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Home My WebLink About3862-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. ~?.~.. ..... Date ........... ~!~t.l. be.~...3.1..., 19. ~ THIS CERTIFIES that the building located at l~ecoll~© .~II ............. Street Map No. '=x ......... Block No .... I= ..... Lot No... == ..... Peeonie .... 1~,¥, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ,~pl"~l' ' ~l~ 19 't58' pursuant to which Building Permit No.. '386~ dated ......... &prll' · '29" , 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 .... .t~x, ivate, one. fmnl:[7, dve;~1~g ................................... The certificate is issued to ...E-:l. ailse. -Lathz:l ..... Owner ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....... 1~o1~, ........................ ...... .... L /: ......... ~ I Building Inspector ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~; UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3862 Z Permission is hereby granted to: ....,~,..~u,~ ..a,/..o.~.~xasae.. ~ta~... ...... i ......... t .~... ~.,,~.t,a ..~t,m~..~,.,,:,, ......... ................. ~:1~ ......... ~,Z, ........... ', ................ to .~...~....a..a..~.x....u....o..~...~ ...~ ...e...z.~..~.~..W~'..~'~.~ ................................ ...................... at premises located at ~..~.'.' ~e0ol~e ~.e. · .': ........ , ' . ~e..e~.~..~ ,.. ~..t.~.~ .......... ; . . pursucm¢ to.application dated ......................... A~.~.:.;...~....!.,~., 19.J~.., and apprpved by the Building Inspector. ~ee $.; ..................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........... ...... Approved I~. APPLIGATION .FOR BUILDING PERMIT Date ........... .................................... ~..** , 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 pub c 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 ~yill 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 Perm t pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ord nonces or Regulations, for the construction of buildings, additions or 'alterations, or for removal or demolition, as here n described. The applicant agrees to comply with all applicable laws, ordinani~ c~e, o:nd regulations' /~,~i~'~-~fgpplicant, or name, if a corporation) State whether ap~icant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~...~~ ..................................... : .................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on whicb-13roposed work wi~ be done. ,~ap No.: .......................... ,~9 ........... Lot No.: ........................ Street and Number ...~.~...~....¢~ ................... ~~ ................... / ~ Municipality . 2. State existing use and occupancy ~and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~..~.~ .......... .~. .......................................................................................................... b. Intended use and occupancy ........................... ~ ............................................... 3. Nature of work (check which applicable): New Building .................. Addition .. Alterotion .................. Repair ................. .~emoval ..................Demolition .................. Other Work (Describe) ........................................ (to be paid on filing this application) 5. If dwellingj number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars .......................... ~ .................................................................. ............................... ................. 6. If business, commercial or mixed occuP~n~y~ specif,/n~ature and extent of each type of use ........ ~ ................... 7. Dimensions of~existing structures, if any: Front ...,:;~ .............. Rear ...... /..~.. .................. Depth ..~....~... ....... Dimensions of same structure with a. lterations or additions: Front ........... ~........;::::;;:;;:.. Rear ...~'~-.... ............... 8. Dimensions of/entire new construction: Front ...... ./...C~, ................... Rear ......... ./....~?.. ......... Depth .....~ ............ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated 12. Does proposed Construction Violate any zoning law, ordinance or_regulation? ......... ~....~.. ......................................... Name of Architect ...................................................... 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 number o~e,~ription according to deed and show street names and indicate whether fnterior or comer lot. STATE OF NEW YORK, COUNTY OF ................................ ~'~' ........................ ~ ................................ : .............................. ......... being duly sworn, deposes a'nd says that he is the applicant (Name 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 performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewi~. Sworn to before me this ............................. · ' ..... y pUBLiC, St~te ~'[ ~,.t~.,~.~(.~ ( ' ' '