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Home My WebLink About345-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... Z. 99.5.8. ........ Date ......~.[r..~.8 .................,198.9. THIS CERTIFIES that the building .............................................. Location of PropertyHouse''' 1. 95.~.9.No. .mA.l.n. . ~. .o~a. ................. St,eet ~'~' County Tax Map No 1000 Section .. 3,.1 ...... Block . ...J-.~ ........ Lot ..... .~, .......... Subdivision ............................... Filed Map No ...... Lot No .............. conforms substantially to the Application for Bulld,ng Permit heretofore fried in tl2s office dated ....ff.~.n. 9..7. .......... ,19 ~. pursuant to which Building Permit No ....... 3[[5Z. .......... dated . . . .J.t~..~..7. ............. 195.~. ,was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this cerDficate is issued is ....... One Fgm~ly Dwelling. ~pon removal of the old dwelling a final Certificate of Occupancy can be iaaued. Joseph W. Boze~n The certificate is issued to .................... ?o'~n¢;'~~ ...................... of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE NO ................................................ ......... ? .... ..... Build~ng Inspector TOWN OI~ $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS F~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o Pern 345' Z Date ...................~z),.r'-,.~... i~ssion is hereby granted to. J'o~ e.ph.....t{e ,~,u~an .......................................... ot premises located at ..... .]:4'~L~.~...~Q~L ............................................................................................ pursuant t~) apphcahon dated ...................... ~1~e ...... g'. ................... 19...~., and approved by the Bulidmg igspector Budd,ng Inspector ii` l~O~ NO. I TOWN OF SOUTHOLD BUIL~DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ×amined .......... ,~pp roved ........................................ lY ........ ~'erm~t No ............................... Disapproved o/c ................... ~.~ ........................ ;.~ ...................... ....... ............ (Building Inspector) Application No ............................. APPLICATION FOR BUILDING PERMIT 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 detailed description of layout of property must be drawn on the diagram which is part of this location. c. The work co~ered 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe 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 and regulations. ..... ......................... ~v,//(Sign~ure of applicant X~r name, if a corporation) (Address of applicant) State whether applicant is owner, less~ngineer, general contractor, electrician, plumber or builder. Name of owner of premises......~ ........ .................................................................................. If applicant is a corporate, s~ig t~e~of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work,iii be done. Map No: ................... ~....~.. ...... i ............ Lot No: ............. ; ...... Street and Number ~ :... Municipality 2. State existing use and occupancy of pjLemises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..........~l n~:.~. .......0 ,,~.~........~....~..~...:...../.~~ .................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building ................... Addition .................... Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost...,~..~. .................................................. Fee ../. .... : ............................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........~ .......... Number of dwelling units on each floor ............................ If garage, number of cars ..................... ~ .......................................................................................... 6. If business, commercial or mixed occupancy, specify n.ature 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 ......... ...~.'....~. ......... P>,ear .....Z...~......~. .......... Depth ......"~.....~. ................ Height ............................ Number of Stories .J...~.....~.~t~-~,,,, 9. Size of lot: Front .......... I.~....'.L~. ...... Rear ........ ./....~...~ ..... Depth ....-~:.....~..J./...l ....... ...?.?.'~ ~ t et u~, ~,, Name 10. Date of Purchase ........................................................ of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ......... /~. ....... "~.: ........ ~ .......................................... ,~_ 12. Does proposed construction ~iolate any zoning law, ordinance or regulation.> ...... .~....~ ..................................... 13. Name of Owner of premises/~'.......~.....~:~A, ddress" ....... ...~........~....~.;.:.~.:...~ ....... ".Phone NO..~....~..~....~.. ..... Name of Architect ................ ~ ............ .t..'t. ..................... Address ................... ?. ...................... PhOne NO ..................... Name of Contractor ........................... .t?. ...................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street .names and indicate whether interior or corner lot. STATE OF Nk-V~YOI~K,, IJ ) S S COUNTY OF .. ,,~.~.__..) ,- '///~. ~ ....................... :.~.....~.~t~.~ ............. being duly sworn, deposes and says that he is the applicant (Name of i~vi~al s~gning appJicat~n) above named. He is t~ ............................................ ~ ............................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file th s app cation; that all statements contained i~this application are trUe to the ~st of his knowledge and belief; and that the work will be performed in the ~n~h in the applica~n filed ~er~ith:~ Sworn to be~re me this ~ ~ ~i~'~ ~ fl.. ~ .. ~ 4~ h, ) I~ ~ .~ ~ ~ ~ day of .......... ~ ~;~'~, ~ig~t;reofappli~t) .................... ~ , I'TA ~~'*~ v ~ Pub i ,