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Home My WebLink About4108-zFOEM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. $.~.21 ...... Date ............... .0.c..t...!2. .... , 19..7.~. THIS CERTIFIES that the building located at . ltunnatawket. Rd .......... Street Map No...xx ........ Block No .... xx ..... Lot No. XX~..Fl~l~e.l~.s..i.s..1.~.n.d....N.,.~. :... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .act.. 25.., 19..68 pursuant to which Building Permit No.. ~..0.8~. dated ............. Oct...30.., 19.68., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Private..one. f. amily..dwelling ...................................... The certificate is issued to..l~icbard. & .Catherlr. e .Jenss~ ..... ~.wne~s .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....B..~.. ............................ .......... !~.?..f?.:/.. .... ~. :(~.... j... 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) Permission is hereby granted to: ........................ ~.tz~e~a..Z~l~u~l ...................... a ad~ ex, stUn ~we lling . ~o ~!.....,~. .......... ~.~.~...~..~ ................... z .......................................................................... ~t ~em~s ~ted ~t .~~-..~.~ ................................................................................... ~zhe~s .................................... Xa~ ~, .......................... Building Inspector. ........... TOWN OF ~OUTHOLD BUILDING I~PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~......~.... ........... ,19.~.?. Approved ........................................ , 19 ........ Permit No ..... ..~... . Application No. ~/! tD ~ Disapproved a/c ................................................................... ~ APPLICATION FOR BUILDING PERMIT Date ...~...~....:.......~.....~.. ...................... , 19.~....~. 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 applica- tion. 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY M,NDE 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances"~Jnd-regulations. (Signature of a~cant, or name, if o corporation) (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~.....~...:.~..~.~.-.~ ...................... If applicant is o corporate, signature of duly authorized officer. (Name. and title of corporate officer) ~ c,t oS~.c~ 1. Location of land on which proposed work will be done. Map No.: ....~..~...~.. .......................... Lot No' . .... Street and Number ................. ~. .: ........ MuniciPali~l ~ ~ , 2. State existing use and occupancy of pr, flrrdses and intended use and occupan,cy of p~olSO~,'ed~construction' a. Exmhng use and occupancy ...... ~ ............. ;;.~....;-.....;.77Z;..:.']...,'.[ ................... b. Intended use ond occupancy ..... .~..~ ....................... ;,.;,,.;.~.¢..~ ....................... 3. Nature of work (check which applicable): New Building :: .................. Addition ....~ ..~.... ...... Alteration .................. Repair ........ ~ ......... ~mova! .................. Demolition .................. Other Work (Describe) ................. 4. Est mated Cost ,~ e'O-O ~ ,~ (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 nature and extent of each type of use .................................... 7. Dimensions of exist ng structures, f anv- Front c~O '~. D .... .~ ~ ~- ,, _, · I/'-~ Dimensions of same structure with alterations or additions: Front ...~ ..... Rear ...~ .... Depth ....~.... Height ...... ~ ........ Number of Stories .~ ....... 8. Dimensions of entire new construction: Front ...... ./..~../......~'..../~. Rear ....... ../..C ....... ~ ......Depth ..../..~........~... .......... Height ...... s~....~ ....... Number of Stories ..... ~ .................... 9. Size of lot: Front ........~?~.~...~..~.... Rear ..... ,/.~..~..:.~....-~....~... DepttY c~ ,~, ~ / ~. 10. Dote of Purchase ......c~....~.....:...../...~...~..~. ......................... ~"~f'Forme'~'~';~;.~.'i~.~.i~..~.~.......~....~...~..,~.~... 11. Zone or use district in which premises are situated ...... ~ ............ ~, '"' 12. _ .... g o ..........~...... ........................................ Does proposed construction violate any zonina !aw ordinance or re ulat n~ 13. Name of Owner of premise~,~.:...~...'.~...~'~.~.~.....~... Address ~*.!Z~.....~..,...~Phone No. ~.~..~.,.?..~..~,~ Name of Architect ................. ~ ........... Address ................................................ Phone No ................... Nome of Contractor ................ Address ......... : ...................................... Phone No .................. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description ~ccording to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW )tOPple, ~ I ) S S ~ being , " . "i~l'~~a~i~i'~i ................ duly sworn, deposes and says that he is the applicant ~ove named. He is the ~ ....... ....... ....~ ............................................ ~ (Contractor, agent, co~orate offic~'r, etc.) ........... ~ owner ~s, and ~.duly authorized to perform or have performed the said work and to make and file this ~plication; that all.statements cOntai~d in this application are true to the best of his knowl~ge a,nd belief; and t~t the work will be performed in the manner set fo~h in the application filed therewith. Sworn~ ~~ ,t° before me this ~ ~ ~ ' ....................... ......................... .............................. N ora ~P ubh c...~....x;~. :.:H~.. ~[9~n ty (Sig n at u re ' ~~'~' - = Term ~plr. M~ch 30, ]g~