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Home My WebLink About5413-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerli icnle Occupnncy No. ~1~] ...... Date ............ D®O. · 1.~ ....... , 19.~.. THIS CERTIFIES that the building located at . Delma~ 'Dr~ ............ Street Map No. Laul~l. ¢OU~~.te~ ...... Lot No. 1~ -. I~ltre.], · -N,Y., ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ,]'u~ .... 19-.., 19.?1. pursuant to which Building Permit No..~1~. dated ............ Ju~.... 19., 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 .. Pr. ira te .one..fam~h~. dwelling ...................................... ertificate is issued to . .ZnlMld. lt~mes..Zne ....... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ilec. 8.. ~9.7~[.. ~ .B,..V.:Ll~a ....... Bouse ~ 1(o~ Delmar .... f;'~:':'?~" :' '~' " ' :': ...... i' ............ Building Inspectlr FOI~ 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) N? 5413 Z Permission is hereby granted to: ................... to ..... ~I .~...~l~...~...~'.~m~.....X:t~L3.lJ.~ ............................................................................ at premises located at ..~.~...~.~.....~dlt~ilLl~..g.~I/il3.t~...SJIl~t411 .................................................. pursuc~t to application dated ............: ............... ~t~. .......... ~kg. ....... , 19..~., and approved by the Building Inspector. Building Ir~ector TOWN OF SOUTHOLD BUILDING DE.P~RTMENT TOWN CLERK S OFFICE .~ SOUTHOLD, N. Y. E×am,ned ..J....~ .......... ]9 '~ ! S'-~ ,_~ ......... Application No ................................. ........................................... , ....................................... ~ ~ ~ ~- ~_~ ~-~ Disapproved o/c ..................................... . ~'~-~ ' _~__ ...... ~--=__1~ APPLICATION FOR BUILDING PERMIT Dot, ........................... 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detoil~l description of layout ofproperty must be drawn on the diagram which is port 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 to the applicant. Such permit 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 o Certificate of Occupancy ~- shall hove been granted by the Building Inspector. ,APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The npplicant agrees to comply with off a. pplicable lows, ordi nonces, building code, housing code, and regulations. .................................. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. .............................................................. If applicant i~ a corporate, signature of duly authorized officer. (Na~Blb and title of corporate officer) Location of land on. which proposed work will be done. Map No.:~l~:~l/,~..~.;....i~..~....~.... Lot No ..... J}..~ ........... Street and Number ]~....~ ../~.....~1~..~,.,..~J,~...l~'.. ~..0~..~: . ; ~ ~::~/-/~ ~.~ ;/ .......................... Municipality *' 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 ............ /......~....4...~.....~...~.,......~.....~.....~.~...~.&/.....~.....~,..... .............................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. f~e)'n~;~a~O;.c:~ ........Demolition ............... :.. Other WJ;irke[i~iscribe) ........................................ 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwell~ing, number of dwelling units ............................ 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 e~cisting structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ........................................................... ; ..................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ..........................He ght ......... ..~"~'~u~ber of Stories ........... ~.. ............ D mens ons A~ ent re new construct on Front Y~. ~Y " "~-~ ~' .... ~ .. ~1~ Height ~ber of Stories ......... I"'/~'~ ............. '1 ~ O · ' 9. Size of lot: Front ........... '~r!~"7/~'/"~7'" Rear .................................... Depth .............. 10. Date of Purchase ........................................................ Name of Former Owner ............................. 11. Zone or use district in which premises are sLtu. ated ............................................................................................ 12. Does proposed construction violnte, aog zon/na_law, ordinanoe c~_reau arian? ,, . ..,. .............. 13. Nome of Owner of premises ......... ~ ......................... Address ............. ~ .......................... Phone No ...... ~4~ ........... Name of Architect .......................... ~ ........................ Address ................. ~ ..................... Phone No ........ .~ ........... Nome of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck 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. ...... ........ t.~.~rY~.r...v....~e......~ ............................ being duly sworn, deposes and says that he is the applicant (Name of individual signirl~ application) above named. He is the ................................... ~ ................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized ta 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 thor the work will be performed in the manner set forth in the appliccrtiorr filed therewith. Sworr~t~ ]pefore me this /'~ __ , 1~,.~'?t~,'W~.w_~m~ ........ . ................................... ....~...~....~..e, ........ ~ ............................ ........ ou., (S,0na ,e of pp,,cant, ~ ~t, aled wok #.Y. Ce. ClI~ & Re~ gl& S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Permit No. I77~ g-ql3 Z.. 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. DEC 8 Chief of General Engineering Service~ 1971