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Home My WebLink About4916-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No./.1+.~.5.1 ...... Date ............. Feb. · · THIS CERTIFIES that the building located at .. ~;/8 · St.'~tlw~,ter. &ye .... Street Map No. ~leetwood' ~ No ........... Lot No.. 1 ~. &. Pt..~.. Cutchegue .... h.~ · conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ltug'' 2'~" ', 1970. pursuit to which Building Permit No .... bgl~ dated .......... aug. · ~.~ , 19.70., was issued, ~d conforms to all of the requ~e- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... {:.riv~te · en~ .family- d.we] 5 lng. ................................... The certificate is issued to .. Eatilda..Burrn~s ...... 0wne~ ....................... (owner, lessee or tenant) of the aforesMd building. Suffolk County Department of Health Approval ....... N. R.. ......................... House ~ 576~ ~till~ater ~u,~'~, ~; ~: l~ORbl NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT i TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BI: KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4916 Z D~e ............................. .~......./........A...(./.~ ,,........?~ Permission is hereby granted to: ................ ~flZ..!..~..~..~ ............. ~.v..~i::.~? w£ ....... ~ ........ ~ ......... .~. ........................................................ ~ .................... a ................... ~ p~,~,~ ,o~,d o~ ..................... ~g.Z.~.~.....~.[L~.~:..~..Tg.:~.....~.~] ..................... pursuan~ to application dated ................................. ~../ ....... ~..~.~ ]9.ZC and approved by the Building Inspector. Fee $ ........................ L TOWN OF $OUTHOLD BUILDING DEPARTMENT $OUTHOLD, N. Y. Examined ................. .~..../. ............ ~.., 19.~..~..,..,.. ........ z,.,. Approved .............. '~'~'....~.~4~..., 197(~ Permit No ......................... Disapproved a/c ..................................... (Building Inspector) Application No. /.L~/~ ~' APPLICATION FOR BUILDING pER~II' Date / INSTRUCTIONS a. This application muse be completely filled in by typewriter or in Ink and submitted in ~plicat~ to the Building inspector. b. Plot plan showing Ioc~t~on o~ lot ~nd of buildings on premises, relefionship to edjoining premises or public street~ or areas, end giving e deteiled description of leyout of prope~ must be drown~en the diogrem which is ~rt of this ~pplicetion. c. The work covered by this oppiiceHon mey not be commenced bafo~e issuance of Building Permit . ~.,, Upon epprpwl of th~s epp[i~tJo~, the Building Inspector will issu~ e Building Permit to the eppllcent. Such permi~ snen De Kept on the premises eveh~Dle ~or inspection throughout the pr~ess of the work. e. No building sh~ll be occupied or used in who~e or in p~rt for eny p~rpose wherever until e ~e~[ficete of Occupency shell hove been grented by the Building Inspector. APPLI~TION IS HEREBY ~ADE to the Building Deportment for the issuemce of e ~ullding Permit pursuant to the Buildin~ Zone Ordinance of the Town of Southold Suffolk County, New ~ork~ ~nd 0the. ~ppli?ble Lows, Ordi~nces Regu~ehons, ~or the construction o~ bui dings, edditions or ~lferetions, or~or removal or demohtion, os herein described. The epplicont ~grees to comply w~th oll eppHceb~e lows, ordinances, building code, housing code, end reguletions. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... ,/,'?../.?....I.,..,.I.,,.Z-.'.T.,..,~.,..,/?. .................... ..~..,..~,,,..~?,.,.'~....~,,...W...~ ......................................... If applicant is a corporate, signature of duly authorized officer. (Name and title'of corporate officer) . ~TI~/~;6D ~Y F/~~ ff~-/~, / .~ /~ ~ ~7 L~ation of land on which proposed work will be done. Map No; .. :~.. ~..~. ......... Lot No.' ........ ~..~, .... o - / '- ' ....... Street end Number ........ ~. ........................... ~ ......... ~.~ ~. ~ ~ ........ ~/ 5 ~ ~/ ~re ~i~H~ .................... 2. State existing use and occupancy o~ premises and intended use asd occupancy o~ propos~ construction: b. Intended use and occupan? .~..~ .......... ~....~......~?,~.~.~..~.~ ......................................... 3, Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............. Repair ................... Removal .................. Demolition .................. Other Work (Describe) ..~........~.../. ~./.)~.~ ...... 4. Estimated Cost ................................ .J~...~....~.. ............... 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 ............ ~....o.. ............ Depth .....'~'......,~,,,. .... Height ......... ~..~. ....... Number of Stories ................. ~.....~'.....~.. ................................................................................ Dimensions of same structure with alterations or additions: Front ~ f3 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 ...... ~...~... ................... K, /D/z- 10. Date of Purchase ............................................... ~.... Nome of Former Owner ........................................................ ]). Zone or use district in which premises are situated/ ............................ ..~..~'.,,~,..I....~....Lz.'...~...T.../,..'~..../:'-T. .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation~ .......... ~ ......................... 13, IName o uw r of premises ........................................ Address ...,-,t~.OT-,-,-,-,..~....Zj..~_.p.l~:~.,~.~.oPl~lone No ..................... Name of Architect ......................... :..~...; ...................... Address .................... ().,?.~..7.. ........... Phone No ..................... Name of Contractor .................................................... t~aaress .......................................... 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, numl',er or description according to deed, and show street names and indicate whether interior or corner lot. / 1.50 ' STATE OF NEW YORK, COUNTY OF ................................ ~ ~ 6/~:~'~) ~/--~ being duly sworn, deposes and says that he (Name of individual signing application) is the applicant 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 tha~' the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................ day of ............................. . 0 /B . ..... . ........... ................................. Notary Public, . .......................................... ..'~.. ............. 'L'"'ounty ' (Signature of applicant)