The URL can be used to link to this page

Home My WebLink About5432-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~. ..... Date ........... X&,~O]a, .....2 ....., 19.~. THIS CERTIFIES that the building located at . .0~O. ~111®. L~tO ........... Street Map No..~ ......... Block No...l~t ...... Lot No.. lgl~... Mat~kttuok..N,][. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Jttl,y. · .12.., 19.71. pursuant to which Building Permit No. dated ......... Jl~l~Y.. ~0 .... , 19.71., 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.$~ate .olde .£a~a.:l..]~y · ¢l¥®!~,~1~ ..................................... The certificate is issued to ...Maltr:}.~o (}ook$ ..... 0w~®l* ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~Oli~-- ~. $972..by. R., Vi,..~a .... . I U~del~r~ter~ Cert I~ ~920288 /~t ?..(... ............. Building Inspe~or FORM NO. ~ TOWN OF $OUTNO~D 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? 5 32 Z Permission is hereby granted to: .... ~3,ea~,~. · ~ er~u~"ctc ~'J:~. · ee~ · · · · A/~ · .I¢~,ee (3oeke ........... 3l~e....,~r.~...L~j..~e..patat~..~ ................. .............. S~.~r~ ....... ~,-~':~ ~'~'"i¢~'"' ................. to .... ~&.~.d...~e~..,~e .. ~..~,..ct,~;e.]:~ ...................... - ......................................................... ....................... (.. ep~.~e~e~ ..ts3~.-~e~.:re~...~..~-~e~t).-.... ......................................................... at premises located at ..... ~)~'e"~l;e"'~[;~"~'~l~'"~[' ....................................................... ............................................ ~;~'~ ....... ~;3;';'~"~;;~';"'" ......................................................... pursuant to application dated ......................... ~T~' ......-~j....'~r~..., 19.~¶.., and approved by the Building Inspector. Fee $..JO,.O{) .......... S-9 $CHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed lo~atton) //// have been inspected by this department and found to be satisfactory. TOWN OF SOUTHOLD '%/?! ~'/~" ~/-'"~/J"~"~)~' ~ BUILDING DEPARTMENT TO~ CLERK'S OFFICE ~ ~'-~ ~*~ ~ ** ~ SOUTH~D, N.Y. ~' .~ ~ ~ ~ ~ ~ Examined ..~ ~....~..~ ................ 19....~... F- ApplicatiOn No...~.~..~..~. ....... ;..., ...... /~.-C..~ ................... , ....... , ..................................... 3 ~ ~ ~ - ~ a~ ......................... ................ ....... ..... ....... .... .................. ................................... < ~. This opplicotion mu~t be compl*t~l~ fill~d in b~ ~powriter or in in~ ~nd ~ubmitted in duplic~ to the Buildin~ t Inspector. b. Plot pl*n showin~ I~mion. o{ lot ~nd o{ buildino~ on pr~mi*o~, relotionship to ad~oinino premi~s or public ~tr~ts or ~ ore,s, ond oivin~ o d~t~il~ d*~cription of I~yout o{pr~ mu~t be drown on the di~orom which is ~ of thi~ ~pplic~ti~. ~ c. The work covered by thi~ opplicmion m*y not be comme~ be{or~ i*suanco o{ Buildino P~rmit. d. Hpon ~pprovol o{ thi~ ~pplication, ~ Buildino Ink, tot will i~sue o Buildino P~rmit to the ~plic~n/. Such p~rmit ~ sholl be kept on the premis~ ov~ilabl~ {or inspection throughout th~ ~r~ss of th~ work. ~ e. ~o buildin~ *h~ll b~ ~cupi~ or u~d in whol~ or in pa~ {or ~ny pu~o~ whoever until ~ C~i{ic~t~ of ~cupancy ~ sh~ll h~ve be~ ~r~ntod by th~ Buildin~ In*p~ctor. APPklCATIO~ IS H[RfiBY ~DE to the Buildin~ Department {or th~ i~*uonc~ o{ ~ Buildin~ P~rmit pu~uont to th~ BuildinO Zone Ordin~nc* o{ th~ Town o{ ~uthold, Suffolk Count, ~w York, ~nd other ~pplic~l~ ~, O~in~c~ or Re0ul~tion~, for th~ co~truction o{ buildinO~, o~iti~ or ~ltemtion~ or for removal or d~moliti~, ~ h~r*in d~crib~. The ~pplicont ~re~s to comply with oll ~pplicobl~ Iow~, ordinonc~s, buildino c~e, housin~ c~e, ~nd m~ul~ti~. ............................. '"~"'J(Address ................... Of applico~t)'~' ................................... ~ ~ State ~e/' applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~..~..~'~./.'...~......~..~...~..~/...~. .................................................................................................... If applicant is a corporate, signature of duly authorized officer. ~ /~ (Name and title of corporate officer) '~-'P ~ 1. Location of land on which prc~osed work w' be dg, n~ /V~bp No.: ...... ~......~.... Lot No.....~.... Street and Number .~..~....~..~..-'...~..t~.~..~.........~.......~..~...~....~.. .......... ~,~.~..~..~...~...~.. ..................... iiiiiiiiiiiiiiii ~.~oO-D ~ ~ -~,.¢, ~,~-,,,,~ Municipality 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 cable): New 'Building ...... .../... ..... n .................. Alteration .................. Repair .................. Removal .................. Demolitio~ .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... ~T..s~..~...~....~...~'...~.. ........................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ./ ................. Number of clwelling 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 .~...~'.. .... I~,~, Height .....¢~...~.. ........ Number of Stories ...~. ............................................. 9. Size of lot: Front ........ ~....O..~ ............. Rear ..../.~....~. ........................ Depth ../...~....-~..~,,~ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..~..q.~..c~4~r,(~...~.C~..; ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation> /.~'..~.. 13. Name of Owner of premises .~...~4:::.~..~.....~..q..~.../~'... .......... Addrass~.e....~.zz..~..,(..~..,'~.~~-. ................ Phone No ..................... Name of Arch tect ......... Address ................... ' ..~... Phone No ..................... Name of Contractor ./..'YTq.~....~...~...~..~..~.~..~'.. ................ ~ ...... Addres-~......~..~..~..;..c...x'..¢../..~'.....~.'~.../../~.... Phone No ?~'..~'..~...~..~.- sf/d . ..................... PLOT DIAGRAM Locate clearly and distinctly a~l 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 a~i indicate whether i~terior or corner lot. STATE Of NE'W'yOP-J~.Z · ~ ~ ' /JZ J hl, £ · COUNTY Of ~.....)- .... -. ...................... x ....................... ~; ;'~ .................................... ~mng duly sworn, dePoses and says that he is the applicant (Name of individual signing application) above named. He is the (Contractor, agent, corporate officer, etc.) of said oWner or owners, and is duly dUthorized 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 that the work will be performed '[fi the manner set forth in the application filed therewith. Swam to ~be.,~e me this ......... ........... Notary Public,~~..~'~l~~ C~~' (Signature of appli~an~'i ........................ Commission ~xplre'~ March 30.