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Home My WebLink About4957-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .E/$...B~$~a.%l. A~ ....... Street Map No.. xx ........ Block No...XX ..... Lot No .... XXlC... $~%t;hol.d....N...Y., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 3ept~ .. 11,..., 19.. 70 pursuant to which Building Permit No. )+9.~7.Z. dated ............ Se.pt...1.1~., 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.a~e..one.. f..a~. $~y..d.¥.e.l.l~n.g ................................... The certificate is issued to ... P~lpl~..F,s.t.er ..... 0~r~,e.r ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... ii.R. ......................... House 1830 .. ................ Building Inst~ector FOR~ NO. ~ TOWN OF $oUTHOLD BUILDING DEpARTIv~ENT TOWN GLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES.UNTIL FULL COMPLETION OF THE WORK AUTFtORIZED) N9 ~957 Z Permission is hereby granted to: f , ............ ~..z~.~.,.!~....,~. ............ i. ............... to .............. ~..~..~.~.?.~.:L.~...~..~?~..u..~...~.:~..~..~%.~........Y'n~' at premises ~oted at ........ ~..~.~.~:~!.~.....i ..... :i,-,--':~ ........ ;.;.....i ...... ~.i ...... .~.: .......... ......................................................... ~ ........... z,~....?, ................ , ...................................... pursuon~ to application dated ............................... ~':"*';~J~;"i";, ]O..~j~, and approved by the Building, Inspector. Building OWN OF sou HOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ExQmined ......... ~ /~l I¢.~~ Approved ........................................ , 19 ........ Permit ..~ .......~ Di pp a/c ...... ............................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot .pi.an sho, w!nR I.oc.ation. o.f. lot ?,nd of.buildings .on pre.re!sos: relationship to adjoining premlies or public streets or areas, aha g~vmg a ammma aescrlptlon or layout o1' prepare/must oe arawn on the diagram whlch Is part of thio application. c. The work covered by this application may not be commenced before i~uance of Building Permit. d. Upon approval of this application, the Building Inspector will I&~ue a Building Permit to the applicant. Such permit shall be kept on the premises available for ir~oection throughout the pragres$ of the work. e. No building shall be occupied or u~ed In whole or in part for any purpoee whatever until a Clrtlfle,.ate of C)¢cupancy~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Perm t pumuant to the ~Build!r~.. Zone, O~inance of t.he T,o~m. of Southold, Suffolk Count, New York, and other appllcob e I.aw~, Ordinance= or ~egu~at~.o. ns, tar me construct?n o? oulldtngs, additions or alterations, or for removal or demolition, as herein described. ~ ne app,cant agrees to comply with all applicable laws, ordinances, building co~, e, hou~ina ,eaSe, and regulations. ,,~'~(SIg~ure of applicant, or name, If a ¢orparatlon) ' ' ' ..................... .................................. .................. (Address of applicant) State whether applicant is owner, Imee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................... If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) Location of land on which propo~J work will be done. Map No.: ........................................Lot No.: ........................ Number ~.....'~t~,~,~.....~...~. ~ ,t~....~....~.~. .... ..~'...~...Ct....~..~..o../....~.. ...... ..~..:...-~.~.... Street and ~/'1 -' / ~'3 &) Municipality State existing use and occupancy of premises and Intended use and occupancy of prapaeed construction: a. Existing use and occupancy ,/~/~/1~,~' b, Intended use and occupan:', .~..?...G'....,~..../.~ ....................................... 3, Nature of wmk (check which applicable): New Building .................. Ax~clition ......... ,~... Alteration ............... Repair .................. R~lm,;wal .................. Demolition .................. Other Work (Describe) ...................................... 4. E t ated Co t ......... ....................... Fee. ......................................................................................... (to be paid on fi~ing this application) 5. If dwelllng, number of dwelling units ........................... Number of dwelling units on each floor ........................ If garage, number of cars ......................................................................... ? ........... .....~ .................. .~. .............................. 6. If business, commercial or mixed occupancy, speci_fy nature and extent ofl~h type Of use ........ ~....~..¢ ...... 7. Dimensions of e~xi~sting structures, if any: Front ........ :.~.~......~... ....... Repr ......~... ....... .............. Depth ....~ ..... Height ....... .~..o~.. ........... Number of Stories ................. .~'......~. ....................... ~/'7'-- .~.~.; ...................................... Dimensions of some structure w th alterations or additions: Front ......... ...~.. ...................... Rear .....'~.....~.. ................ Depth ..... ~...~....~. .............. Height ............ :..//..~'....~......Number of' Stories ............ ./.. ................. Z~~ ~ ........................ 8. Dimensions of entire new construction: Front ............ ~ .................... Rear ...... ~ .................. Depth · ~ . ./ Height ...... ./.. .......... NumbeJ:.af Stqr. Jes .................................................................................................................... - r~ . ~ ,~ , 9. Size of lot: Front ........~.....~....:,.d~ Rear ........... ~..~.....~..~.. Depth ............. .~,.~,4/,~ ....... , j 10. Date of Purchase ........................................................ Nome~of Formqr Owner .............. .~'..~ .................................. 11. Zone or use district in which premises are situated .......... .~/..~..~.....'~...../...~-.. .......... ; ........................................................... 12. Does proposed construction vioJ~ite any zonir~ law, ordinance or regulation? ............. ..../~.....G. ..................................... 13. Name of Owner of premises ..'..'~/?..(.?..'..~........../~-...S...~.....E"./...~'Address .?..~..~..~..~...u...~...u..e......-~.9.?.~Phone No ..... ../.~....~.....~T'.. Name of Architect ...................................................... Address ............................................ Phone No ........................ Name of Contractor .................................................... Address ............................................ 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 number or description according to'deed, and show street names and indicate whether interior or comer lot. STATE OF NEVi' I~. p.,~,,/j.j t-- / N COUNTY OF ...~ ........... .~.~":~ , (Nbme of individu,al signing application) above named. He is the ............. ' ................. ~ ................................................ '~ ....................................................... (Contractor, ager~t, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the ~aid work and to make and file this application; that all statements contained in this application ore true to the best of his knowleds~-4kncl belief; that the work will be performed in the manner set forth in the application fil~l therewith. ~/" NOTARY PUBUC. State of New Yor~ No. 52-8125850~ Suffolk Cou~y Term Expires March 30,