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Home My WebLink About4320-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No..~,~7.'1.~. ..... Date ........... De.e.o$.be..~....~.¶..., 19..6.9. THIS CERTIFIES that the building located at . ~.e$.e}l~.eH~d....1~..( .F~T.. ) ..... Street Map No ............. Block No ........... Lot No ....... (~teheg~e ..... ]1~,.~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ J~e ..... ~ .... , 19.69. pursuant to which Building Permit No..~3~. dated ........... J.l~l~...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 .....~.1,~...re. m..e...f~..~,~)-..d.~.e~,~ua .................................... The certificate is issued to . .~b~rt. t~lalh~o~. of the aforesaid building. Suffolk County Department of Health Approval ...eerier. ......................... (owner, lessee or tenant) Building Inspector FORM NO. 2 TOWN OP SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CfHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4320 Z Date ........................ ...~.....~:.~ ..."~..~..~..//~'- ...... , N? Permission is hereby granted to: .......................................................................... ~..~:.:~.~ .................................................... ............................................................................................... .~?....~Z.: ............................................ pursuan{ to application dated .................... ~ ........~:?.~, ,9.~....~., and approved by the Building Inspector. Fee $ ........................ Building Inspector (Building In. lpeator) APPLICATION FOR BUILDINe PIRMrr .................. ............ Ibis I KUCTIO~qS 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 prapirty-muSt be drawn on the diagram which is port of thie application. c. The work covered by this application may not be camrnenced before issuance of Building Permit. d. Upon approval of this application, the Building Impector will Issue a Building Permit to the applicant. Such permit 'shall be kept on the premises available for irlepection throughout the progress of the work. e. No building shall be occupied or used in whole or In part for any puq~oee 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 pur~Jant 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 aws, ordinances, bui ding code, housing code, and regulations. (,,/(Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which p~ work will he done. Map No.: ........................................ Lot No.: ........................ 2. State existing use and occupancy of premises and Intenc~ed use am:l, occupancy ofprapased construction: o. ,,,,,ng,and CUpa ................... Z..j .......... ...................................................... b. Intended use and occupancy .................... .~...*. ................................................................................... , ................... 3.Nature of work (check which applicable): New Building ! .................. Addition ....................(~......... Alteration .................. Re air ........ Removal .................. Demoj;itiOn.....;'...L~;... Other Work (Describe) ........................................ OO ..fi_ - Y 4. Estimated Cost ................. Z. ....................................... Fee .~ ...... ~.~.". ............................................. ~ ............................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~Number of dwell ng un ts 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 ................ ~ ...... r Number of Stories ................................ 8. Dimensions of entire new construction: Front ..................... ......... Rear ............ ............ Depth-....~u~.. ............ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear ...,.~ ............................ Depth ..................... L~:~"~,' / , 10. I~n*~ .'-~...of Purchase .......................... ~....~.. ............. Name. of Former Ow~ner ..:....~ .............................. 11. ~ or use d,str,ct m wh'ch Prem'se~ ore/situated ...... :~::'"'~~'" ............. ~ ..................................... 12. Does proposed construction violate any Zoning Iow, ordinance or regulation? ............................................................ 13. Name of Owner ofPremises ~ /~//~""~'""~7"'"~"~'~"Address ' ~"'~'"~"'~'"~"'~'""~:~'"~ Ph°naN°~'~"'?""~'"'~'"/'"/'"~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Aw-r/lc Phor. Name of Contractor .................................................... ,~:klress .......................... PLOT DIAGP-J~ Locate clearly and distinctly all buildin,gs, whet,her e.x!s, ting or p,.?pa~l., ?r~, indi,cat, e all .set .-I~=ck dimens~i?~..r=~e property lines. Give street and block numoer or aescnpT~on accora~ng ro aeea, ina snow s~reet names aha ma ca whether interior or corner lot. ~;t~l~r~ ~::~L~ ~/ STATE OF NEW YORK, ~ S~ ~ / COUNTY OF ......................... .........................................................~ y swom, deposes and says thor he is the applicant (Name of individual signing application) above named. He is the ~/'//'TTt~l"-~ ........................................................ (Contractor, agent,..corporate Officer, etc.) of sa d 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 contained in this appl cation are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth Jn the application filed therewith. Swam to be[ore me this .............. ............. ..................... ....... ? Nota, b,c, · ....................... Co n, .................. of ......................