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Home My WebLink About1679-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southotd, N.Y. CERTIFICATE OF OCCUPANCY No Z20138 Date AUGUST 8r 1991 THIS CERTIFIES that the building Location of Propert~ 10 HICKORY ROAD House No. County Tax Map No. 1000 Section 54 Subdivision ADDITION SOUTHOLD Street Hamlet Block 06 Lot 14 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 27, 1962 pursuant to which Building Permit No. 1679Z . .. dated MARCH 28, 1962 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is BUILD AN ADDITION TO EXISTING DWWJ.T.ING. The certificate is issued to JEAN C. SWEENEY (owner) of the aforesaid building. SDS'FOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/~, - /~6il~i~ Inspector FO~82~ 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) N? 1679 z Date ...................... ll~r~lm ...... ~9 ........... ~96a... Permission is hereby granted to: W~, l~ni-..i/~., l~-,r..&..~g~.. Itaye~ ........ ...... 2.21~..ttos'!.yn.. 8~ ..................................... ..... ~.~l&p...~e~'aee ........................................ to .~:alld...au..addl~;lo~..on..a~_..~;~.sl, lng...dw.e~ ;!_JLn~ ....................................................... at premises located at ...C4h~t~l.t,..&...~],~lc~r.. l~tl- ................................................................. J .............. ...................................... ~.ctl~,~.~.~.. · a ,.~ ,, ......................................................................... pursuant !o opphcahon dated .............................. 11/~. e~....~.~. ............ 19~...., and approved by the Building !nspector Fee $..~'.,.~. ............ Building Inspector NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Exomined ...................................... , 19 ........ i9 Perm,t o / 6 ? 7 Approved ........ .~J~...... ~.. · .~'-...., ........ ' N ....; ...... : ..................... DisapprOved a/c .~'....~..:~...~......~.'......-.~..'"~'~ ..................... .... (Building Inspector) Application No ............................. APPLICATION FOR BUILDIN(~ 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 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 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building P~rmit 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, os herein described. The applicant agrees to comply with all applicable laws, or~dJnances and regulations. (Signature of applicant, or name, if a corporation) ..... ....................... (A~Jdre~s of ~pplicant)/ State wlgethertapplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................................................................................................ Name of owner of premises..~.,~....z ....... [. :~ .~L~j ~.~. ....... f~,,~ ............................................................... If applicant is a corporate, signature o~ duly authorized officer. ~ (Name and title of corporate officer) 1. Location of land on which proposed w. ork will be done. Mpp,No; ...................... Lot No: ..~..L-...~...~ Street and Number ...~.' m~..~4~.~.~...~c~.~ul~.~'~..g.~.....~..~/...~,..).....C.~.~...~ .................... M unicipality ~ ~OC/~,)O ~_~. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................ i~ ................................................................................................ b. Intended use and occupancy .......... %..~.m~.ne,.~.~,.......~.~. ....................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair ................ Tt- Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Est mated Cost ~. ............................... Fee ...~......'~.. ........................................................................... (to be paid on filing this application) 5. If d~lling, number of dwelling units ............ ~. ................ Number of dwelling units on each floor ............................ If garage, number of cars ................. ~ ........................................................................................................................ 6. If business, commercial or mixed occupancy, specify natureond extent of each type of use .......... ~ ......... 7. Dimensions of existing structures, if Any: Front.....~.~....~.~,.:... Rear ......... ,~..~'.,.. Depth ....~.....~..~.~j~ ........ Height (~l:)i~.,...J..~.~.~. ..... Number of Stories .............. ] ............................................................................................. DimensionJsl of sam~ st ructure with olteratons or oddtons Front ...L~..7..£.J1'., Rear ....~..~..~.~ Depth 8. Dimens~ns of entire 'r~& construction: Front......~...:~..~....¢.,. ..... Rear ..... ~ .~.~.~..:. [~pth .......... ~ ..1.~ .~.~.: Height Number of Sto, ........... ! ..................... / '" of ol.JFront ........ Depth ......... ]0. Date of Purchase 11. Zone or use district in which premises are situated ........ .l~.l~.~.l,.~.Enj.[.~.~. ........................................................ 12. Does proposed construction violate,any zonina law, ordinance or re~lulaLi~n~ .(~....O Name of Arch tect , :. JAddress of PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~k dimensions from proper~ lines. Give street and bilk numbers or description according to deed, and show street names and indicate whether interior or corner lot. 13q.¢o STATE OF NEW~YQRK,. ~, ) ,. ,. -~' couNTY OF ~ ...... ) ~'~' . ....................... ; ................. i ................................ '..2 ...... being duly sworn, deposes i~nd says that he is the applicant (Nome of individual signing application) above named. He is the ............../~;~~ .................................................... .;.....~ ................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perform~l the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner 'set forth Jn the application filed therewith. Sworn to before me this ' ' JUDJNi t. ............ ~:~-:~....-.~d a y o~r_~ ............. ~'. ' ~-'~P..~iJ,.~lo~l~. J~ u~ .~,.....-.~-:-~ : ~'~ ) ~,2,-~'?~,~ ~,~e/~ ..... .</..~,:.C/-~...~ .............................................. Notary Public, .....~.._ ..,,~...~~un~y~ (Signature of applicant)