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Home My WebLink About4216-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. z. ,~493 ..... Date .......... ~, ..... 2.7., ......, 19(59.. THIS CERTIFIES that the building located at . Zast~ood. Drlv~ ........ Street Map No. l~as.~ood... Block No ........... Lot No..9.. ¢~tcho~ue ,. New. ~r~zk ..... Sec. I conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... March... 2.7...., 19 ~9. pursuant to which Building Permit No. 4216. Z.. dated ...... March ... 2.7., ..., 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 ...private. nne. ~am:[1.y..dwelltug. ~ith. addt.tion .................... The certificate is issued to ../~o. Dank ............................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Inspector /. House % 195 Eastwood Drive 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? ~216 Z Permission is hereby granted to: ...... ~.,...~e~,:~....a.....s..e~....~ .~.......~.~....~ pursuan,t to appiicotion doted .................................. ...~..~.~.~.. ......... .~, 19......~, and approved by the Building Inspector, Fee $..~.t...~... ............ Building Inspector / FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Examined ..................... 19 .... Appr, oved ..................... ~9 .... Permit No .................... Disapproved a./~; ~'. ............................ Application No ................. APPLICATIQN FOR BUILDING PERMIT Date ..... .................... INSTRUCTIONS a. This application must be completely filled in by type~vriter or in ink and .submitted in duplicate to the Building Inspecbar. b. Plot.plan shelving location of Lot and o~ buildings o n premises, relationship to adjoining premises or public streets .ar areas, .and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The xvork covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building In specter will issue a Building PmTnit to the applicant. Such permit shall be kept ~n the premises available fo r inspection throughout the progress of the work. e. No building shall be occupied or used in whole oN in part f~r amy purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspeet~. APPLICATION IS HEREJ3Y MADE to the Building Department for the issuance of a Building Permit pursuant Lo the Building Zone Ordinance of the Town of S~uthold, Suffolk C~unty, New Y~rk, and other applicable Laws, Ordinances or Regulations, for the construction ~ build ings, additions or alterations, .ar for removal or demo- lition, as herein described. The applicant agrees to com ply ~vith all applicable laws, ordinances, building code, housing code, and regulations. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or If applicant is a corporate, ~.gna~tu~e of .duly ~thorized ................ (Name and title of cerpo~ate officer) 1. .~ficer. o Location ,of land on which proposed w,ork will be done. l~fap No ................. Lot No..~.. Municipality State existing use and ~ccupancy ,of premises an d intended use and .occupancy of proposed construction. b. Intended use and :occupancy ................................................................... 3. Nature of work (check which applicable): Nexv Building ........ Addition ........ ~/~ Alteration ........ Repair ......... Remollig1 ........ Demolition ....... .,~D~ Work (Describe) ...................... 4, E,stimated Cost ~ ~. O 0 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 .~r 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 ................ Numbter of Sbories ..................... 8. Dimensions .of entire new construction Front ....~'- .~. ........ Rear .............. Depth . .~...4..-.. }.. Height ............ Number of Stories ............................................................. 9. Size of 1,et: Front ................ Rear . .............. Depth ............... 10. Date of Purchase ............................... Name ctf Former Owner ............................. 11. Zone or use district in which premises are situated .................................................... 12. Does proposed construction violate any z3ning law, ordinance or regulation? ........................... 13. Name of Owner of premises .... ~..'..~. ~.~/...~... Address ...~.~'..~.~..~.?.~..,~..~... Phone No ............ Name of Architect ..... ,..~ ................... -~ddress ...................... Phone No ............ Name .of Contractor . .~.'...'.~'.. t..~.4/.-~. ,~..~.~'.. Address . .~..~..~. r. 1. r. ~..¢~ Ph,one 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 ~r deseripti, on acoording to deed, and show street names and indicate whe~her interior or comer lot. . STATE OF ~YORK. a )S.S. ....... il~;'~;f in~l'i~i/l~i~'ati;~i ....... being~duly sworn, ~deposes and says that he is the appli- cant above, named. He is the ............................ ~ (Oontractor, agent, carp.orate officer, etc.) of said owner or owners, and is duly authorized bo peff,*rm or have pe~ormed the said work *.nd to make and file this application; that all statements oontained in this applieati, on are true to the best of his knowledge and belief; and that the vam'k will be performed in the mann er set fortl~ in the application filed therewith. Sworn to before me this ................ Y .................... 19 .... f ~///~ ,~---.~__~ . Pubiie .................... toady ................ ~~~ '/~ R0ra~Y Pl'e~lC Stale c,* New York ~