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Home My WebLink About4485-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z 37.82.. Date April. THIS CERTIFIES that the building located at . Maple Lane Map No. r~ Block No. XX Lot No. XX S(~althold 19 70 Street conforms substantially to the Application for Building Permit heretofore filed in this office dated .. OCt 1 , 19 69 pursuant to which Building Permit No. 1+1+85z dated .. · 0ct 2 , 19 .6~ 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 .Pre, rate..one The certificate is issued to of the aforesaid building. f. amil. y dwelling... Harry Smieh Suffolk County Department of Health Approval House ~ 320 ..... Owner (owner, lessee or tenant) Building InspectOr FOR~ ~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4485 Z Permission i's hereby granted to: .............. ~e~t~& .............................................. at premises located at ..................... ~l~J,....JJJJlJJ3~J. JL~ .................... L: ............................................. .................................................... t~e~t~ ............. ~1;~ ................................................................ pursuan¢ to application dated .......................... ~JL...,J .................... , 19....~ and approved by the Building Inspector. , , FORM NO. I _,~ WNOPSOUTNOLD BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICE ~ ~,. ~,/~.,~,~ ~/ ~ INSTRUCTIONS APPLICATION FOR BUILDING PERMIT ~ ~ Date ...; ....................... ~~,19~..~ a. This application must be completely filled in by typewriter or in ink and submi~ed in duplicate to the Buildings,, 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<3rt 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 shell 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 Counfy, New York, and other applicable Laws, Ordirmnces 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 code and regulations, j / (Signature of applicant, or~ If applicant is a corporate, signature of dully authorized officer. (Name and title of corporate officer) 1. Location of land on w.~osed work_will b~~ .............. Street and~u/m, ber__ .~ ~ ~......~ ................................. iiiiiiiiiiiiiiiiiiiii.~t...N..~i:..iiiiiiiiiii'.iiiiiiiiiiilMunicipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....../'/~.__.~ ..................................................................................................... b. Intended use and occupancy ..... ~ ...... ...~../......~.....~..~ .................................................................... 3. Nature of work (check which applicable): New Buildirig Addition ....~............ Alteration .................. Repair .................. Remov~al .................. 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 ~rs ............................................................................................................................................. 6. If business, com~rcial or mixed ~cupancy, speci~ nature and extent of each ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ........~ ........ Rear ....~.~ ............. ~"... Depth ...~...~ Height .....~..~ .......... Number of Stori~ ~ .~ ................................. ;..;; ........................................... 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 ....~..~ ............ Height ........ ~ ........ Number of Stories ......... ~ .............................. ; .......................................................................... 9. Size of lot: Front ...... ~.~ ....... Rear .............. ~.~.~ ........ ~pth ...~.~.~ ............. 10. ~te of Purchase ....... ~..~..~.~ ........................... Name of Former ~ner ............. ~ ............... ~ .......................... ~,].- Zone'or use district in ~hich premises are situated ..... ~..~.~. ......................... ~ ................................................. 12. Does proposed construC{ion violate any zoning law, ordinance o~egulation? ....... ~ ................................. 13. Name of Owner of premise~.~.~.~~Address .~.~.~.~.~.~ ...... Phone No~.~ Nome of Architect ........ ~ .............. ~ .......................... A~ress ............... ~ .............. ~ ...... ~ Phone No ..................... Na~r ~...~ ~..~..Address ~..~.~ ~ Phone "' :'" ' ................ L~a~nd distinctly all buildings, whether existing or pr~osed, and indicate all ~t-~k dimensions from pr~er~ lines. Give street and bl~k nu~er or description according to d~d, a~ show street nam~ and indicate whether~~~~interior or corner I°"fl [II w' I 1 STATE OF NEW~--Y'OR~,,,~, ~' ~ c c COUNTY OF .,~=~'~L~.~.::._~.L.....~ .~ ~ ~ ................................ ~.~ ...................................................... Demg duly ~orn)-d~es and says t~t he is the applicant (Name of indivi~al signing appl .... obove n~med. He is th~ ......................................................................................................................................................... (Con~ractor, agar, co~orote'officer, etc.) of said owner or owners, and is duly authorized to perform or ~ Performed the ~id work and to ~ke and file this application; that all statements contained in this application are-~ to the best of his knowledge and belief; and that the work will be performed in the manner set foah n the app CatCh fi ed therewith. Sw°m to bede me this ~ __ '~ , ~ ..... ~day of ...~ , I~ .~,)~ ' ~ ~ ,'~ of .oJ~.v ~~w ~o,~ ~ /] ~o. 5~fol~ Coun~ Co.mission ~plres ~arch ~0, ]9~J