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Home My WebLink About4677-zFORM NO. 4 TOWN OF SOUTHOLDi BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No, g. 3787 ..... Date .APr.~.~... aa ..... , ~o..79. THIS CERTIFIES that the building located at . N,/~t i.. M:tcldle..Roatl (¢R27)Street Map No..XX ......... Block No...XX ...... Lot No... ~ ...... [~a~.t.f~U.e~... E:~ t... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Apr~'ik '" 6 19 .?0. pursuant to which Building Permit No .... dated ......... A.p~i,1 ....8.. , 19 70, 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 ... p~.ivat, e. fal~al, bl;cLi~tling. (&~ceasol'lff.). ,,,old'tekell .hoR$.e ........... The certificate is issued to . .Stal~.~ey. ~uth:i,].~ ............... .~.~¢tz .............. (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....N.*.R) ............................ iBuilding Inspector ~o~se # 1335~ FOH~I NO, ~ TOWN OF SOUTHOLD ; BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL£T~ON OF THE WORK AUTHORIZED) N? {677 Z Permission is hereby granted to: .~.,.~.,;~ .~...¢..~......$~....~..~.~.....~.. $.~_$~ to Build new farm (acc®~o..~.) blzt. ic~Lu.$. :..-. e.h.~,.e.k~ ho.u~ ..... ot premises located ut .... ]~.,~...F.~.~.~,F,...~.~, ....(~..~]L[ ............................................ ..................................................... ~.~.~;~.~'~.~ ....... ~..,.~.., ........... : ......................................................... pursuan,t to application dated ............................... ..A.~..~.~...I: ....... .~,.i.,..., 19......~.., and approved by the Building Inspector. Fee $*.,~. ~...,(~*. ............. FOEM NO. ! I~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ~' ..................... , 19 ........ Approved , x ~ ~ ~ ........................................ , 19 ........ Permit No ........................... .. Disapproved a/c ......... ~, . ........ ~' ' (Building Inspector) APPLICATION FOR BUILDING P~/RMIT Dote INSTRUCTIONS a, This application must be completely filled in by typewriter or in ir~k and submitted in duplicate to the Building ~ Inspector. "~ b. Plot plan showing location of lot and of buildings on premises, relatibnship to adjoining premises or public streets or areas and giving a detailed description of layout of property must be drawn dh the diagram which is part of this applicat on ~ c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ~ Building ~ermit 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 ifSuance of o Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New Y8rk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or f~r removal or demolition, as herein described The applicant agrees to comply with all applicable lows, ordinances, buildil, ng code, hsusing code, and regulations .. (SignatuCe of applicant, or name, if o corporo~tion) ....... (Address of ~pp cant) State whether applicant is owner, lessee, agent, architect, engineer, general~ contractor, electrician, plumber or builder .................................................. ................................................................ Nome of owner of premises .................... '..'~..~.~.,...TI~I.,'I4.L~.~. ................................................ nt is a corporate, sig~ture of duly authorized officer .................... (Nome and t~le of corparot~l'officer) Location of land on which proposed work will be done Map No.' ....... ; ................................. Lot No.' ........................ Street and Number ................ ~..~'..'t~.t~,~k.).~..f~...~.'~.~l~l'T' .~..L~.t ~"~".4~...~..~ ~/ /..T .~ ,~_..~' Municipality State existing use end occupancy of premises and intended use andi occupancy of proposed construction Existing use and occupancy ..............--~',~. ............. .~. ,~'~U/~. ~, · . .................................................. L~ Intended use and occupancy ............... ..~.~.'.~..1~..~....:~[~...~.".¢~.~.~,~... ................................................ 2 Nature of work (check which applicable): New Building ...~.. ........ Addition .................. Alteration .................. Repair .................. Rer~?al .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................ .-~.(~t.(~........'~... .................... 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 .1~..~.~ .............. 7. Dimensions of existing structures, Jf 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 ....... .I..~, .............. Depth ..2~...~. ............ 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 construction violate any zoning law, ordinance or regulation? ..... [..~.~. .............................................. 13. Name of Owner of premises .~.l,~Jt~,~l..~i~:.~U.f. Nl.~,.~..Address ...ll~l~..t..~'~..~.~.~k .......... Phone No ..................... Name of Architect ..................................................... Address ............................................ Phone No ..................... Name of Contractor l'.~.,.~..~'.~...~...L..~;)~li'~'~' ...... Address .~l~i~.ll.l.~'.~,.C ................ Phone No~-.~..~.:...~...IJ PLOT DIAGRAM Locote 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 ond indicate whether interior or corner lot. STATE OF NEW Y.O.R~, ~ ........... L'.'~.~..~.~......[.~.~..[~'..~...,~.~.¥.~ ........................ being duly sworn, deposes and soys that he is the opplicont (Name of individual signing application) above named. He is the ..................................... .~.I~.C~..~........~,~D.N.~.I~,d~.C.~'.O.~'/,. .............................................. (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 thor the work will be performed in the manner set forth in the applicatior/filed therewith. Sworn .to before me this /m / ........ ....... ..................... ,.., NOTARY PUBLIC, ~".!e RESIDING IN SU~",;.)L[~' No. 52-5~'~900 ~mmils;on Exp:ras Match ?~, /~-~ ,~ ~ ~, ' ' . ~ BU gOING Cb~STRUCTION "