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Home My WebLink About4026-zTOWN OF SOUTHOLD BUILDING DEPARTMENT 'I"OWN CLERK'S OFFICE SOUTHOLD, N. Y. EERTIFIEATE OF OCCUPANCY No... ~. ;~.3~?;!:. Date ...... 13~3~ .... 17.,. ....... 19.~ THIS CERTIFIES that the building located at I, aural. Z~ke ................ Street Map No ............. Block No ............. Lot No .... ~tt;;I.~;~,~. 3~1~1~k ........ conforms substantially 1~o the Application for Building Permit heretofore filed in this office dated ......... .8.~;~K .$,, 19.~ pursuant to which Building Permit No..4026 .~ dated ......... ~.elz~:z~r. ~,, 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 . .~l~Va.~,~. O~ql..~:~..~l~l]~..~d~. iil~t:~O~l ....................... The certificate is issued t,o .... ~01~ .li[,. I~]~:[~ .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ....... .; .......................... FORM NO. ~ 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) 4026 Z Permission is hereby granted to: ~arion E. Smith ................... ..~....t..t...t..t....ue..~ ....................................... Build an additio~ o~ an exiBting dwelling Pet Soad # ~8 ~/g ~aurel ~ake at premises located of ...................................................................................................................... Battituek N.Y. pursua:nt to application dated Sept 3 19...{~....., and approved by the Building Inspector. Fee ............. Building Inspector TOWN OF' 5OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19....~.... Permit No. .t~.. .. Disapproved a/c ..~ ............................... ' APPLICATION FOR BUILDING PERMIT ate ......... .............................. , .... 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 p~rt 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 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, building cede, hous_,~ code,~and regulations. 7-0 ..,. .............................. (Signature of applicant, or%ame, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ..... ~.....~ .............................. : .............. ~ ......................... Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ~ b, Intended use and occupancy 3. Nature of work (check which applicable): New Buildlhg .: ................ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated 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 ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify ~ature and extent of eac/b type of use .................. ? ........ 7. Dimensions 9f existigg structures, if any: Front ..........3;.,....'~-.. ........... Rear ......... ..?..~. ................. Death ......?...-}. ........ ~=_ ~- ~ - . Height .t. ..................... Number of Stones ............. ~ .............................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................... ). ........... 8. Dimensions of e,ntire new construction: Front ......... ~..3c./. ................. Rear ........ ~.~'.. ............. Depth ........................ · $~;~ . Height .................... Number of Stones ............. ~i ....................................................................................................... Size of lot: Front ..... l.~/7D...~ .......... Rear ......... ~.....,~.....I. .............. Depth ......... ...2~...~....~. ........... Date of Purchase ......... ~..~...~.. .................................. Nome of Form. er Owner .~. ....... Zone or use district in which premises ore situated ........ ~.~ ................................................................ ' Does proposed construction viola~te,,3~, _ ' ~-~ -A' :.-~any zoning ~w, ordinance or regulation? ..... "2""715~'"'~/~"'"'"~"~ ................................... Name of Owner of premises,~..~..~...~Address ~./..~, -- ................... ~6 ~'~,~ Name of Architect ..............,~ ..................................... Address ............................................ Phone No ..................... Nome of Controctor ............. Address ............................................ Phone No. "v ................ 10. 11. 12. 13. 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 whether i.nterior or corner lot. s'rA'r ./ s COUNW ........... ~~ ........... ~ ................... being duly sworn, deposes and says that he is the applicam (Name of individual signing application) above named~He is the ~ ............................................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke 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 ~t forth in the application filed therewith. Sworn to before me this ~ .............. ....... ..................... .......................... ~E9 c,A~ - ///I N0~AEY PUBLIC, State ~ ~ew N0. 52-06~8~00 Suffolk Commission ~p~[es ~rch ~.