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Home My WebLink About4364-zFOItM NO. 4 TOq/N OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. 3822 ..... Date ........... 3.~ne...8 ........ , 19.7.0. THIS CERTIFIES that the building located at -Dogwood. L~.. (p~t. R&)... Street Map No. 2'~.%. aec. I I Block No ........... Lot No... 100. &l 0.1...East .l~arAoll.. 1~ · Y confoms substantially to the Application for Building Permit heretofore filed in this office dated .......... Ju~.~... 3' ' ', 19. (~ pursuant to which Building Permit No... ~1+. Z dated ........... Jtt~" ' 7 ''" 19. '(~9' was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...l~r~v~te. one. family. <lwet.l.~g ..................................... The certificate is issued to ... Albert..~]~alle~ ...... 0~mer ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........... 1~olt, .................... ............ ........... t~ouse ~ 30 FOltM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4364 z Dote .............................. ~T~I.Z......~. ......... , ~9.6~.. Permission is hereby granted to: ..... 6t.8....&t,l,,..a,~ .............................................. ..... I...Iozthpazt ...... 11.X.......1.$~31 ............ to ............ Jj~lA..au..adiJ,~..au..at~.~rJ~t~..~mliJ~ .......................................... at premises located at .............. J4Jt~....~.~...~...l~JJ]......~'~l~J~lJ~.lL~Jl~TM ..................... ................................. ~...3~....lle~o~..t~ ......... ,,..~.. JeJ~..~..,. Jent.....l~.t~' ............... pursua:n¢ to application dated ............................ ~l~.....J...~ .......... , 19~¢~..., and approved by the Building Inspector. BUILDING DEPARTMENT Examined .................. , 19.. /, \ Approved ........................................ ,1, ........ pa..it .o. '~.~ 'r Disapproved a/c .............................................................................................. ..... (~'""~'""~'~i .............................. :" INSTRUCTIONS ' "~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building ~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o 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 application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for i~-~paction 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. APPLICATION 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 demolition, as herein described. '-The applicant agrees to comply with all applicable laws, ordinances, building code,~ousing code, and regulations. (Signature of applicant, or name, if a corporation) ,,' _-, -- .................................................. ,.,t..,'" ~ ~.....~,' ,,,,..r'~:,,' (Address of applicant) ///75/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. ............................................................................................................................... Nar,,,e of ow,er of prem,,, ..,~/~'...'...~....Z....4..'f...'..././.~..': .......................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ..~.~..~..(~C,~.~ ............. Lot No.: f.O..q..~.../...D./. .... Street and Number ........ ~.~.,g-<'.Z(...~.~.~9. A'.d.g,..6~. .............................................................. _ ri ~,o- w,,,.r~:~~,~Z'"'~';~ ........... 2. 5tote existing use and occupancy of premises and intended u~e and oc~/pancy o~o-tr-ph3pbs~l 'construction: a. Existing use and occupancy ........ .~..~..~9......~. e./- .. ~..9..~....~,,, ................. b. Intended use and occupancy .~...~.. ~ ~ .................................. 3. Nature of work (check which applicable): New Building .................. Addition .... ~ .... Alteration .................. Repair .................. ,Removal .................. Demolition .............. ~,Other Work (Describe) ........................................ 4. Estimated Cost ........ ~...°..9.~ ...... ~...~....z .............. ; .......... 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 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 ..... ~..~ ................Peer ...... .~..~. .................. Depth ...:~,...~. ........ Height ....... .~....3,..~ ....... Number of Stories ......... ~....~./...~.. ........................................................................................... Dimensions of same structure with alterations or additions: Front ....... ..~...~.. ..................... Rear ...~..~. .................... Depth ..... ~,.~.. ................... Height ........ ~ ............. Number of Stories .......... ~....././...~. .......... 8. Dimensions of entire new construction: Front ............ Z,~ .................. Rear ..........~....~. ............ Depth ....Z.~ .............. Height ....... ~..~ ........ I~lumber of Stories .......... ./. ......................................................................................................... Size of lot: Front ..... ~..~ ...... Rear ........ ~..~.....~.t~J....'.....Depth..... /.5.L~./._..7...~.... Date of Purchase ............. ~..~......~..?. .......................... North-jar ,Former ,Owner ..~?~j.'.~..c,..~.A.~...? ...................... ' Zone or use district in which premises ore situated ....... ~...~..~... ....... ~, ............................................. Does proposed construction viola?e any zon~3,Jaw, ordinance or regulation? ...x...~..~..~.. ............................................ Name of Owner of premises ,~../d~.¢.~"../..2Z~'.'~../~//~,~'ddress . .~...~..:..?.~......~.~..~..~.Z.~..~b Phone~'l~/~.,fr'.....Z~..~.~... Name of Architect ............................. ,~ ...................... Address ............................................ Phone No ..... .~ .............. Nome of ....... ................. ^ddress .o_ 10. 11. 12. 13. PLOT Locate clearly and distinctly all buildings, whether property lines. Give street and block number or whether interior or corner lot. proposed, and indicate all set-back dimensions from show street names and indicate COUNTY OF , , duly sworn, and says that he is the applicant ( above named. He is the ......... ~t~.~~.,..(: corporate officer, etc.) of said owner or owners~ and is duly authorized to perform or hove performed the s~id work and to rnoke or~J file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the ~pplicotion filed therewith, Sworn tobefore me this .......... .......... do, o, ........... ................... , ~'~//. _ i ~.~ ~ ~rqr~ . ~ ~ ...~, .....~?~ ...... z.~,.._~. ~ ................................. o~ '"p ilo P o 5 E_'I) -po~c~ OF '])oci d oo-~ LA: ~ c- EXIST'It,lq It 0." --T