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Home My WebLink About4034-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z..3431.... Date ............. ~rCh.. 14o..., 19.69. THIS CERTIFIES that the building located at ...gln~t .StrUt ........... Street Map No ............. Block No ........... Lot No.. ~r.~.®n~..1~..York ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... klotmr.. 10,, 19.58 pursuant to which Building Permit No.. dated ..... $~.~i:~r.. ~.0o., 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 .... P~l.v.a~;e..~r~e. ~u~$1F..d~elXtng .................................... The certificate is issued to . K~e~.h .&. Nut. Icl. ~o~r~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N/~ ................................ Building Inspector FORM NO. ~ TOWN OF $OUTHOLD 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) N? 40~4 Z Permission is hereby granted to: ........... J, JJ~..~..~..l~.~:;1,~;t,...ll, gaJe, ............... at premises located at ...J.j~.....J,j.J~.J~l......~ ...................................................................................... ................................................... ~)l~eat ...... ~e~L, ............................................................................. pursuant to opplication d~ted .............................. ~.~..~ ....... ~t ........ , 19..~., and approved by the Building Inspector. ,- 'rowN OF SOUTHOLD BUILDING DEPAI~TMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ~Y. Approved ........................................ , 19 ........ Permit No ........... Disapproved a/c ...~ ............ ~~. APPLICATION FOR BUILDING PERMIT Application No..,,,~,,,,~,,.,~,.,,,~,, ......... Date ............................................................ , 19 ............ INSTRUCTIONS ~' ' a'. Thi{ 6pplication must be completely filled in by typewriter' or in ink and sub~ni'tted 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 drown on the diagram which is part of this application. c. The work covered by this application may not be commenced before issu=nce 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 premise~ qv..a~[lable for inspection throughout the progress of the work. e. No building sh~ll 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 Buildi.ng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable 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 cad--ns. --~0 ~ ~ (Sign/lure of applicant, or name, if o f:orporation) (Address of applicant) ~ State whether applicqnt is owner, lessee, agent, archittect, engineer, generpl contrastor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on w,hich proposed work will be done. Map No..' ........................................ Lot No.: ........................ ~' Mun.c~pahty State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~...z .............................................................................................................. b. Intended use and occupancy ..~,.. ...~ ....................... 3. Nature of work (check which applicable): New Building ....~ ........ Addition .................. ~,~ *-~AIterati°n .~y ............ Repair ............ Removal .................. Demolition .................. Other Work (Describe) 4. Est mated 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 nature and extent of 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 construction: Front ........ ~..~..~. ................ Rear...~.~. ................ D~th .Z.~ ................. Height ....~.~..~.'~' ...... Number of Stories ........ ~ ........................................................................................................... 9. Size of lot: Front ...ZZ..~.~ ...... Rear ....... ~.~.~.~ ........... Depth ...Z~.~z..~.y ...... 10. Date of Purchase ........................................................ N~ Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ...... ~ .................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ..~ ............................................... 13. Name of Owner of premises~.~.~~.....Address ..... ~~ ................ Phone N~.~..~ NameName of°f ContractorArChit~t ............................ ~...~~.....Address~'~ ~'- ~--"-~ ....... Address ]~[]~][~~][]~[~]~] PhonePh°ne No~.~.}..~.~.~ iN° ..................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from propeffy lines. Give street and block number or description according to deed, and show street names and indicate whether i,nterior or corner lot. STATE OF NE'M/YORK, ~ ~ COUNTY OF .~..i.~..?..~..~..~.~. ......... ~'"'~' .................. ~....~...~....~. ....... ~...~..~..~r'.Z.~.~. ................................. being duly sworn, deposes and 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 therewith. Sworn to before me this ,~ ,~~ ..... ......... day of ........... .................. , · ora Pubh 9 ff _ // 7 ~ ,,~ ,,r'- f'/cOZ-- . ........ ,....c~...~..,-~..~........~.~...~ .............................. ~ ry 'c, .~'.*~r-~..~7,,e'.r,~, ..,J/'.~......f:'. .......... ~. County //(Signature of applicant) raN ;, // NOTARY PUBLIC, State of New York ~ No. 57.-7267800 Suffolk County ~erm Expires March 30, 19~1