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Home My WebLink About3963-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Of[ice Southold, N. Y. Certificnte Of Occupnncy No...Z. 3.4~i7... Date ........ AI~£1... ~.S, ...... , 19 59. THIS CERTIFIES that the building located at .$8[~ .Oak./ttre~t ......... Street Map No..]~Ug~zi~ .... Block No ........... Lot No. 18 .&. 1.9..C~ztcho~ue,. I[.Y. .... ~:Lghtm, ~ # 856 conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... July...18,.., 19.68. pursuant to which Building Permit No...396~ .3 dated ......... J. ul¥...19o..., 19. ~8., 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 ... p~tva~z~, on~. £~l.lt. d~lllng. ..................................... The certificate is issued to ..... 1~ o. W&llace. ~,&wr~nc~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Insp~r ~ ::..~. (~ SOUTHOLD, N. ¥. Examined ............ , 19 ........ Approved ..................................... , I9 ........ Permit No .............................. TOWN ~ ~UTH~D BUILDING ~PARTMENT TOWN CLERK'S MFICE Applicatio~ No. Disapproved a/c .~ ............... ..~...~ ....... -- -- (Building Inspector) / APPLICATION FOR BUILDING PERMIT Dote i~....,~..~ ................... , INSTRUCTIONS o. This opplicotion must be completely filled in by typewriter or in ink ond submitted in duplicote 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 drown on the diagram which is port of thi.~ applica- tion. c. The work covered by this application rn~y 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 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, ordnances a~ regulations ......... ............................ (Sig~re o~f~_~licant, or name, if o corporation) .............. ............................... 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. ]. Location of land on which proposed work will be done. Map No.: ~......~..~.....~,. ................. Lot No.: ~ Munic pa ~ '" 2. State existing use and occupancy of presses and intended use and occupancy of pr~osed construction. a. ~isting use and ~cupancy ....... [~ ................................................................. b. Intendeduseand~cupancy ~~ ~ ~ 3. Nature of work (check which applicable): New Building: ................... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ........../....0..Z~ ............................... 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 ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................................... 7. Dimensions of existing structures, if any: Front ........... L..~.. ......... Rear ........... ./.....~. ......... Depth ...:~...?.'. ................... Height .......... / ................. Number of Stories .........~ ............................................................................ Dimensions of same structure with alterations or additions: Front ......... L...~'.. ............... Rear .....~.....~.. .................... Depth ........ .~..../.. .............. Height ............ ........... Number of Stones ................................ 8. Dimensions of entire new construction: Front .............................. Rear .............................. Depth .............................. Height .............................. Number of Stories .............................. 9. Size of lot: Front .......... .~.....O... ......... Rear ....... ,~.~..O. .................. Depth ...... /..~...( ............ · ...~...i~.....,...I..~ .............................. Nam, of Former Owner .~..~.....~ ....... 10. Date of Purchase ! 1. Zone or use district in which premises are situated ....... ~.~~+;~f2~ .............................................................. 12. Does proposed construction violate any zonin~Jaw, ordinance or re, aulation? ....~....'......~./~....~.....t.:: Owner of premises .~.......(~.....e~..~.d~~ss ..... ~~.Z..)?....~..:.. Phone No ................... 13. Name of Name of Architect .................................................... Address ................................................ Phone No ................... Name of Contractor ~..~.'. ......... Address ...~~..1...~...:.~...... Phone No.').~.~'..z~.(;.~.~.. PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil 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. ~ ~ ! 131' U STATE OF NEW YORK, ) COUNTY OF ............................ ) S.S. .............. ~...~-.~J~-..: ....................... being duly sworn, deposes and says that he is the applicant (Name of individ'~a! signing application) ~-~ above named He is the .............................. ~~... .................................................................... (Contractor, agent, corporate officer, etc.) of said awner 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 therewith. ........................ doy of ............................................ , 19 ........ Notary Public ............................................................ County (Signature of applicant) ~OBM NO. ~ BUII.DtN8 DEPARTMENT TOWN CLERK'S OFFICE SOIJ'FHOLDo hi. ¥o BUILD,lNG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3963 Z Permission Is hereby granted to: ......... .~.~,~e ................................................. t 18&.1 ~ m.~ . at premises located at .....~.~....~ ................ ~. ...... ~ · ~ .................................................... ............................ Ill~..~t~.e~.t, ....... !l~~ ....... i,d~ ............................................................ pursua~ to application doted ........................... .~T~. ....... edJ .......... , 19..~L and approved by the Building Inspector.