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Home My WebLink About4476-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. Z3~9~ ...... Date .......... ~ .... l ......... , 19.~0. THIS CERTIFIES that the building located at .. ¥1~.. ~r&7. ~*$'e .......... Street Map No. (}~l~lt, l~lock No ........... Lot No..93. & .~.-..l~i~el ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Sept...2~ 19. ~ pursuant to which Building Permit No. dated ......... 8ep~;... ~..., 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 ..... P~iva.te. ona .fm,~!l~. d~ell~ng .................................. The certificate is issued to .... Lou~e. Fox ........ O~er .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ]q.e.Re .......................... FOB,M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4476 Z Permission is hereby granted to: II~.t~...lSelm&..~e~....L,..~e~ ............ pursua~' to opplication dated ................................ .~..?.~...t,. ....... ..~..~......., 19....~..., and approved by the Building Inspector. Examined · ' " " Approved ........................................ , 19 ........ Permit No... ~' Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PERMrI' ~, ~ a. ~is applicati~ must be completely fill~ in by ~writer or in ink and submi~ed in ~p cate to the Buildi In~r. ~ b. PI~ plan showing I~ation of lot a~ of buildJ~s on premiss, relati~ship to adjoining pmmi~ or o~lic str~ ~ ~ a~s, and givi~ a ~ail~ ~ri~i~ of I~t of p~ must ~ drawn on the diagram which is ~ of ~is applicati~. ~ c. ~e wo~ c~er~ by this application m~ not be commenced ~fore i~u~ce of Buildi~ Pe~it. ~ d. Up~ ~p~al of this a~lic~ion, ~ Building Ins~ctor will i~ue a BuJldi~ Permit to the ~plicant. S~h ~it ~all ~ k~t on the premi~ available for i~ction thm~h~t the p~r~ of the work. e. No building s~ll ~ ~cupi~ or u~ Jn ~le or in pa~ for any pu~ whatever until a Ce~ificate of ~cupancy shall h~e ~n ginned by the Building In~r. B .A..P. PLI~CATIO~N .!S HEREBY.MA_DE to t.h_e Bu. ilding Department for the issuance of a Building Permit pursuant to the ,uua~ng Lone, urn. ,nance of the Eown at ~outhold, Suffolk County, New York, and other applicable Laws, Ordinances or t~egulations, ?or the construction of buildings, additions or alterations, or for removal or demo t on, as herein descr bed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of C6pplicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor Name of owner of premises L. FOX 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.: ..G......Z........~_~.~..]: ............ Lot No.: .~.t:;....?.~.....~.........c~ Street and/~u~mber ~ ,?..~.,.~... ~et~.c.~ . ~.~.~.~ .~~ ..................Municipality .......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: dwe" l~.n a. Existing use and occupancy ......................... ~ ....... g .............................................................................................. b. Intended use and occupancy ................. aR.8,1~. ...... ~.~,.~ID,..a,C~i~a"L .................................. 3. Nature of work (check which applicable): New Building ................... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. E~t~moted Co,t ....~.~.~.0....._+. ....................................... Fee ...['..~.: ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .O.b.e. .............. Number of dwelling units on each floor ............................ If garage, number of c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each t3/pe 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 ............ .1.~ ................... Rear ...... .1..~.. ................. Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions af entire new construction: Front ....... ~.~. ........................ Rear ...].~ ..................... Depth ....~) ............... Height .................... Number of Stories .......... oz3e ..................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11, Zone or use district in which premises are situated ......... ."..A...e.....~.~.S..~ ......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. ,1BD. ......................................... 13. Name of Owner of premises ...~...~.Q~ ......................Address .......T.nttZ'~,~, ...................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..... ..~..;.;..~...~..e..~...e..]3... ........................ Address .......... ..~..~..~...~..e.~ ................... 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 NEWa~OI~J~, ~_ ! e e COUNTY OF ...~..u~...~..u...~... ............ ~'~.~. ........................ ~...~ ............... ~.~ .......................... being duly sworn, d~oses and says t~t he is the applicant (Name of individual signing appli~tion) above named. He is the ........... .~o~0~ .............................................................................. ~ ....................................... (Contractor, agent, co,orate officer, etc.) of said owner or ~ners, and is duly authorized to perform or have perfo~ed the said work and to ~ke and 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 ~ performed in the manner set fo~h in the applicati~ filed therewith. Swam to before me ~is ................... ................... ............... , , ....... ............... TA~ pugHC s~te o~ ~ew~york o ~-8115 · N. ~ i~ ~arch 30, 1~