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Home My WebLink About4436-zFOI~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z~310 ....... Date ............,Tala. · 23 ....... , 19..7~ THIS CERTIFIES that the building located at I~.S. IZadt~zt .N®ek .Road... Street Map No..XxX ....... Block No..Xx ....... Lot No.. X~Oc. · .P.®eo~e.. I~,Y, .......... confoms substantially to the Application for Building Permit heretofore filed in this office dated ............AII$...~., 19.~. pursuant to which Building Permit No..I~.~Z. dated ........~ag. ~-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 . Pr~v&te .one..ff.a~.l.y .dv~,linl~. v~th. an. &4dit$o~ .................. The certificate is issued to .......... ~.o.h.n..S.h.J.?.:-. .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N.o~R, .............................. UNDERWRITERS CERTIFICATE No.. palld~ng ................................... HOUSE NUMBER .... 606~ .....Street .... IncLtan. Reek. Lane..(.~a~t,). .......... .... ......... FOI~[ 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) Permission is hereby granted to: to ............. ~L;I/A ..a~a.. &d~,~Lo~..t~ .~z& s t,~a& ..clue .1.1.IJ~, ................................................ at premises located at .................... J. ltlJ.fl.a~..JL~ltJL..ZdiZt~ ................................................................. .................................................................. l~z~.¢....I.~'.,, ............................................................... pursuan¢ to application dated .............................. ~.1~ ....... ~. ........... , 19..1~.., and approved by the Building Inspector. Fee $...~ell~) ............ Building Inspector ~ ~o. ~ ~/~/~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Examined .............. ~:.t- .................... , " " Approved ........................................ , 19 ........ Permit No ......... Disapproved o/c .............................................................................................. Application rio ............................. ~ APPLICATION FOR BUILDING PERMIT Rte ~ .~ ¢ ........... ........................................ , 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 propertymust be drawn on the diagram which is port 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 inspection throughout the progress of the work. e; No building shall be occupied or used in whole or in part i~or 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 Lows, 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, ordinance, buij~ling code~an~)regulations. (~Tture if. applicant, or~6me, ifa corporation) ....... (Address of applicant) 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 work will be done~ Map No~,~ ........... ~ ............................ Lot No: ...~.. ............... ~ i- Street and Number ..... ~...~.~ .............. ..~..?T...~~ ................................................... ,i~J'/ -- b O ~ ~ ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~......~...~.~ ............................................ b. Intended use and occupancy ...... ~,~-- ~~-- ,9,..~....~...~..~~.........?...~~' ,~. . ........................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. RePair ................... ~em°Val .................... Demolition ................. ~ther Work (Describe) ...................................... 4. ' Estimated Cost ..... ~..~.....~.. .......................................... Fee ....~... ................................................................................. (to be paid on filing this application) S. 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 ~ ........ Rear. ...~ .... Depth ..~.. ....... Height ...... .~...~.~ ...... 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 ..... ~.s~.....T. Rear ...~...~...~.!.. -Bef~h ...~./..e~..... Height ....~...~.~,,., ~--Number of Stories___ ,,~----~'"; ............... 9. Size of 10t: FrOnt ...~Y~.. ...... Rem-..~.~.~-~'....~..~ ..... Depth ..~2..~v~.......~....~..~...°./~// . , 10. Date of Purchase ...~ .~...../.~..~..~..~/~~ ---------- .................. Name of Former Owner------' ~ .~ ...~...-..~ ........... 11. Zone or use distrJct~in which premiSes are situated ....... ~~ ............................................................ 12. Does proposed construction·/vi°late any'.p/,_zoni,ng law, ordinance/ ~: ~°Z rqgulation?,:.. ~... ......................................... ' 13. Name of Owner of premises ~~..Address.~~ ...... Phone No. Name of Architect ........ ; ...................................... Address ............................................ Phone No ..................... Name of Contractor ..................~~ .......... Address ............................................ Phope No ..................... :li PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate .oJ,[ set-bJlck di~ensions from property lines. Give street and block numbers or description according to deed, and sho~:.~, ~et¶~rnesiand indicate ,F? ' g'/' STATE OF NEW YORK, '~, -* ......... ~:..~.~._.?;.~. ............ :..being sworn, applicatio/0') ,~-- ~J/~ o~ duly . depOSes and says that he is the applicant ~me above ~amed. He is the ....... '...~ ............................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty authorized to 'perform or have performed the said work and to make and file this application; that all statements contained in '~thi~ application are true to the best of his knowledge and belief; and that the work will be perfermed in the manne~ set forth in the app~ation filed .t~rewith. Sworn to before me this ~ -. ~ /-~ ! I ~ I I