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Home My WebLink About4290-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z .3615 .... Date ........... 0c~cebe~,..~..., 19.69 THIS CERTIFIES that the building located at .. Rabb~.t' 'laa~ ............ Street Map No .... xx ...... Block No. am ....... Lot No.. 'XZ ..... Ra~g 'MI~:[OlI'~' '11;~',' ' · conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~i~ .... 12'" 19 '69' pursuant to which Building Permit No. ~290Z' ' ' dated ......... 14~, ..... 11¥.., 19.6~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pr~ate 'one' 'fa~iTy' dvellLl~ The certificate is issued to . 'Harriet' ~ 'Mool- ~ -,-~o(owne~see tenant) or of the aforesaid building. Building Inspector Ho~ae ~ 300 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4290 Z Permission is hereby granted to: ............... ~-~set.z...m~. ............................ ................. 3~....~..at ................................. ................. 2~r~el~..~el41t~..~i.~e.....~.$)~ to ............... ~J,~ · ~li& ..~l~tr~l~ .-~17' e~,e~l~. · ~1~ ~..~:~ll~ ............................................... at premises located at ................. ~).....~al, b~,.~..~ ..................................................................... .............................................................. ~et.-...~ell ............ 11.~/.~ ................................................. pursua~ to application dated ............................ ~ ..........ee~ ......... , 19...~1~, and approved by the Building Inspector. Buildin~ Inspe~ Disapproved a/c . ~ ................ Application No....~. · .~'..~..~. ..... BUILDING FERMIT ~ Date ............................. 19 INSTRUC-rIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspecbor. b. Plot plan showing location of lot and of buildings o n premises, relati~mhip W adjoining promises or public streets .or aroas, 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 n~t b e commenced before issuance of Building Permit. d. Upon approval of this application, the Building In spector 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 ca in part for any purpose what. ever until a Certifica~ of Occupancy shall have been granted by the Building Inspec~r. APPLICATION IS I~I~-~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 County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, (Signature of ,applicant, or,~ne ff_a~ t~ (Addres~of applic~nt) //.~,~-~ ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or Name ,of owner of premises ~:~..~. · · ~ .-:.~% ~ · · ./~. ~. · ............................... If applicant is a cvrporate, signature of duly authorized officer. (Name and title of corporate officer) ~_. ~7 ~/-f~/ Vi r ~ 111 b e do Ma N ~ ?~--~-~ T ~, N~ . 1. ~ation of l~d ~ which~~' ~ ~ .... . ........f~ ............ Strut and Num~r~.~~~ .. ~-.,...~~~i¢ ~.k: ............. ~~ u p y 2. S~te exist~g use and ~p~cy o~%~nd~~of ~ ~t~ion. a. ~isting use and occup~cy . ~rr~n -5. :....~. 7 .... ~. ~ ............................. b. Int~ded ~ ,~ ~cup~cy ~ .......... (f ......... ~..~ .................................. 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration . ...~.... Repair ...... .... Remova_~ ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated C~st ...... .~.~..~.O..t./~. ? .......... Fee ........... ~ .................. (to be paid on filing this appUcation) 5. If dweiling, number of dwelling units .... /. ....Number of dwelling units on each floor f If garage, number ,of cars ........ .7.....? ............ .~. .............................................. If business, commercial or mixed occupancy, spec~at~e .and extent of eacl~tvae of use ...._ .... ~4'.. ~.. 7. Height "f' '~'~' Number°fSt°ries / ~' , / .............. / ..... Depth ....c~..~. Height ../~-.~.~,~..~.......:. 'Number of Stories ..~..../ ............ ~' 8. Dimensions or'entire new constructiol~. ~ .................. Rear 't ........ .~,... Depth ............ Height ............ Npmber of Stories .~...~... .... (t. ~... ,..f~L~... ~,4q~L~-~ ........ 9. Size of lot: Front ...//..~.~.~, Rear .......... .~ .... Depth .............. ' (JL~ · ~ __ . ~ 10. Date of Purchase...~..~./../. ~..~.~.....Nan~e o~ Former OwnerShiP. ~..~.~.~ 11. Zone or hse district in which premises are situated...: ........................ _. y~ ................... 12. Does proposed construction v, ipla~e any~ing~law, ordinance or regulation? ~.]E..g? .............. . ...... 13. Nameof Ownerof premises ~~?~,ddress .~...~.-.~o~...~...._~.¢~.~..'~. Phone No.~.L~....'~.: Name of Architect ~ ............................ ~ldress ...~,~.~2...~ Phone No ............ Name of Contractor ............................ Address . .//....'~..'..~...~./.~. ~.?. Phone No...'~..(.?. ~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give s .treet and block number or d.~escription acoording to deed, and show 'street names and indicate whether interior or corner lot. ~..] ,4/f Sworn to before me this NOtary Public, S~*~e of New York Qualified i~ Ulster County C~mmission Exl~res March 30, 19. (Signture of applicant) STA'~3 OF N~ YORK, ~. ......................... being duly sworn, ,deposes and says that he is the appli- (Name of individual signing application) cant above narnedx-/He is the ........ ~ .................................................... (Oontractor, agent, cra-rotate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statemer~ts oontained in this application are true to the be~ of his knowledge and belief; and that the w~rk will be performed in the manner set forth/in the application filed therewith.