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Home My WebLink About5104-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate Of Occupancy No..Z..~.923 ..... Date .............. l).e.C... ~ ..... , 19.72. THIS CERTIFIES that the building located at . ~dezt. Road ................ Street Map No...~. ......... Block No...:~ ...... Lot No..~X....C.l~;~,h0gt~0...N...¥~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Dec...1.~. ·., 19.7.0. pursuant to which Building Permit No. ~l ~Z.. dated ........... .D.e.¢ .... 15.., 19.7.0., 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 . .Pr£v. ate..Qne, family..dvelling ...................................... The certificate is issued to . .~. Harry. Lister. .... .O.~rner .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... N. :.R.: ........................... UNDERWRITERS CERTIEICATE No .... N.'.R.: .......................................... HOUSE NUMBER..80~ ....... Street .... Wes.1~ .Road. .................................. Building Inspector [ 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? 5104 Z ....................................................... ' .............. '~'~:'""i~' ........... i~"":~i .............................. pursuant to application dated ........................................................... , 19 ....... .., a d approved by the Building Inspector. , Fee $ ..... Examined ..................................... , 19 ........ e~ol~f ' NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................. Disapproved ale ................... ~........~.~ ....... ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~ o. This opplication must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plat .pi.an sho. win.~ Ioc.ation of lot and of bu.Jldings on premises, relationship to adjoining premises or public streets or areas, and gwtng a amailed aescriptlon of layout of property must be drown on the diagram which s part of this appllcation.~ 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 Bu ding 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 hove bean granted by the Building Inspector. B .A..P. PLI~CATION IS HEREBY MADE to the Bu ding Department for the issuance of a Building Permit pursuant to the ui~aing Lone Ordinance of the Town of Southo d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bu dings, add tions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature cf applicant, or name, if a corporation) .............. ................... ~Kddress of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · Name of owner of premises ,/~.~..~..~. If applican,~:.:, .r~rot,, s~gn.a_~,LC~_o~ dulv_ authGr~zed officer. ~ .................. .... (Name a~ title 'of co~orote officer) 1. L~atl~ of land on ~ch p~d wo~ will ~ dane. Map No.: ........................................ Lat No · . ............... ~ Str'' ond Number ~~'"~~'~7..~' ~ ...:: :'.:: : 1 (~ ~0~ / Mdn c ~ (~ .......... 2. State exl~ing u~ and ~cu~ncy of pmmis~ and intended Use and ~cu~ncy of pr~ comtmctl~: a. ~isti~ u~ a~ ~cupancy ............. ~ ........................... ~ b. 'ntend~ use ond ~cupano,' .... ~ ''~~. ~ ~/~ ........ 3. Nature of work (check which applicable): New Building .................. Addition ....~ .... Alteration .................. Repair .................. Removal .................. Demolition .................. Ot~er Work (Describe) ........................................ 4. Estimated Cost ............ ..~.....~....~...:...~.. .......................... Fee ............. ...~-.~.~ ................................................................ ~ (to be paid on fi~ing 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 occuponcy~ specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... ~.0. ................ Rear .....~..~. .................... Depth ...~.~. .......... Height ...... ~.~. .............. Number of Stories Dimensions of some structure with alterations or additions: Front ............. ~...~. ................. Rear .~.~.. ................... Depth ........~..~. ................... Height ....... .~..g. ............... Number of Stories ........ ~...~ ............... 8. Dimensions of entire new construction: Front ........... ~../. ................... Rear .......... ~....~. .......... Depth .m~.~..../. ............ Height ....... /.~.../. ..... Number of Stories ........... ~. ......................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Ow~,~ ~......,~,,...~...~ ................................... 11. 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~ ~- ............................................ Phone No Nome of Contractor ("~/~'~Name of Architect ...~ ....... ; ......./1,,.~, .............. Address/' 1/'~7',~,~,,, ~ f'~/~ ........................... Phone No.,,.~.~. ............. phone N o~'.4~.. _ .~.. ~.~.... 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 Io~. STATE OF NEW Y~OR~m m/ tee COUN, OF ......... ~:~'~/~'s~- '~'"'"-~ ............................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) ~ above named. He ~s 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 thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ........ day f ........................ ,.,. ............. Notary Public, ..~/Notary Public in~ StSte~_of?~9/Yeti[ County' No 52-£~20575