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Home My WebLink About4481-zNO. 4 TOWN OF $OUTHOI,D BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. '5' 3~9 .... Date ........... t~oV ..... 28 ..... , 19.69. THIS CERTIFIES that the building located at 0~k.D~'$ve ............. Street Map No.. XX .... Block No. 'XX ...... Lot No.. ~ ..... Cutehogue ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... [~l~t' '29 19 6¢j pursuant to which Building Permit No. dated ....... Sel)t .... 29., 19 69 , 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 . Pr-~va~e ' one .faz~ty-dwelt~Tr4~ ...................................... The certificate is issued to . . John (~rame~ .Jl' ...... Ou~nel, ....................... (owner, lessee or tenal~t) / of the aforesaid building. Suffolk County Department of Health Approval i~0~ 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) Z Permission is hereby granted to: O~e.~....A/ll....~ei~.~w,~ ............ to ............... 1~/1~ ...~ ..~AULt fm~...grA..~m ..~,~.t~...~w.~I;L~ ........................................ at premises located at ................... JJ~Jr~.~....~[~..J)~l~g~J. .................................................... ............................................... ~ut~la~ol~:m~, ........... Ig~Z~ ..................................................................... pursuor~ to opplicotlon doted ............................ ~t~-***~ ............ , 19..~1~, ond opproved by the Building Inspector. FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................. Disapproved a/c .............................................................................................. (Building Inspector) APPLICATION FOR BUILDING PER~IT Date ........................................................... 19 .......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin. Inspector. b. Plot plan showi.ng location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and giving a de,ailed description of layout of propertymust be drawn on the diagram which is part of this applicatior c The work caverned 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. Sud permit shall be kept on the premJses available for inspection throughout the progress of the work. e. No budding shall be occupied or used in whole or tn part for any purpose whatever untd a Certificate of Occupanc, shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other ~pplicable Laws, Ordinances o Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described The opphcant agrees to comply with all applicable laws, ordinances, building code and regulations. .......... ..... ............................... ........... -"'""' ....... V State whether apphcant is owner, lessee, agent, a~~eer, general contractor, electrician, plumber or builder If applica~nt ~s a corporat~e,,~signature of duly authorized officer. (~ame and htle of corporate b~ficer) Location of land on which proposed work will be done. Mop No ............................................ Lot No: ................... Street ond Number ' ' ~ '~'' ....... '~' ' '~i~'~] .................... /' .................................. State existing use and occupancy of premises and.) ~nte~n~ use ond occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .................. Addition / Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Estimated Cost ........... .,.~.,~¢~...O..:..~.O.. ............................ Fee ........................................................................................ (to be paid on filing this application) 5. If dwelhng, number of dwelling units ............ ~[ ............. Number of dwelHng 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. D~mensions of existing structures, Jf 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 ............................ Depth .......................... Height ............................ Number of Stories ............................ 9. Size of lot: Front .......... ~..~. ............. Rear ......... .~'..~. .............. Depth ......... (.,q...q. .............. 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... 11. 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 ..~Z..o~r~..,.~.£.q.m.~.~. ........... Address ..~.~.ff#,4.~.. .................... Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor .~.~:C~¢,....t~.~,~C,f~ ..................... Address .....~7.O.......~-~...~ff,..~,....~..~r~:. Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exmsting or proposed, and indicate all set-back dimensions fro property hnes. Give street and block numbers or description according to deed, and show street names and indica whether interior or corner lot. STATE OF NEW YORK, ~ ¢ ¢ COUNTY OF ............ "-'-:"x'"""'~ .... ........... ~ ..................................................... ~ be'ng duly sworn, deposes and says that he is the app c '~ove r~e (mNe;.mH~:f,s'~i:i~,~.a.l..~i.g..~i.n.,9...~-P..P.l.i.~.a.~i~.n.l ................. .~~ ................................................................... (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 th~s application, that all statements contained in this application are true to the best of his knowledge end bel and that the work wJII be performed in the manner set forth in the application filed therewith. Sworn t.,o before me thisfi'T--//,,,-,'~ /')/)~ ........ ......... · " T~.~14 ?~,/t ~ ~ ~'~t~ ~~ .~;~, ' C, State o~ ~4e ~ t)BLt , S Ik, Coun '"~ ........ : .......................... ; ...............................