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Home My WebLink About4355-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPA_RTMF. NT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. Z~%+~ ...... Date ........October. 17! ......., 1g.73. THIS CERTIFIES that the building located at .l~ua .Neclr .Roast .......... Street Map No.. XX ........ Block No..XX. ......Lot No. XX .... ~o~thol~ ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......J.~ln®. 26! ..... , 1969.. pursuant to which Building Permit No. ~3~5Z.. dated .......J. lme. 26! ...... , 196.9.., was issued, and conforms to all of the require- rhents of the applicable provisions of the law. The occupancy for which this certificate is issued is .. PxivoA:e. o~le .£amil.¥. dwollAng ..................................... The certificate is issued to .W&l.tex'..V.,. ~iao..l~l:l. ah .... o~oF ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~ ............................... UNDERWRITERS CERTIFICATE No...P?.~.~.i..~. ................................... HOUSE NUMBER27..%. ·0 .......... Street...P..i~..e..N.e..~., .R.o..a.~. ...................... ~outhold Building Inspector FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT I'O~N CLEitK'~ OFFICE SOUTHOLD, N; Y. N.° 4355 Permission is hereby granted to: BUILDING PERMIT (THIS PERMIT MU~$T:~!~/ON THE PREMISES UNTIL FULL COMPEET!ON 1DF~T3~ WoR~ '~ ...... ' ................. 6 69 Z D~ ............. ?~....,.~ .......... , ~ ........ ...... ; ......................................... ~.~.h..o..~..a. ....... .~...~.:. ............................................................................ p,~,~, ~-., _-_~ .: '~ ;,~. _ ~ .~..~, ~~:,~ ~; ~ Building Ins~c~r. : ,, · .'. ~ F, S.5.,.~. ............ !' *TOWN OF SOUTHOLD TOWN CLERK'S OFFICE r~/,, ~-9 ~ -.~: A~rov~ ...~ ...................... :X ......... , 19....~. Pe~it ~ ~ ~ ~ ~ ~ D'~pprav~ ale ................................................ _ ............. ........ ............ .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and sl~bmitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises br 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 nat 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. "";~PPLIC~ATION 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 dernolitien, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. location of land on ~vhich p~mpa~ed work will be done~,AAap No.: · ....................................... Lot No.: ........................ 03 Street and Number ....... .~.~.~..~ ....... ~ ,...~"~o...~, ...... ~. J~Z .-7le c~ 7~'0 ~ ' Municipality "r' ~r" ...... .~ 2. State existing use and occupancy of premi and int.e .r~led~ use and occupancy of proposed construction: _~- a. Existing use and occupancy ....... :...:.m~.~.~ ................................................................................. ~ b. Intended use and occupancy ........... ~.~.:. .............................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ........ Alterotion ........... Repair .................. P,.~val .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~..~...~ ........................... 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 o3rs ...................... /. .................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... ~, ....... 7. D,mens,ons of ex,st,ng structures, ,f any: Front ..... ~..~.. ....... .~. ..... Rear ....~.~......~...~.. .......... Depth ..... ~ ....... Height ..... ~...~.../.. ........ Number of Stories .............. ./.. ............................................................................................... Dimensions of same structure with olterations or additions: Front .................................... Rear ............................ Depth ....... .~..~...f. .............. Height ........ /.;.~...~. ......... Number of Stories .......... ./. ................... 8. Dimensions of ~ntire new construction: Front .................................... Rear ........................ ,~.. Depth ...~....~.. ........... Height ....~..~...~. ....... Number of Stories .......... /. ................................................................................ 9. Size of lot: Front ...... /....~T~......~. ....... Rear ..........~...~...~. ......... Depth ....... ~....f. ........ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ........... .~. ..................................................................................... 12. Does proposed construction vioJate any zoning law. o[di~ance or regulation.;) ....... ..~..~.. 13. Name of Owner of premise ., ress .............. Phone No.~..~..5...'..~..?....~0.. Name of Architect .......................... ~ .......................... Address ............................................ 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 street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~OI~, ~, ............. ~~....~....~..~.~ ................ ~ing duly sworn, d~es and says t~t he is t~ applicant (Name of individual sig~ing a~lFcation) above named. He is the .................................. ~ ................................................................................................... (Contractor, ag~t, co~orote officer, etc.) of said owner or ~ners, and is duly authorized to perform or hove performed the said work and to ~ke ~d file this application; that all statements contained in this applic~ion am tree to the best of his knowledge and belief; and that the work will be performed In the manner set fo~h in the applicati~ fil~ therewith. Sworn to before me this ....... .......... o, ............. ........... , . ,_ .. ..... ................... · E AB~H ANN H~I · Not. Term Ex~ires M~rch