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Home My WebLink About4297-zFOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. 1~ .36~.. · Date .....Oc'tO~Z ....9, ......... , 19~9.. THIS CERTIFIES that the building located at egl;...]~a~[ 4t~ne ......... Street Map N~l~z~m(~lm .... Block No ...........Lot No. 1~...ezee~lmZto .ll~. ~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....i~Y. · 1~, ........ , 19~9. pursuant to which Building Pemit No.. ~2~7. I dated ....I~y.. 3.9° ......... , 19..&~[ was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... [r~.$v&te .o~®..lem&.l.y. &eellJ~g ..................................... The certificate is issued to . ](Blt~Z .]ic~J~gl ...................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... liou~e ~I, 182S e~1.1 l,m~d Zdme FORM NO. '* 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? 4297 Z '~ ouirding Inspector TOWN OF SOUTHOLD.~/~.~/~'~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOU'THOU), N. Y. Examined .................... 1 · ................... ~ ..~.....~ 1 ~ rmit No. Approved Pe ............................ -- APPLIGATION FOR BUILDING PERMI'r ................. ...................... , ............ Disapproved a/c ....~ ........... .~ .................. ................................................. iljjjjjilj..ji i. _ ._ ~ (Building Inspector) INSTRUCTIONS a. 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 property must 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 app. lication, the Building Inspector will issue a Building Permit to the applicant. Such Dermit shall be kept on the premises avadable for inspection througF. OUt 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. APPLIC^TION 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 aterat ons, or for removal or demolit on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, budd ng code, housing code, and regulations. (Sign cant, or name, if a corporation) (Address of applicant) ~J State whether applicant is owner, lessee, agent/architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............................ ~<~. ............ ~...~-- ................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed Workwill be done. hAap No.:..~.~.~.~.eu...,.~'.~.~.~.~.. L~t No.: ......~Z..L....~... umber ............. ....... ...................... 2. State exi~Jng use and ~cu~ncy of premises and intended~cu~ncy of propos~ con~ction: a. ~[stjng USe and ~cu~n~ ..., ............. ~ .................. ~)~ ............... ~ ....... ~ ............................... ~..... ....................... b. Intend~ use and ~cupancy ....~ ................... ~ ............... ~ ................................... ~ .................. ~.....; ....... 3. Nature of work (check which applicable): New Bu~ drag .................. Addition .................. Alteration .................. Repair .................. Removal .................. , Demolition ............. i~,. Other Work (Describe) ........................................ Est mated Cost /.~.~ ~ ,~ Fee '~" ' . . (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... i."'.~..~ ......... Number of dwelling units on each floor ............................ If garage, number of cars ........................ 6. If business, commercial or mixed occupancy, speCify nature and extant 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 3 6 ~&' W ................................ Height .............. .Z..~. ........ Number of Stories ....... :....~... .................. 8. Dimensions of entire new construction: Front ................ ~,./. ............... Rear ........ .~. ............... Depth ......~...~. .............. Height ....... .~...~. ....... Number of Stories 9. Size of lot: Front ........... /...~.. ........... Rear ............ .//./ ................... Depth ......... ..3,.3...0.. ............. 10. Date of Purchase ........................................................ Nome of Former Owner ...... ..~.~..~...~. ................................... 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does ro osed constrbctiOn vioate On zon n a ord nonce r r ' P P y g w, o egulahon ......... ~ ............................................. 13. Name of Owner of premises ....~'.e,~....~....'t,..-..~Jf ....... Address ..~...~q...../t~.~./~..~..~....u~.~.././.~.S...~. p~n~ne~,qo. ?..?..~.....~.../...~.~' Name of ArchiteCt ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~-ee ~.~/e~'~ Address ................................. ?..c..~.~... Phone No. ............................................. ~.s~ Cox/,,, C'~ ..Z~..Y..~:.o..~.e PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property tines. Give street and blc~ or description occarding to deed, and show street names and indicate whether interior or comer lot. I STATE OF NEW' YORK, ~ S S COUNTY OF~,~l (~,/~,^~'~' (Nome.of i(31dividual signing application) ..... above named. He is the ......................................................................... ...~...~ ........................................... (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 file this application; that all statements contoined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner s~t forth in the application filed therewith. Sworn to before me this _ , ....... ~.~ ..... day of ........ .~...~ ...........~ ........ , 19.~/.~... ~, . ~ ~ . Notary Public..~~.~... County,S' '~"~':~ ............................. No. 52-8125850, Suffolk Or,.'.*~' Term Expires March 30. 197i!)