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Home My WebLink About5077-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..2;~3.~ ... Date .... AllgnSt.. 2~' , 19.'~'i. THIS CERTIFIES that the building located at ~alt Lal~e. · Street Map No..~.a.l.t...L..a~.e.. V~t~k No .... Lot No. ~ ...l~a.ttitll~Ig.. 1~.,~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... NoV,.. 30 , 19 ~ pursuant to which Building Permit No.. ~07~ dated ......... N~V, ~O , 19.70, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is (owner, lessee or tenant) issued is .. P~ivate one family. ~welltn~ .. The certificate is issued to ... E~lwar~l .l~paeth. ·. of the aforesaid building. Suffolk County Department of Health Approval House ~ 260 TOWN OF $OLITHOtD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5077 Z Permission is hereby granted t~l~L~ ~)~ ~.~A~O ~t ...... ~....~.~.~.~..,~ ...... ~ ..... .~..~.~,~ ~ · at':~premises located at ................................................................................................................... '~. ........ pursuam to application dated ,~ ~,/'Vt/ ]9 7~) and opproved by the Building Inspector. Yee $ ........................ Building Inspector TOWN OF souTHOLD BUILDING DEPARTMENT ~, N. Y. INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of bu_llding$ on premises, relationship to adjoining pmmJem er public streets or areas, and giving a detailed description of layout of properly must be drawn an the diagram whlch Is laert ef ~le appllcation.~ c. The work covered by this application may not be cammenced before muance of Building Permit. d. Upon approval of this application, the Building Inspector will IBue a Building Permit to the c~plicant. Such permit'~' shall be kept on the premises available for inspection throughout the progrel~ of the work. e. No building shall be occupied or used in whale or In part for any purpese whatever until a C~lrtlflcate af Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to theg ~Build!ng Zone. Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lawl, Ordinances or Kegu:ations, tar the construction of buildings, additions or alterations, or f.or removal er demolition, al he,In dma:rlbed. The applicant agrees to comply with all applicable laws, ordinances, building cede, housing cade, and regulations. (~/ (SIg~bture of applicant, or name, If a cerlmmtlon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ ,,~...../'~....~.. ~...~.,, & ~ If applicant Is a co~mte, signature of duly autherlzed officer. (Name and title 'of co~orate officer) I. L~ati~ of land on ~lch p~ ~ will ~ done. Map No.: ........................................ ~ No.: ........................ Strm and Number . ~ &Z .............. M~IcI~II~ .............. 2. State exi~Ing u~ and ~cu~ncy of premiss and inten~d use and ~cu~n~ of b. Intended use and ~eupGnc, . ...................................................................... ~ ............ ~. ................................ 3. Nature of wo~k (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... .. ........ 4. Estimated Cost ........... ;.-~.. .............................. 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 ........................ 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 ................. .~....~. ......... Rear ............................ Depth ....../..~... ............ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ~..f..~...~....~...7~...~........~.~....T. ................. ! 1. Zone or use district in which premises are situated .................... ~.....~...../...~.. ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation; 13. Name of Owner of premises ..,~-~,,.,..,?,,,.,~.,?...~./~., ........ Address..T.~.~.~;;,~l,~. Name of Architect ...................................................... Address PhoneNo ..................... Name of ........................................ ~ .......... Acid .............. ~. ,~...'-,'~.. ,~..-,'~. #~'./~ ....................... 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. /~0/-1 ~ STATE OF NEW Y(~K,~i ~A lee COUNTY OF ..... ~ ....... ........................................................... ~ ............. .t .................... Demg duly sworn, d~oses and says t~t he is the applicant (Name of individual signing application) a~ve named. He is the ...................... ~.~.~.~.~.~.~. (Contractor, ~t, co~orate officer, ~c.) of said owner or ~ners, and is duly authoriz~ to perform or have perfo~ed the said work and to ~ke ~d file this application; that all statements contained in this application om tree to ~e ~st of his ~owl~ge a~ belief;' and tha~ the work will be performed in the manner ~t foffh in the opplic~i~ fil~ t~r~ith. Swam to ~fom me ~is i~~ / ~ ~ ~--~~'~ ~ ~ NOTARY PUBLIC, State of New N", 52'812'50, Suffolk ~u~4 Term Expir~ ~rch 30, _