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Home My WebLink About5066-zFOB, M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice $outhold, N. Y. Certificnte Of Occupnncy No .... .2.~. ...... Date ................ C~t...1.2 ·.., 19.71. THIS CERTIFIES that the building located at .Pvt. ~oa~l. o££. I¥S- 0~-$ent~reet Map No...F...~ ,~Z.t.. Block No ........... Lot No ....... .Fishers..~.stand. · .~,.l/., ·. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~' · 20., 19. ?O pursuant to which Building Permit No.. ~0(:~, · dated ........... Eo.v..2b~ ....., 197(1., 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 ... ~r~.va.te · one .£amlly. dwelling .................................... The certificate is issued to . .H~L.Boger. t ..... ¥~mer ............................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) Building Inspecto FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT 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? 5066 Z Permission is hereby granted,to: pursuan,t to application dated .......................... ~.Cit4 .......... ~ ...... ~..,.., 19,..~,'-and approved by t.he Building Inspector. ' r , ~' BuTIding~,lnspecto(i~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ./.. ................. ..Cl....., 19 ........ ........................................ , 19 .... Permit No ............................. Disapproved a/c ........................................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoin ng prem ses or public streets or areas, and giving a detailed description of layout of proparty must be drawn on the diagram which is part 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 M,~DE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinahce of the Town of Southold, Suffolk County, New York, and other appl cable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations or for removal or/demo t on,~s herein described. The applicant agrees to comply w th all applicable aws, ordinances, building code, housing code, and /egulotions. ( ~(Sign~u~f a~ic~an~, or r~ame, if o.c,orporati~n~ ~' (Address of applicant) / 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 b~Jone~. Map No.: ........ e,~.~:: ............. Lot No..'~...~. .................... Street and Number ...~.....~..~.~_a~.~..~...~....~....~..~..~...~~ / Municipality ........ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ../.../.. ./..~. 3. Nature of work (check which applicable): New Bailding .................. Addition .....~...... ..... Alteration .................. Repair .................. Removal .................. Demolit on ................. Other Work (Describe) ........................................ 4. Estimated Cost ......................................................... ,.Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ;i. ............... ;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 ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ' 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed con,ruction v. iolate ony~on~g law, ordinance or .reg, Hlation? ............................................................ Name of Architect ..................................................... 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 corner lot. STATE OF NEW YORK, 1S.S " ~ COUNW ....... - .................. ..7.~../.(~...~ .............................. being duly swam, deposes and says ti'mt he is the applicant above named. He is the ......... 4..,~c. ar ................................................................................................................. (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 that the work will be performed in the manner set forth in the application' filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ .~,. ,n.~'~~ Notary Public, ............................................................ County