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Home My WebLink About4493-zFOEM NO. 4 TOWN OF SOUTHOLD BU-HDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z..369.1 ..... Date ............ D. ec .... ~; ......., 19..69 THIS CERTIFIES that the building located at . .Baywa. ters..Read- ......... Street Map No. l~asea~- P.t, .P]~ No..se~l. D ...Lot No. 378... Cutehogue. ' conforms substantially to the Application for Building Permit heretofore fi]ed in this office dated ............ Oct' '6 ...., 19.69. pursuant to which Building Permit No..b~93. '2 dated ......... ~et .... ? ..... , 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 ..... Priv'~te' one' f'amily 'dwelllllg ................................... The certificate is issued to ...... i/ChiW '~yrne ..... 0~rn'er' ' · ~ ........ . ..... . '~ ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · · N.,.R, ............................. ....... .......... Rouse ~-23~ TOWN O~ $O~TNOL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, BUILDING FER/~iT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~93 Z Permission is hereby granted to: ..e...,.~...~.?..........~......~..~ .............. at premises located at .......... ~JJt,:3~J~.....JJtll'Jl~__~.~i*.~.t~.~.tlt~ .......................................................... ...... .... .............................. .l~.~e~..l~Jm.6, ......... ~'~,..~.e.~g~ .....~.,.~. s .......................................... pursuon~c to application dated ........................... J~JJ ......... irk ............. , 19.J~g.., and approved by the Building Inspector. ,Fee $..,..~e,~., ......... Examined ............................ .7 ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No, '~/'~"("~"~ ~ Approved ........................................ , 19 ........ Permit No ........................ Disapproved a/c ................................................. (Building Inspector) / APPLICATION FOR BUILDING PERMIT Date ............. ../.0./~...~..~ ............................... ,19 ............ INSTRUCTIONS o. 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 propertymust be drawn on the diagram which is part 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, bg, ilding code and r_egglations.j~~ (Signature(df applicant, or nome, if a corporation) . .................... ...... ........ ......... (Address of applicant) LJ If applicant is a-~Corporote, signature of duly authorized officer. (Name a~J title of corporate officer) ~.c .,~) ', 1. Location of land on which proposed work will be done. Mop No: Lot No: ........~ ..... $ Streetand~u~mber..~.. ,..~.~ ~ ~ .~ ............. ~,J ~'~ni;ipoli~ ......... g .................................... State existing use and occupancy of premises and inten~occupancy of proposed construction: a. Existing use and occupancy ......................................... ~ ............. ~ ................................................................... b. Intended use and occupancy .................................. ~ ........... ~ .......................................... 3. Nature of work (check which applicable): New Building .................. Addition / Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost .............. .~..~.~..,.(;~12 .......................... 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 ...... ~.~. ............... Depth ...~. ................... Height ......... ./.~. .............. Number of Stories ........ ./. .................. i .......... ............. 9. Size of lot: Front .............. /..~. ...... Rear ................ ~ ........Depth 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 ~.'~.(..t~/..~T./....~,).4~....Address .~.S'.~/.~.....~.~..~..~..~.~....~.~.9..n..~a~none No Name of Architect ...................................................... Address ............................ . ................ Phone No ..................... Name of Contractor .~..l~....~f~.~/l~['~ ............................. Address ..~,E'~...~X/~.~.....~.?...~.~... ...... Phone No ..................... PLOT DIAGRAM existing or Locate clearly and distinctly all buildings, whether proposed, ond indicate all set-back dimensions from property lines~ Give street and block numbers description accordi.ng, to deed, and show street names and indicate whether interior or corner lot. tc~u / STATE OF NEW ~1~,_ COUNTY OF ..~ ....... ....... ~ ~ ................................... being duly sworn, deposes and ~ays that he .is the applicant " (Name of ~l~dividua signing app cat on) o ow ........................................................ .............................. of said owner or ownem, and is duly authoriz~ to ~Horm. or have performed the ~id work and to ma~ and file th s application; that all state~nts contain~ in this apphcati~ are tree to the ~st of his ~l~ge end belief; and that the work will be ~ffo~ in the manneF ~t fo~h in the app ication fi ed therewith. Swo~ ~b.e{ore ~ t~.. . ~ ~,_ S ~'.,.,.. '"'*~ .....................................