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Home My WebLink About3650-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 7...3629 ..... Date ........... 0Ct ..... 3.1 ......., 19.69. THIS CERTIFIES that the buiIding located at ~4anm~lon. House. Dx, ....... Street Map No .... x~ ....... Block No~u~ ........ Lot No. xx...F~.sl~erz .isLand.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~ept...28., 19..67 pursuant to which Building Permit No... 3~.0..7. dated ......... S'e'ft ....28"" 19'67" 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. on~ .£am~ly. clue llir, g ................................... The certificate is issued to ... ,~'oI'~e r. C-o s s ...... Owner ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N. ~. ....... .... / ...... FORi~ NO. 2 . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERM, IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? pursuant to application doted ................ ..~..?.J~.....~. ....... ..~..~.~ ............ , 19..~..?.., and opproved by the Buildinfl Inspector. ..... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , !9 ........Permit No ................................ Application No....~'....~....~....~.. .......... Disopproved o/c~ ................................................. /'~ "~ "~* "(Bui)dJng Ir~pector) APPLICATION FOR BUILDING PERMIT Date ..................... ~....?..~ ............ ,: ~...(..?. .... INSTRUCTIONS o. 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 klEREBY 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 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 and regulations. .......... ......... ........................... ............................... 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) Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ........ ......~...~....~...~.....~......~..:~ ....... ,~,&~.,~.....~,.;..~...:...~...~. ......... Municipality 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 . .~..~'.~..'T.~ ............ ........ ....................................... ............... 3. Natu[e of work (check which applicable): New Building .................. Addition .................. Alteration Repair . Remova . . Demo it on ........... Other Work (Describe) Estimated Cost ...................... 4 ..................................... Fee ] (to be paid on filing this appl,ication) ,5. If dw,lelling, number of dwelling units ............................ Number of dwelling units on each floor ....~...~...~... If ga~'age, number of cars ~. If bisiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. D~me~qs~ons of ex~stmg structures, ;f any: Front .......................... Rear ..........................Depth ..... He~glfit ............................ Number of Stories .......................................... m ........ ~': ....... : ....... .~..:..:...~. Dim!nsions of same structure with alterations or additions: Front ......'~....~..~.~ ~ Depth .............................. Height ............................... Number of Stories ........................................ 8. Dime'nsions of entire new construction: Front ............................ Rear ............................Depth HeigJ~t ............................Number of Stories ............................ 9. Size )f lot: Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase ! ~'/,~) ..Name of Former Owner :.~...: ~ .......... ~.. 11. Zon~ or use district in which premises are sltuoted....~'~..~..Z~ ~2. Dae~ proposed construction violate any zoning law, ordinance or regulation:) ..~ ..... 13. NarrB of Owner of premises ..~..~.~..~ ....... Address ..~...~,.~,,...Lf.....~. ............. Phone No. Nami~ of Architect .......... ~--'~.....%.i~ .................. Address ..,~.~.....?..'~...~.... Dhone No. NamJe of PLOT DIAGRAM Locat clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lirjes. Give street and block numbers or description according to deed, and show street names and whether intj~rior or corner lot. application) ................ i~'ame of individ above nar~ed. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and this application; that oil statements contained in this application are true to the best of bis knowledge and and that the work will be performed in the manner set forth in the applicQtion filed therewith. Sworn to ~Jefore me this ..... · ......................... ,,day of ..,~ .................. ,19 ........ ,, _~ ~¢¥ ~ .... .¥~.~...~.z.'..~....'~ ........ Notary Publ~o,,~'~.~Z~tl~ ................ County (Signature of apl: being duly sworn, deposes and says that he is the applicc