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Home My WebLink About4279-zFORM NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z · .~6.~ ..... Date .............]~ov...6 ......, lg~g. THIS CERTIFIES that the building located at .. N'/~ .W~.~giut -St ........ Street Map No. ~,B,¢ ...... Block No ...........Lot No .........Gre~npo~.t. · H,X. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... )',ay ..... 6' · ', 19.69 pursuant to which Building Permit No..b,2~9~ .. dated ........F~ay ...... 6 .... , 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 .. Priw.~e · on~ 'fa~'ly' dw®li~axg ..................................... The certificate is issued to .. Ethel- ~inge-l'con ..... ,0wnel. ....................... ~owner, lessee or tenant) ' ' of the aforesaid building. Suffolk County Department of Health Approval ........... N,I{., .................... House 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) 4279 Z Permission is hereby granted to: to /~/1 ~ at premises located at .......................................................... ~.~/ .........~,'~f~t~'~-'~-"~ ................... ............................................................................................. ~.~_..,~.,~.~.:~ ........................... pursuant to application; dated ...................................... ~...../~q.~,, 19.~ and approved by the Building Inspector. SOUTHOLD, N. Y, Disapproved a/c ...... ~ .... ~ ................ Application No .......... (Bull,ding Inspector) APPLICATIO~'~ FOR BUILDING. P,ERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Piot plan showing location of l~t and of buildings o n premises, relationship to adjoining promises or public streets or areas, .and giving a detailed description of lay out of property must be drawn on the diagram which is part of this application. c. The work covered by this application may r~t b e commenced before issuance of Building Permit. d. Upon app~ovai of this applicatkm, the Building In spector will issue a Building Permit to the applicant. Such permit shall be kept g~n the premises available fo r inspection throughout the progress of the work. e. No building shall be occupied or used in whole Occupancy shall have been granted by the Building Ins pect~. APPLICATION IS I-IE~7~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~athold, Suffolk Oo~nty, New Y~rk, and other applicable Laws, OrdMances or Regulations, for the construction ~f build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with ail applicable laws, ordinances, building code, h.ousing code, arid regulations. (Signature of .applicant, oxt name if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .............................................................................. E -)-H b-- L .S I AI G I_L-- ~'-O N ~ame of ,owner of ~remis~ ............................................................................... If appli~ s 6.?~p~ate' ~gnature of duly authorized officer. .......... .V4VW... :..U~.. ~ .~ ~ ................ (1~ Street ne and title of corporate officer) d,land ~n which propos..ed work will be done. Map No ...... ~ ....... Lot No .............. "~°? x,,~..,Y ~/ & 6- /4//~-//V.~ S-//?~-E,T umber ........ '% ...................................... ~I~lh'i~i' '~lii~ .......... ZF/- ~- P State existing use and occupancy ~ premises an d in~anded use and occupancy of proposed construction. I ............................ a. Existing use and occupancy ...................................... b. Intended use and occupancy .................................................................. o Nature of work (cheek which applicable): New Building ........ Addition ~' Alteration Repair ......... Removal ........ Demolition ........ Other W_o~k (Describe) ...................... Estimated Cost ........ ~ .~...~..~. ............. Fee ...... ~.~-~ ................................ (to be paid on filing this application) If dwelling, number of dwelling units .......... Number of dwelling units on each floor .............. If garage, number of cars .......................................................................... If business, commel~cial or mixed occupancy, specify nature and extent of each type of use .............. 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 ..................... Dimensions of entire new construction: Front ...... ~..(~. ..... Rear .... ~ ..... Depth .. ~ ..... Height ............ Number of Stories ..... D/~ ~'~ Size of k~t: Front ....... . .~'..~ ..... Rear ...... ~..O. .... Depth ...... /..~....~.. . / Date of Purchase ............... ~...~. ........... Name of Former, Owner ............................. Zone or use district in which prem'~s are situated .......... .i'.~. ...... .'~...k. ~.(. ~ .................... Does proposed conmruction violaie any zoning la%_ordinanee .or regulation~ ~ ' · ...... · ~- ..S'/A,/~-Z./2?Z~ .A/(~ldress 9~ ~//~:/A,"~ ......... Phone I~ Name of Owner,of premises . ................ ...................... ............ Name of Architect ........... 7~. ................A. ddress ...................... Phone No ............ l~ame of Con etor ..... .:~: ............................... )~A. Vh-~7~ .... Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or de seription ac0ording to deed, and show street names and indicate whether interior or corner lot. ~0 STATE OF NEW YORK, )S.S. ~&'! ~-~- ~/~( S ~7-~'T COUNTY OF .............. ) ........... ~.~ .... ~ ..... ~ .................... ~in~ ~ ~o~, ~ ~ ~ ~ Y~ ~ ~ ~H- (Name of ~ivid~ signin~ application) c~t 'a~ve n~ed. He is the ...~0.~.~ ........................................................ (~n~r, a~t, ~a~ ~icer, etc.) of ~id own~ ~ owne~, and ~ duly aut~ ~ p~orm or have pe~ ~e ~d ~k ~d ~ m~e ~d file th~ applica~n; ~at ~ stateme~s ~nt~n~ in ~is appli~ ~ ~e to ~e ~ of h~ k~wl~ge and belief; ,and ~at ~e ~k will be p~ in ~e mann er set fo~ in the application filed ~e~. Sworn to ~fo~ me ~is ............ ~ day2f ~r 19~ ~ -- Nm ~bl,c ' % ~ '/~'~t ....... ~~'"~'~"~~ ............ ~ ' , ....~ ............... Y { L (Si~ of a~plic~t) ~ ANN NEVILLE iZAB~ rk