until a Certificate of Occupancy APPLICATION IS HEREBY MADE to Building Zone Ordinance of the Town of Regulations, for the construction of bull, The applicant agrees to comply with all apl Department issuance of a to the Suffolk New York, and other apl for'removal or demolition, i, building coder housing code, and or name, if ai (Signature of State whether applicant is owner, lessee, agent, architect, an, plumber or builder. Name of owner of premises If applicant is a corporate, signature of duly authorized officer. . ' 1. Location of land on which proposed work will be done. Map No.: ....................................... Lot No .. Street and__Number ..~..~...~.....~,...~......~..~ ............................. ."~.-.~..~...~.~.~.~. ~. ........ i ............ '/ 2. State existing use and occupancy 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 applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~ .................. Number of dwelling un ts on each f oar ............. 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 .................................... ~eor ...... ~..~........-~.. ..... Depth ................. '~. ...... Height .................... Number of Stories ........ L. ...... . .... 9. Size of lot: Front ....~..~...~.~.~..~....[. ' " Rear ...~../.~..<..~..~. ................ Depth ..../..~.~..:.~....~.........~ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction~.~/ - ~,,,vi°late any zoning law, ordinance or regulati~,,~L// ........................................................... 13. Nome of Owner of premise~.~.~i~....J./~'.~,~ddress ..~.~r~,~.~.~..,v~ .~....~.. Phone No Nome of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor ............. ~..~//',,,f/'~{~. .................. Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. NEW 0 K, JSS / co~~.....;~~ . . . "~~ "'~ ~ing duly swam, d~os,~ and sa' t~' he is the a Ii (N;~;';~ i~~";~;ii~;~ ........ 7: .... __ ~ , y~ pp cant o~o~e n~m,~. ,, ,s th, ................. .......... ~.~Z~.C....~.~J ........................... (~ntmctor, &g~t, co~orate officer, of said owner or owners, and is duly authorized to perform or hove pe~o~ed the ~id work and to ~ke and file this application; that all statements cont~in~ in this applic~i~ om t~ to the best of his ~owledge and belief; and tha~ the work will be performed in the manner ~t fo~h in the opplicatim filed ther~ith, Swam to b~ore me this ~ ...~...~, ..... ~.. ~ ........ . ,~....../~ ~ :f~. .... ~ ............ "~" ~2 st258~o S~k Co~