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Home My WebLink About3818-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at I~00tlet;~;Z...8~; ............. Street conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Al~r~l.. ~.., 19.. 6~ pursuant to which Building Permit No...3.~.1..~.. dated ............. ~,l~l~L. ~., 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 The certificate is i~ued to ...... Ha~r,y. P,. Fag~ ..... 0w~r ...... (owner, lessee. ,or tenant)' of the aforesaid building. Suffolk County Department of Health Approval .. I[,i% ............................. Building Inspector ( 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) N? 3818 Z Permission is hereby granted to: at premises located at ...... J~3.......~a.~,~L....~T..~e.~ ......... F..lS~.t~..~,~l~t~w ........... pursuant to application dated ......................... ~.3: ......... ~ .......... , 19..1~, and approved by the Building Inspector. Fee $..;~',~.eJ~ ........... ct 19'~.f.... Permit No. Approved ........................................ , · ow, OPSOUT,OLD DEPARTMENT BUILDING TOWN CLERK'S OFFICE Disapproved .......................................... , ...................... o/c ..................................................... ~.--~--"--- APPLICATION FOR BUILDING PERMIT .................................. , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever.until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for,the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southotd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinan(~es, building code, housing cede, and regulations. ($Tgna~re of applicant, or name, if a corporation) ................... : ...................... ~ ....................... ~. ....... .~. .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................................................................................................................. Nome of owner of premises ...~....~.../~..'..~...~...........~..'........~..~.....~...~..~........~..~..'.¢ ........................................................................ If ~plicgnt is a co~orete, signature of duly aHtharized officer. ....... .... (Name and titl~of ~o~orate officer) 1. L~ation of land on which prop~d work will be done. Map No.: ........................................ Lot No.: ........................ Stre~ and Number ................................. ~ .............................. ~ .................................................. ~/~ ~o M~nici~,~ 2. State existing use and ~cu~ncy of premiss and intended use and ~cupancy of prop~ construction: a. ~isting use and ~cupancy ~~ ~ ~ ~/~ b. Intended use and ~cupancy ............................................................................................................................ Nature of work (check which applicable): New Building ..ii .............. Addition ....~... Alteration .................. Repair ........... ~'~1~,' Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost~../.'.~,p..~...~..~Tx ......................................... 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 ...... .~.?...t. ............ Rear ...... .~-....~'..~ ................ Depth .~....~.../. ........ Height ..,../....~.~ ........... Number of Stories ...... ./.. .......................................... .. · "'~';~ ................................ :~Z"; ........... Dimensions of same structure with alterat,ons or add,tions: Front ........ ~..~..;~.........; ....... Rear ....?.....~...~.. .............. Depth .........~..~../. .............. ~. Height ....... ../....~..~ ............ Number of Stories ......... ../. .................... 8. Dimensions of entire new construction: Front ........ /...ZV-..~.~...~. ............... Rear ....... .?..~..~ .......... Depth ...,./.,~../. ........... Height ..../..~,..~ ........ Number of Stories .............../.. ..................................................................................................... 9. Size of lot: Front ..... ,./...~....°...(. .......... Rear .......... ../..O....D....~. ............. Depth ....... ../...~....O...~ ........... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ../?..~....~.../..~..~.~..,~/.~....Z~.. ............................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation.;) ..... .~...~.. ................................................ 13. Name of Owner of premises ~..~..'....~...~...Address .....~....E'...X.~'~.....~..~,~..~...~...~.~...~.~.~b~o~:ne No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~./.?....~.?....~.-..~.....~.....~...O...~..?..g...~. ....... Address ....g...~...~..~...~..~....~...~....~.. .............. Phone No..."~......~......~....~..~ PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines· Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. /' 0 O ~' /oot 17/ ~0o / STATE OF NEWt'~)R~J, J~'_ ), ~, ! 0 t ~ ' r rj ................................................. 2 ........................... ~.....:.[.....boin~ ouW sworn, ~oses ~no s~s thor he is the opplicant (~ome o{ individual siflnin~ opp~~,' ~.'~ ~ obovo n~med. He is the ......................... ~...~.....~.~.~ ............................................................................. (Controctor, a~ent,.carporoto officer, etc.) o~ soid owner or owners, ond is duly outhorized to-perform or have per{ormed tho sold work ~nd to m:ke ond 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 fo~h in the application' filed therewith. Sworn to before me this N ................... ..................... TOWN r~ O1: SOUTHOLD PROPERTY RECORD CARD OWNER FORMER OWNER LAND 70o NEW Farm Tillable 1 Fillable 2 Filloble 3 Noodland ~wampland 3rushland qouse Plot Fatal SEAS. IMP. lq-aa NORMAL Acre VL ,N ~c.' ?> 7/ /? 6s FARM TOTAL DATE ~' ".: ' _: BUILDING C j91 BELOW Value Per Acre VI LLAGE DISTRICT ACREAGE TYPE OF BUILDING SUB. I LOT I 1 ' COMM. IND. CB. MISC. Est. Mkt. Value ABOVE FRONTAGE ON WATER Value FRONTAGE ON ROAD M. Bldg. Extension Extension ~xtensJon ] reezeway Patio Driveway Bath / Porch Porch Floors Interior Finish Heat ~-£ Roof Type Rooms 2nd Floor J Dormer