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Home My WebLink About1670-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CEETIFICATE OF OCCUPANCY No...Z...t~)~.'t. ........... Date ........................... ~)e~o~r. ..... ~.., 10...6~. THIS CERTIFIES that the building located at .(~e~ta.t,~..J~OiJ..~ ...................................... Street Map No ....... .1)+'~ ...... Block No ............. ~. ....... Lot No...~ .......... S~l~th~ld.t...~,~, .................. conforms substantially to the Application for Building Permit heretofore filed in th~s office dated ........................................... ~}~.....'1.9., 19.~. pursuant to which Budding Permit No..16~.~..~ dated .......................... ~{a.t~h'"..~ ........, 19~,..., was issued, and conforms to a~the requirements of the apphcable provisions of the law. The occupancy for whmh thru certificate is issued is ........ · "l~l~.'"orm"~'a~l'ly"~re~'~Tn~ ............................................................................................. The certificate is issued to ...l~.l~e..~....~e.~J.~t ......................... .0/t~gL~' .......................................... (owner, lessee or tenant) of the aforesaid building Building Inspector 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.° 1670' Z Permission is hereby granted to: at premises located at ..... J~o~.4~..~.....~:Lo~k,..~',....,~:~r,e~o~..~,l~;4~1~tll .................................. ............................................. ~"~,..:i~.8,~ ...~t, hol6 ........................................................ pursuant to application dated ........................... ~h-'-.-~O ............... 19(~...., and approved by the BuildJng Inspector Fee $. ]~O.J:~ .......... FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN C,ER.'S OmCE SOUTHOLD, N. ¥. Examined c-~ 6'"~ ~O ,9...~.....z~ Approved ........................................ , 19 ........ Perm t No ................................. Disapproved a/c ....... ~-~7~"~/~'-~ ........... ~ ......... /..¢... ........................... ................................. APPLICATION FOR BUILDING PERMIT Date ....................... ~'t. Ch ....19 ........... , 19...6P- ........ INSTRUCTIONS o. 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 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 o 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 pa rt for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 oil applicable laws, ordinances and regulations. (SignCture of applicant, or name, if a corporation) Bei.~e~onx Southold~ N.y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builde~ ~Wne~ Nome of owner of premises ............. .G.~,g.e......~.......~.g..~..1...e..s. .................. . ................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ...... 1Ll.'~2. ............................ Lot No: J~.~Jf~....-..?:.... Street and Number ......................... 0~oh~z~t,...P-,oa~ ................................ ~...i.: . ..... Municipa ity ..... / 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Uni.m. pz~oved land b. Intended use and occupancy Residence 3. Nature of work (check which applicable): New Building ....... ~ ........ Addition .................. Alteration .................. Repair .................... Removal .................... Demolitign .................... Other Work (Describe) ........................ 4. Estimated Cost ........... :~.c)oo0,.~0 .............................. Fee (to be paid .on filing this application) 5. If dwelling, number of dwelling units ...... ...[~...e. ............ ~....Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................... J..~ .......................................... 6. If business, commercial or mixed occupancy, specify natureond extent of each type of use ....~ ........................... 7. , Dimensions of existing structures, if any: Front.....ZlOlle ............ 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 ......... .2..8..~ .............. Rear ......... .~..~.~ .......... Depth ..~..f...~. ................. Height ............................ Number of Stories ......... Qrze ................... 10. Date of Purchase ]-.9.~.~.. ............ ~ .......................... Name of Former Owner B. clbBefLxedon 11. Zone or use district in which premises are situated ............ 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... .~,.o. .......... .......: ............................ ~3. Name of Owner of premises Gz'ace R. NicklesAddress Beixedon Phone NoS° 5 ,~279 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. 5 STATE OF NEW YORK, ~)' ~!~ COUNTY_OF ........ : ................... . ' '~ _ ,' .......... ' .............................. ...................................................... be ng duly sworn, deposes and says that he is the applicant (Name of individual signing application) i ~ above named~H~ is the ...... ,~-~f:'~....~.......~.~L ................................................................................... (Contractor, agent, corporate officer; etc.) bf said owner ar owners, and is duly authorized to perform or have performed the said work and to make and file this a,pplication; that'all statement's contained in this application are true ta the best of~ His knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to b~ore me this ' .....¢~...0. .......... --- day bf ...~ .............. ,19.''~'.,''%-- C~.~.~.~ ~ ~ Nothry Pub,,c,. ,~.~,~..4~. '~.,~ County .....................i~"~'rYt¥~"g¥'~l~l~'ii~'~'~'i .............................