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Home My WebLink About4977-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~J+118 ..... Date ............. J~ ..... 1~...., 19. THIS CERTIFIES that the building located at . ~..~am ............. Street Map No..~ ........ Block No .... XX .... Lot No.. X~.. ]=-W .S~folk..I/,X.. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~1~;...~..., 19.70. pursuant to which Building Permit No..~. dated ........... //ept-..~., 19. ?0, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is 'l~.~&t®' .on~. ~a~'17 .dw~ll/.~ ....................................... The certificate is issued to . .LOuis. & 1~1'o~..I)~Max'tt~t ..... ?~m~l,~ ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~i.,~, ............................. llou~e f 2~0 .. /~--O.-v~,'~ (..,/.,.;.;....:1 ...... ......... J]'&i~ling ~.~pect/(r ..... / FORI~ NO. 2 TOWN OF $0U~THO~D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE! COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? t977 Z Permission is hereby granted to: to ................. t~lll..au., aittiaea..~i~atl~ .... e~. ~1 ~..dwt,~tae ........................ at premises located at ........... ~.....~...~ .................. i'""' ........... ~ .............. ~ ...................... ..... ~ ................................................... ' .......... ~..~e~........:..lJ.~. .......................................... ? pursuon¢ to application dcrted ...... ................ ~lJp~J'""';"'j~ ........ ~;..;, 19..~ and approved by the '.Building, Inspector. ',Fee $'"'~,1~{~ .......... IPOBal NO, I TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. F__mined ............. ~....~...~....., 19Z..~... Approved ........................................ , 19..~.~.... Permit No. %'~ ~ 777 Disapproved a/c ..... ........~ .............................................. Application ,o......~..Z.Z.Z ....... ~' APFL,C*T,ON FOR .U,LD,NG PERMI 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 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 part of this application. ~ c. The work covered by this application may nat 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 pursuant 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, as herein described. The applicant agrees to comply Tith all applicable laws, ordinanc~g code, housing code, a~d regulations. (Signature cf applicant, or name, if a corporation) ~dress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .... ~ .... ~.: ............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on Which proposed work will be done. Map No.: ........................................Lot No.: ........................ Street and ........ · ............................ 7- ..................................................................... ~ ................................. ~)/~/ Municipality 2. State existing use and occupancy of Premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................... b. Intended use and occupancy'. ............. ...~'..~...~..~. ................................................................................................... property lines. Give street and block number whether interior or corner lot. 3. Nature of wOrk (check which applicable): New Building ................. Addition..................g'/ Alteration .................. Repair .................. Removal .................. Demolition .................. _Other Work (Describe) ........................................ 4. Estimated Cost ............. ~ ................... Fee .....~... ........................................................... (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ...~ ......... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If busine~, 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 ................................ I , 8. Dimensions of entire new construction: Front ............ ~..~ .................. ~o /~ j Rear ............................ Depth ........................ Height .................... Number of Stories ............~.....~ ......................................... ~L~'""~) ......................................... 9. Size of lot: Frant .......... ~..0..~.'..~.~.~... Rear ......... ~ ......................... Depth .......... ~ .................. 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................... 12. Does proposed construction violnte any zo~ina law, ordinance or regplationP ..... /..~.. . . . 13. Name of Owne;of premises ....................... ~ .~.....~g'wh'~::.~Address ...-.~.~....~....~i.ii.iiiiii ~ ~i iiiiiiiiiiiiiiiiiiii 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-I:x.,ck dimensions from or description according to deed, and show street names and indicate STATE OF NE~OR~,! ^ ~ ~. ee COUNTY OF .~...~TT......$'~"~' ,, ~n ....... ~,: ..................... ........ ~..~~being duly sworn, dm~s and says t~ he is the applicant (Name oF individual signi~ application) above nam~. He is the ................................... ~;~.;.~ ~.....~~..; ........................................ (Contractor, ag~t, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work a~ to ~ke ~d file this application; that oil statements contained in this application are tree to ~e ~ of his ~owledge and belief; and that the work will be performed in the manner ~t fo~h in the applicatJ~ fi~ ~r~ith. Swam to ~fom ~ ~is ~ ~ // ................. of .......... ....... : ........ , % ...... ...... ............. ~H ANN N~ILLE - ~ .' ~Y ~L~C, ~a/e of New York ~ ~12~0. Suffolk ~