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Home My WebLink About5396-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~.~3 ...... Date ............ 14&~r.. 2.6 ....... , 19. THIS CERTIFIES that the building located at l(~. 8~¢l. ¥;l.®V. ~rO ..... Street Map No.. ;1~ ....... Block No... ;1~ ..... Lot No~DI;Z... I~.O~;~O'll:l .... 1~.¥, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ,]'~]L;~ .12 .... ~119 .... pursuant to which Building Permit No.. dated ......... ~.~.7 ..... .]~.., 19. ?.1., 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 .. l~l~llg~;e. O11~. ;falit:l. llr. ~,~ol].:~g ..................................... The certificate is issued to .. ~o~'go..t~e~..][¥ ....... ~1' ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Ja.~. .~...~.97.2 !~.R.o..~i11~ ...... UNDERWRITHRS CERTIFICATE No .................................................. ItOUSk: NUMB[:~R. 9305 ....... Street... ~t.llll,D.I!..~:~W..~.0 ............................. ....... Building Inspector FORM NO. ~ 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) 5396 Z Permission Is hereby granted fo: .............. .~ ~.~t...~.~,.~....I...V. ............................. ................. i~ ~.~/$.t.uak ......................................... to ....... ~u~.~,[..ne ~...~n.......ma~.. ~me.l~$~l. ............................................................................ at premises located at ....~lJ~..~Gt~l~d...l[~.elf...~. ............................................................................ ............................................... ~,the3~d. ...... ~..?L.. ............................................................................ pursuor~t to oppficotion dated ............................... .~?',L~' ........ $.~ ....... , 19.~..~..., ond approved by the Building Inspector. Fee $..%~.,OQ .......... ...... /.*.,,...- ................. ~.......-,;.....,...l .................. / Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTHEHT OF HEALTH Date ~4AN 11 197Z Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure (Give deed location) located have been inspected by this department and found to be satisfactory. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .A~./.f. ~.,.~..~..~.,~....~treet Map No .... .X. ....... Block ~o... X ...... ',or No.. :. ~ .... ..~.~..~-~/..~......~/ conforms su~tantially to the Application for Building Permit heretofore filed in this office dated ..... .~ .'v.~..-~..~...~.'.., 19..'];. ~ pursuant to which Building Permit No..~.~..~. (:'. dated ...... ~te.,. ~'.~....I..~...., 19.~.!., was issued, and conforms to all of the require- ments of the )licable provisions of the law. The occupancy for which this certificate is issued is ~.~ :~-:.'...(0~...~: ~...'~. ~..~.. ~~, The certificate is issued to . ~.'~.':. ,~ .... ....... ~ ..... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval TOWN OF soUTHOLD '-' ~-~/~/~ - ~/~-~ ~ ~ BUILDING DEPARTMENT ~ ;--~3~- / ToWH CLERK'S OFFICE ~, / '// ~. ~ ~ S~THOLD, N.Y. ~ ~~ _ /,.. /}~ Exomin~ ..~.~ ~ ....... :~ .......... , 19..~ ipali~lion No..................~ ~.X .... A~roved ........................................ , 1~ ........ Permit No ............................. Di~ppr~ed,/~ ......... ~ ................................................... ~ ........................ ~ ~- ~ ~ ,~ INSTRU~IONS a, T~is application must be completely fill~ in by t~ewriter or in ink and submitted in ~plicate to the Building Ink.tar. b. Plot plan s~owin~ I~ation of lot and of buildings on premiss, relationship to odjoiniag ~m~s or public streets or areas, and giving a detailed description of layout of pro~ must ~ drown on t~e diagram which is ~ of thi~ ~pplic~ti~. c, The work cover~ by this application may not be commenced bafore issuance of Building Permit. d. Upon approval of t~is application, the Building Inspector will issue a Building Pe~it to the applicant. Such shall be kept on tBe premises available for inspection t~ruughout th~ profess of the work. e, No building s~ll be occupied or used in w~ole or in part ~or any pu~ose w~atever until a Ce~ificate of ~c~ncy shall have ~een granted by t~e Building Inspector. APPLICATION IS HEREBY/v~,DE 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 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. Geerge Penny IV (Signature cf applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genera contractor, electrician, plumber or builder. .......... .................................................................. Name of owner of premises ..... .~l~.tl~'.~..~..~,,-'l~.....~..Y.. .......................................................................................................... If applicant is a corporate, signature of duly authorized officer. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~(Name and title'of corporate officer) Lot N'o ' 3cx 1. Location of land on Which proposed work will be done. Map No.: ...... ~F~.~. ......... ~ ......................................... Street and Number .......... .I~/~...~.tt.I~.~....Y..:J,.e.~....~.~.e. ....... ..S..~.I~..~..~..e...]...~. .................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .~.&C,&]13.~..'lazl.~ .............................................................................................. b. Intended use and occu[;an:', ....................ei3.eJ..~.nJ::['l~'...~.~Ja'l'lfl3,J ............................................................... 3. Nature of work (check which applicable): New Building ~.~ ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................ 20t.00J~.....'~... ..................... Fee ....1...0.~..0...0. ........................................................................... (to be paid on fi~ing this application) 5. If dwelllng, number of dwelling units .....~T~e ................. 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 .......... [~l/r. ..................... Rear ..... ~8. ................. Depth ...~.8 ................. height .................... Number of Stories ...~.~ ............................................................................................................ 9. Size of lot: Front ....~0~. ............. Pear ........ ~.0.0~ .................. Depth .............. ~..0...0...~+ ...... 10. Date of Purchase ........ ::[.~..1 ....................................... Nome of Former Owner ..... ~:L].'i.~L~.ItS...~..S.~ ..................... 11. Zone or use district in which premises are situated .....I.~.JL.~l....d..~..s...~. ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~a~ ........................................... 13. Name of Owner of premises .....G..e...e.~'..g.e....?.e....z.~.?-...Y.....[..V. Address Ma.'l;~ c .............. :~.~.~.. ~ ................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .....s...~...e. ....................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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 YORI~,, ~t- COUNTY Of ........ ~..~..,[..?...'~... ...... }"~"~' ~ ~ ..................................... ~.~[~..'~.~...[~. ....................... ~ing duly swo~, d~eS end soys t~t he is the opplicant (Name of individuol signing oppllcati~) obove nemed. He is the ................................ ~=..,..~ ........................... '~ ....................................................... (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to pe~orm or have perfo~ed the ~id wo~k and to ~ke ~d file this application; that all statements contoin~ in this application am tree to the ~st of his knowl~ge a~ belief; and that the work will ~ performed in the manner ~t fo~h in the appllcatl~ fll~ the~lth Swam to ~fore ~ ~is .................... ................... .......... No. 52-8125850, Su '~ Term [xpir~ March 30, SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~JAN 11 197~ Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory.