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Home My WebLink About4923-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z~2! .0~. ..... Date ............. &Dr!l .... .2-2....., 19.7.1, THIS CERTIFIES that the building located at . Smith. Dr. Sauth .......... Street Map No. Gee se -l~eck Block No ........... Lot No.. P.t. 11.1+..&..1 ~.~... $.e~th.o.14 .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Aug ..- 25 .... , 19.70. pursuant to which Building Permit No.. ~92~.. dated .......... -Aug ....27..., 19.?O, 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.ivate .oDe../;atoll3[. dwelling ...................................... The certificate is issued to .... Charle. s .Ho3~es ....... Owner ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~:~.. ............................. House ~ 11~-~ FOILM HO. ~ 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? 923 Z Permission is hereby granted to: .... l~b ~,x~ ~...ii~,~ ~.t~..a./~ ..gha~--~e; Lae~ ........ ................ ~i~tit~l~fl ............................................ at located at ............. ~ ..... ~ .... '1 ................................. ....................................... 15~..~-.~.~:~ ......... i~¢,'~t/t~:.,-~.,~, ............................................ pursuon~ to opplieotion doted .............................. j~,~-~g~--..~.~i;..-., 19.~0.., >*nd opproved by the Building Inspector. Fee $..~) ............ -~ Build ng inspector/' IK)&M NO, I 3~OWN OF soUTHoLD BUILDING DEPARTMENT · TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Application No ............................. Disapproved a/c ....... ~ ............................ __ __ APPLICATION FOR. BUILDING PERMIT ............................. ........ , .............. , .... INSTRUCTIONS o. This application must be completeJy filled in by typewriter or in ink und 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 property must be drawn an the diagram which Is pert 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 pumuont 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, os herein dem:ribed..z~9 The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. Robert (Signature cf applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, .......................................... ...................................................................................................................................... Chas s ............ Name of owner of premises ................................................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title'of corporate officer) /~/ Goose Neck Est 1. Location of land on which proposed war__one. Map No.: ........................................ Lot No.: ....~.~. ......... Street and Number ..... ~,:Lt, h..~r.....-~e~ll~.~" ............ ~ll)lll;l~o]d~l. .......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... Df~te.].l.t.l:lg, ......................................................................................................... b. Intended use and occuponc, . ........ sam~..w~th..add~t~on ............................................................................ 3. Nature of work (check which applicable): New Building ~ ................. Addition .33J; ............ Alteration ....~ ...... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ............................................................ Fee ...~..~,.Q0 .......................................................................... (to be paid on filing this application) S. If dwelling, number of dwelling units ...._n.~.~_. ................. 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 ......... 6 ................. Depth ....'J~. ................ Height .................... Number of Stories ....... O33~ ........................................................................................................ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ........ ~.~..~;J.~t .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ J~ ............................................... 13. Name of Owner of premises .C....J~....~....~...O...;~...e...~. ............. Address ......... ~..g~t~.~.~,4. ............... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..... ~..J~i3~.~t. ........................... Address .............. ~O1;;Lt, J:ls3'l¢l. .......... Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether inte 'Jar or corner lot. STATE OF NEW. YOBK. IS.S COuNT OF -? _. ........................... ~.~c .............. r~.~ ......... being duly sworn, d~s and says t~t he is the applicant (Name of individual signing applicat~ ~~ above named. He is the ................................. ~~~ .................... ~ ........................................................ (~ntmctor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to pedorm or h~e perfo~ed the ~id work and to ~ke ~d file this application; that all statements contained in this application am tree to~e best of his ~l~ge a~ belief; and ~hat ~e work will ~ perfor~d in the manner ~t fo~h in the ~licati~ fil~ ~er~ith~ ~ ~ J ~ ............. ....... ............. ............... , .............................. ......................... MARION A REGENT ~' NOTARY PUBLIC, S~ of New Yor~ No. 52-3233Z20 ~lt County 1'erin ~ires ~rc~ 30, 19~