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Home My WebLink About4439-zFORM NO. 4 TOWN OF $OUTHOLD B[m.r~ING DEPARTMENT Tow~ Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z36~8 ...... Date ..........l~ove~abe~.. ~6 .... , 1g.69. THIS CERTIFIES that the building located at ....liar. th. Road ........... Street Map No...~ ........ Block No.. ~,~ ...... Lot No. xx ..... Greeapo~,t. · t~,¥, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........~,~29 ......, 19[~. pursuant to which Building Permit No....1~.3~. dated ...........itlg. · · '29", 19 69- 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 ..... P~vate '(accesscrzT)' ~corag~ .bu~..lO~ng ........................ The certificate is issued to .. t~e,son .Te.l. sey .&. ~lfe ....... 4~me.x,s ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .....N.o2~ .......................... Building Inspector llouse ~ 6~7~ FOF,~ 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) 4439 Z Permission is hereby gronted to: at premises located at ...................... ~.~.~....~'~..~ ............................................................ .................................................................... Oz~'~ ....... I,~.,, ..................................................... pursuon~ to application dated ................................ &ll~ ............ ~1)..., 19.~1)., and approved by the Building Inspector. Fee $..~el~ ............ Approved ........................................ , 19../'. ..... Permit No ....... Disapproved a/c ............................................................................................... APPLICATION FOR BUILDING PERMIT ~ ....... ........... ~"~............. ~...-... .................. , ,9.~.~. .... INSTRUCTIONS a. This application must be completely filled in by bypewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot a.nd of buildings on pre.m,llas: relatiomhip to adjoining premiees or public streets or areas, and giving a detailed description of layout of propmty mU~ be arawn on the diagram which is port of this application. c. The work covered by this application may no+ be commenced before issuance of Building Permit. d,;, U.pon ~ap..r.~ of .this applicati ,o~, the Building Irmpector .will i~ue a Building Permit to the applicant. Such permit snal De Kept on me prem,~es available tar impecflon throughout the pragre~ 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 i~uance of a Building Permit pumUant 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, housing code, a~d regulations. (Signature of applicant, or name, if a corporation) (Address of pppllcont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ....... .............................................. a m~licant is occP~po '~ '::':'n''''~'-l/"~*'*'at~l~bf d: '5'""a~';:;'"~'""~;:""~: ............................................ ~ ....................................... ' (Name and title of corporate officer) 1. Location of land on which pra~ work will be done. Map No.: ....... ....,~.~ ......... ~ ....... Lot.No.-, ..,~ ................ Street and Number .; ................. 'Z.~... .......... ~~"...~....~..~...,.i ~~ ~ -' ..... ...... ...... ..../..... 2. State existing ~ and occupancy of premises and~ use' arid' ocCuppncy.of proposed constra~-tlon: a. ~.,ng.. o.~ occ~,~ ............. . ......... /..~.~.~ ~ ................................................ b. ~ntended ur~ and. occupancy ..................................... ~ ............. . ......... ~ ............................ , .................. Repair .................. Removal .~, .............. Dem61ition....;.:;....;::.:: ~.Otl~er Work (Describe) ........................................ 4. Estimated Cost ........................................ ~...,.....Fee, ...... ;~ ................................................................................ (to be paid on filing this application) ,5. I~ 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. Damon, sions 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 ................................... Re~ ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear ........................... ~ ....... D~,,pth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. ZOne or .use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ............................................................ 13. Name of Owner of premises ............................. .~ ......... Address ............................................ Phone No ..................... 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 lat. STATE OF NEW YOI~,' C~N~ ~ ....,....~..~.,, _,, ,,-., ~ ~ ,.-- ~-- ................ ..z du,y,,om, ond ,ho, h.,s th,,,pp,, on, /(Nc · of individual signing applicatigD) ' / ' ' is the . .~..'~'~..~.....'~ ......................................................... ~ .............. aoove namea. ~e ................................................................ (Contractor, agent, corporate officer, etc.) ' ' of said J~wne./or owners, and is duly authorized to perform or have p~fo~ the.said .w .ink a~l~to ? ~ file this appllL-afion; that all statements contained in thi.S app!icatlon.?re tm.e..to~..t~e be~...of I~,s y~o~,~eaqe are oe.m; and that the work will be performed in t~ manner set forth in t~be applIcation Sworn to before ma this /-~]~r.-z~//~C/~'- _ k~'-//'"~ /'~'~AJ~'~ , // \ ~J~/'~ ~, ........................ .of ..... ........... ¢r .... Term Expires March 30,