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Home My WebLink About5451-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.2~i~52.9. ...... Date ............. ,Y~'. '2~ ....... , 19.~. THIS CERTIFIES that the building located at .Rlith .Roa, ................ Street Map No. S~lla~. l~ols Block No... I~ ..... Lot No..6 ...... M&.tt~.t~l~k ·. No¥. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... A~i~t. · .10 197.~.. pursuant to which Building Permit No....~517. dated ....... Atlgus-~-- lO..., 19~1.., was issued, and conforms to ali of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P:.$vat, o. one. fant~.ly. D.~ol:l..~g. ...................................... The certificate is issued to -Mike. M&ltl'~W~k~l. ....... Owf~' ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval House ~ 182~ Ruth 65 Surrey La · g~n--%1-.. 19~2.- by-R-.¥~lla ..... Buildlng lhspector ~ FOEM NO. 2 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) 5451 Z Permission is hereby granted to: .... 3,~...~'~.~...~.~ ....... ,.~.~,~....~,,~,~,~:1, ...... .~3g.....l~3~e ..c~t~'..~;~a~ ............... ........ .,Sa.'l~,ea. ...... .I,,~L,, ........................................ et premises located at ..... ~O~..J~....~tliJ~t~..]~l~O]-.~JL.SlO..~ ..................................................... pursuan.t to application dated ............................. ~J .......... iQ.; ...... , 19..o.~.~, and approved by the Building Inspector. Fee $..].{~.{~{~ .......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH { fi¸ Date o~,~i 1 ~ lg7~ Bldg. Permit No.._~'~ZZ,,~/.~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. Examined pr, d " " ' ........................ ~ ............. :.~ 19 ........ Pemit No.:.,.~'...... ,~ .,,,.,,,r,.,., .,, .... ..... _ o, b. · ' ~°/,~'.._~. w'...~' ~,'~: . ~, ~ ., , 1~)~ NO. I - w ..... ,.-- . . ~ ~ ,.,,,,. ~. ~ ~,< ,~ ~ ~. ..... ~ .. , TOWN·OFsOUTHOLD ,,~-~ ~ . ~ · , , . , '. ,:TOWN CLERK,S OFFI~. . n , , ~ ~ ~ ~..~ ........................ , ~.....~., . . . ~ ~'..,~,,.~.~-~ ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin~ Inspector. b. Plot plan showing location of lot and of buildings on premises~ re otio~ship to adjoiri ng premises or public streets or~ areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which s I~art of this 0pplicatjon. c. The work covered by this appl'ication may not be commenced before issuance of Building Permit. d. , U.pon.~ppraval of this application, the Building Inspecto~ will issue a Building Permit to the 'applicant. 'Such permitL shall De Kept on the premises available for inspection throughout the progress of the work. ~ ~"~sh No building shall be occupied or used in Whole or in part for any purpose whatever until a Certificate of aeil have been granted by the Building Inspector. Occupancy APPLICATION IS HEREB. Y MADE to the Building Deportment for the issuance of a Building Permit pursuant to the [.u~.d,i_n.g.,_Z_.on~e:.?~in__~_,?. at .t. hq T.o.~..o.f. Southo. l.d.!. Suffolk .Cou.n~, New ,York, and other applicable Laws, Ordinances or .~.h~_'_'l~o~tm~a~C~o ~_truct?n..o~.. ou!!a,ng.s: _~a~,j?,mns or a!teror,ons, .o.r .tar removal or derr~ht,on, as herein described upp ~.rn agm~ m Campty w~m,al! applicable laws, ordinances, budding code, housing code, and regulations. " ...... (Signature of applicant, or name, if a corporation) (^ddre~_~ ~of applicant} ! State whether applicant, is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. ~' e. ~ -. ........................................ ....................................... .~....0~...~.~'~.~.....~...~ ............................... , ....................... Nome of owner of prem,ses ....~.....~.....~t~.t~e.l~.~.J.~.S.~...~. ........................... l. .................. g.~. .............................. -- If applicant Is a. corporate, signature of duly authorized officer. .............. ....................... (Name and title of corporate officer) · - · ' - $~r ~'a~..~ 1, Location of land on which proposed work will ho done. M,op No.: ....... ~..~:'..~ ....... ~ ...... ;... lot No ...... Street and Number .... .~...~....'~.,.,~.....~.4'~.. ...................... :..:.~.~.,..,.~..../..~ ...................... · /~'.l. ~, ~ /~ ~ ~ ~ MunlC~pality '~' I- 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting u~e and occupancy ~.. ....... Z ............... .~L ........................................................................... ~.. ~.nd,~, and oc¢upa_,~ ,.....,,~..~..~..,-.. ................................. ,,..., ...... .,,,., .... ,,, .............. ~ (check,~hleh 01~ ~c~ble): New Building ..,. .............. Addition .................. Alteration .................. Repair .................. Remmml ..................Demolitio~ .................. Other Work (Describe) ........................................ ~ o~ F .......................................................................................... 4, Estimated Cost .. ............. ~,,~,,, ......... ) .......................... ee /0 (to be paid on filing this application) , ! r 5. if dwelling, number of d~elling units ............................ Numbe 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 ............................ Rea~ ................................ 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 ........ ~ ..........'......,... Rear ....... ~, ........... De~th ...;..~..~. ........... Height .~.~.~e~ ......... Number of Stories .............../.. ........................................... ~ ......... ~ ............................................. 9. Size of lot: Front ..... I..~.~ ............. Rear ...... .J..~. ................. Depth ....... ~.....i ..... 10. Date of Purchase .......... J...~[..~..~. ................................. Nome of Former Owner ........................................................ 11 . Zone or use district in which premises are situated ............................................................. ~ ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....~.J~ ........... 13. Name of Owner of premises~,.~l..~t~:..~.l~.~.~e&.~...'%~.Acidress ..~.~..~..~C.....'~.. ........ Phone No ............... : ..... Name of Architect ..... ~ .............. Address ~.r~6v/~/~/4~ ~vl~' Phone No ................. ..me of con, ...... .................. ......................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or prapmed, end indicate all set-back dimensions from prope~/ liner~ Give street and block number or descriptlan re:cording to deed, and ~ atreat namm and indicate' cd, ether Interim er miner lat. STATE OF N RK,~ . J) ! c c ' ..................... ~.....~ ............................................. bel~ duly ~torn, d~o~s and ~ ~ ~ i~ th, ~pplicam (Na~ of individual slgnl~ appJicoti~) ~ / ~ / / . · ................. ....... ....... .. above ..a...~. He ~s the .................................... ; ................................ (~r, ~t, co~mte officer, etc.) of said ~ner or ~ne~, and is duly authorlz~ to perform or ~ pe~d the said ~k a~ ~ ~e ~ file this a~llcation; that all statements contoln~ In this applic~i~ am t~ to t~ ~nner ~ fo~ In the ~pll~ fil~ ~i~. ~ the ~rk will be perfo~ed in the Sw~_i~ ~~ ~ "~ ~ thlsM,/?~.o ... '