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Home My WebLink About3698-z]FORM N~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I"OWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE DF OCCUPANCY No. ~..29~.~ .... Date ............ F. eh ......3 .......... 19.68 THIS CERTIFIES that the building located at . ~/~ .l~.g~'ohsor~ .Road ....... Stx'eet Map No...l~, ....... Block NoX21~ .......... Lot No. ~ ..... C~l~ce, hog.~e· .N ,~., ........ conforms substantially ~o the Applicat~0n for Building Permit heretof, ove filed in this office dated ............ ~OV.~ .... ]..., 19.(~.~. pu.rsuant to which Building Permit No. dated ..... I~OV.~ ....2 .......... 19..6~, was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The occupancy f~or which this ce{tificate is issued is . .Pr. iva.~e, one..fa'~.,lly .cl~et.'l.:~r~g ......................................... The cex-tificate is issued ~o ...~ec~ .~.f~a~k ......... ~A~I; ............................ (o~vner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ............. I~. !.I.~ ....................... Building Inspeet~ FOR~ NO. ~ TOWN OF $OUTHOLD 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? 3698 Z Permission is hereby granted to: ... ~ae,.. ~,bZ.a~..~/~....~e..~taek ............. .................... .O.~l~e~ ....................... ~ .............. to .... l~.. ~.. ~.~.t~,.~..~..~..~.~.~......~...e~...~..~;... at premises located at ...~.....~.~'~q}~i.~l~..~J~ ...................... ~ ....................................................... ................................................. ~.e.~,~..... ~ .,.~.:. ........................................................................... , pursua~¢ to application dated ........................... ~0~. ........... ~ ........... , 19..~.., and approved by the Building Inspector. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~]..~....]..'~... ........ , 19.....~..'.~ Application No. ~ ~ ~'~ Approved ........................................ , 19 ........ Permit No ......................... Disapp roved a/c (Building Inspector)/ APPLICATION FOR BUILDING PERMIT Date ,2//j~/~ ,~ . 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 propertymust be drawn on the diagram which is part 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 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 Couqty, 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 applicon} agrees to comply., with all applicable laws, ordinances, building(~ ~c°de and reg~u~)t~9~s. (Signature of (~lplicant, or name, if a corp~i'ation) x'-~-/-~J/2/,/ , ...................... ......... --OAddress of applicant) State whether ap~)licant is owner, lessee, agent, ~ec2e~r, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work vxill be done. Map No: ............................................ Lot No: .................... Stree~ end Number .......................................................................... Municipality 2. State existing use and occupancy of premises and intended use an~ occupancy of proposed construction: a. Existing use and occupancy ..................................... ./~....-~'~ b. Intended use ond occuponcy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ~ Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost......,.............~, ......OOO.......~ .~..O.... , .......... . ........ 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 or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front .......... .~..'~.~. ......... Rear ....... -~..?.../. ......... Depth ....~...~. .................. Height ......... J...~.. ............ Number of Stories ............... ./..~.~. ......................................................................................... Dimensions of same structure with alterations or additions: Front ~O Rear Depth .......... .~'?. .............. Height .......... /....~. ............... Number of Stories ///~' 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front .......... ./:~..~. ........... Rear ...... ./...~...~. .............. Depth 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or reg.ulation? ...... ../~..~ ........................................... ~.eo J'Y/¢ ress ~ro~J~e, /~.~,¢ Co/~'~ vc.p one o 13. Name of Owner of premises .............. ~.. ...... .~. .............. Add ..................................... .%~... h N ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... . le Name of Contractor ...~¢.~,.....~.....[.5. ........................... Address ...~..o~.cq.e.~..~..c(... .~.~' 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ c c COUNTY OF .............................. / °'°' ~. ~ ......................................... being duly s,,b, orn, deposes and says that he is the applicant ............'"' (Name o~ individual signing application) ~ --~ above named. He is the ................................................... ,&~.)~ .............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make 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 be performed in the manner set forth in the application filed therewith. Sworn to before me this /;2 .......... ,~.¢.~..~........ day of ...... ~~ ......... , ....... ~ _.,-,.*, Notary Publi~.'~c~rer~...C..~'.'..'/r~'~c0~gt~i~ ............ ~"~'ure of applic~'~r'"~'~";;';i ..........................