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Home My WebLink About4385-zFORM NO. 4 TOWN OF SOUTHOLD BUn.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . Mai~' J~ad ............... Street Map No. X~ ......... Block No... ~x ..... Lot No..x~...0~'Ae,at~ .~IoY~ .......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ......... Ju,].~ · ...~6.., 19.69 pursuant to which Building Permit No .... ~3~Z dated .......... Ju~y .... $6.-, 1969., 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 .... Pri~ate. Garage .-. ~eeetsox'y. l~ttildi~g .......................... The certificate is issued to .. l~ill~am.lI~t~ ...... 0crier .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... N,R., ..................... Building Inspector[ ltouae # 3~1.920 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°. 4385 Z Permission is hereby granted tO~Ll.~B ~:[1~ OrX~ ~ ~l .~.. 19...~..., approved pursuan¢ to application dated ............................... !...g~.. · .................... , and by the Building Inspector. ,Fee $....~..e...O~... .......... BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved '~ ~ ........................................ , 19 ........ Permit No ............. Disapproved a/c .............................................................................................. Application No ............................. APPLICATION FOR BUILDING PElt. Mr/ Date ........................... ~.1A~......1..6 .............. , 19..~..~. ..... 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 thie application. c. The work covered by this application may not be commenced before issuonce 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 ir~oection 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 ogrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. ............................................... ~er. ....................... ~ ............................................................................................................. Name of owner of Premises .......... .~..~,~.~..~..8...~.....~..e....~...S. ........................................................................................................... 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.: ........ 3~ ........................... Lot No.: ..~.. .................... .......... .................. i ............ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ¢:J~.e3.~L:J.I~ ........................................................................................................... b. Intended use and occupancy ............ .8.~1~,~...~,1~..0,.~.~9~,~.~...~..~.~.~1~.e. ........................................................ 3. Nature of work (check which applicable):' New Building ~ .......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Co~t ...... ~...0...0...+_. ......................................... Fee ..~....~ ................................................................................. (to be paid on filing this application) 5. ~f dwelling, number of dwelling units ...... ~QTA~ ............. 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, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of StOries ......................................................................................... i ....................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height.~. ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ...... .1.~0. .............. Rear .................................. Depth .......... .1.~0.....~ ....... 10. Date of Purchase ........................................................ Nome of Former Owner ....... ................................................. 11. Zone or use district in which premises are situated ...... .~,......~.~.1~ .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ~ ............................................ 13. Name of Owner of premises ..W.~.~,.a..~.....H...e.~..D.,q. ........ Address ....0.N~l,.e..ll...~ ........................... Phone No ..................... Nome of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor ...... $.{%~t ..................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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 NE~( Y~Q~I~~ ~ c c COUN~ ~ .~.~ .............. ~'~' (Nome of individual signing ~lication) ' above named. He is the ................. O~ ............................................................................................................................ (Contractor, agar, co~rate officer, ~c.) of said owner or ~ners, and is duly authorized to perform or have perfo~d the said work. and to ~e ~ file this application; that all statements contained in this application are tree to the best of his ~owl~ge and belief; and that the wore will ~ performed in the manner set fo~h in the ~p[icati~ fil~ ~erewith. Swam to before me this