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Home My WebLink About1169-zFORM NO. 4 TOWN OF -qOUTHOLD BUILDING DEPARTMENT TOWN CL~--RK'S OFFICE SOUTI'IOLD, N. Y. C~"--RTIFICATE OF' OCCUPANCY THIS CERTIFIES that the building located a~ ..~3./~.. L~,~.~...~r.~.V.~.,_.S.~.~]~i~. Street Map No .......... ~.?.?...... Block No....~...??....~. ...... Lot No....~(~ ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ..~.N.~..~.~.t....~ ......... 19...,6..0 pursuant to which Building Permit No ........ ~...~,~,.~.. AUgUSt 12 19~.0...., was issued, and conforms to all of the requirements 4ated ................................................. of the applicable provisions of the law. The occupancy for which this certificate is issued is PRIVAT~ ONE FAMILY DWELLI.N_G.. ....... This certificale is issued to Robert F, White, owne~ (owner, lessee or tenant) of the aforesaid building. FO]~M ~0. 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) N? 1169' Z Date ............................ Atl~S~..-.-~ ...... 19...6.0 Permission is hereby granted to: R~]~e~.t...F...-~rtit.~ ............................................ .......... Leet~..~z.~&.¥e .......................................... ............... ~v:~he~.~.~......~.~f.~ .............................. to ..ButXd...a~..add tt l~...o n... a~ ·. ~l.s ¢.tn~/; .. ~.w~Zi.~g. ....................................................... at premises located at ....N/.B.....~e.toFt..~-i.~e ................................................................................ .............................................................. ~eu.~he.t~.~....-¢~.,-~.a ............................................................... pursuant to application dated ............................... ~,ttg~:~'""~. ......... 19.60.., and approved by the Building Inspector Fee $...~'..00. ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT Town C,ERK'S OmCE SOUT,OLD, N. Examined ......... ...~....%~...I.....'~T.. ........ 19...~...O.. Approved ........................................ 19 ........ Permit No ........................... Disapproveda/c /~~ ~ ..................... ................................. Application No ..... !.L.~...~. ............ 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 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 a Certificate of Occupancy shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE 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 and~,,~ns. (Signature of app icant, or name, ~ a corporation) .............................. ' g .............................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ..,.x... 1. Location of land on which proposed work will be done. Map No: ...~....~.. ....................... Lot No: ....~....~.. ........ Street and Number ......... Municipality 2. State existing use and occupancy of,,.~pr.emises and intended use and occupancy of proposed construction: a. Existinguseandoccupancy ........ ~.~..,~...i~:~. ...................................................................................... b. Intended use aha occupancy ...................................................... r ............................ :' ........................................ 3. Nature of work (check which applicable): New Building .................... Addition ...... ?/~i-~....Alteration .................... Repair .............. .N..Removal .................... Demolition ......... ~1~ ........ Other Work (Describe) .................... 4. Estimated Cost ....... ..~....~...~......~.. .................................... Fee ...~.. ................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. (~r~.....~....'~-.......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 ........ ~....."~w.....~. ..... 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.....~...~:....~-. ......... Rear ............................ Depth ............................ Height ............................ Number of Stories ..~.! ........... 9. Size of lot: Front ......~......~.. ............. Rear ......... ~Z.....5~... ......... Depth .......... ~i...(~... ...... 10. Date of Purchase .........../...~..(.?.....O. ............................. Name of Former Owner ..... -.~.~..:.......~...~ ............ 11. Zone or use district in which premises are situated ............... ~.[.: ....... '~.~.~ ................................................... 12. Does proposed construchon v~olate any zomng law, ordinance or regulahon .......... ~ ................................... 13. Name of Owner of premises....~..'~'~....~ ...... Address ..~..~;~...~..~.'....-.~..~..:.Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor ................... ~.: ............. ~.: .............. 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 NEV~-.Y01~I~, ~/, ) S S COUNTY OF ...~'~m.~..'~.....) ' ,., ....................... ~..~.~ ....... / ~, ,~[../.....!T~..being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .......................... ~~.Z......~.~:..~.: ............................................................ (Contractor, agent, corlborate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this app cat on; that all statements contained in t~,is alie~i,~;ation are true to the best of his knowledge and belief; and that the work will be performed in the m.anner~,~ Sworn to before me th s ~/ ,/ ~ da- of (:3C-<~W--~,3--%,. 19,,(L~o~, ~;;;~,~z~0o ,,, ~Signature of app cant) ....................... .' ~._;r , '""'"~;~ ........ ~] ......... J~"c¢~ ........ Notory Public,~.(..~./~.~.%~..~..¢.~.'.'.~....~.~J;~..~.:~..~?.,.. '~'".."~-:.'.County ' ~(