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Home My WebLink About3875-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE~ SOUTHOLD, N. Y. CERTIFICATE: OF OCCUPANCY No...~..,~15.t. ........... Date ...... ~Tu~.y. ....... 1Z,. ......................... , 19_68. THIS CERTIFIES that the building located at .... 40L.~,~].aa~t,c..Aven~e .................... Street Map No ....................... Block No ....................... Lot No..-.G~e~n~o~.t~¥..~...Yo.z~ ..................... conform~ substantially to the Application for Building P'ermit heretofore filed in this office dated ................... ~a.¥ ....... .9, ............................ , 19...6~ pursuant to ~vhich Building Permit No. dated ......... J,~ay'.. ...... .9~ .......................... , 19....6~B, was issued, arid conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ · .p,r.~,,~at~..~a~ge...(.a¢~e~ ~y...b~./,t~t.ing.) ................ : .......................................................... The certificate is issued to ..................... HOW~,M~ .W~--.I~hltV~I0'~ ......................................................... ('owner, lessee or tenant) of the aforesaid building. Building Inspector FO~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST 5E KEPT ON THE PREMISES UNTIL FULL COMPLEFION OF THE WORK AUTHORIZED) N? 3875 Z D~e ........................ ~. ....... 9. ............... ,9.~.. Permission is hereby granted to: .............. ~.a.~..~: ................ ~ ................. ~t premiso~ I~tod ot ........ ~ .......... .......................................... ~ ............ · .................................... .............................................. ~~ ....... ~i~ ............... ~...2 ....... '.:~.:..: ....................................... pursuant to application ~ted ........................ ........ ~ ...... .~*-,~?*..., Building Inspector: Fee $ .................. : .... and approved by the TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No .......... '~"J' ' '(Building InslJector) APPLICATION FOR BUILDING PERMIT -.,~/ · INSTRUCTIONS a. This application must be completely fille~l 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 ar~as, and giving a detailed descr ption of layout of property must be drawn on the diagram which is part of this application. c. The work ~overed 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 applican.t/Suc, l~ 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,,buj~ing code, housing code, ond~e~ulations. .............................. ........ State whether applicant is .owner, lessee, agent, architect, ~ngi.neer, 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) Location of land on whic~ proposed w~k wilJebe done. Map No.: ........................................Lot No.: ........................ Street ~nd Number ................................................................................................................................ : ............ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ............................................ ...................................... '~"-'~'; ...... A~ 3. Nature of work (check which applicable): New Building .................. Addition .................. Repair .............. ,~. Removal ................ ~ Demolition .................. Other Work (Describe) ..... ~ ................................. I 4. Eshmated Cost ............................................................ Fee .......................................................................................... (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 ............. ~....; .................................... ;....'......i..,.. ....... .................. ;.,. ....................... 6. If business, commercial or mixed occupancy, specify nature and extent 0f each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ 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 const~ti°n:· Front, .~ .~..~:Z.... Rear ........... ../...~.. ......... Depth ..~ .~.....:.. Height .................... Number of Stories ...... ..~......~...~r~ ............................................................................................. 9. Size of lot: Front ............................ Rear ...... : ............................. Depth ................................ 10. Date of Purchase ..: ..................................................... Name o~[~Former Owner ........................................................ 11. Zone or use district in which premises are situated ....~..~. ....... .~.~.[. ..................................................................... 12. Does proposed cOnstrUctipn ~c~te any z~OPing/~, ordinance, o~r_~gu,~la~ig~? ....~L~..;...~.O.. .................................. 13. Name of Owner of premises~..:..'....~....'~.'! .............. 7~..~..~( Name of Archit~t ....... .~ .................. ; ............... .//.. ....... Address .v~. -/..~./~---..~i ............. ./..'. Phone No ..................... Name of C~)ntractor ......~.~..~ ................ 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 or description according to deed, and show street names and indicate STATE OF NEW YORK, I. c c COU N'Pr' OF ................................ ~'~"~' (Name of individual signing applic~on) above named. He is the ......................................................................................................................................................... (Contractor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke nod file this application; that all statements contained in this application are t~e to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swam to b~ore me this , ......... ...... o, ..... ...................... . ,o o, ..... ............. .... ~ ~k~l~ 5', REGENT ~ARY p~BLIC, State of NeW ~o, 52-3233t20 Suffot~ County Tern ~pir~ ~rch ~, 1~