HomeMy WebLinkAbout4759-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z3.01+9 ...... Date ........... ,%Ugttst .... 27. ·., 19. ?0.
THIS CERTIFIES that the building located at Ett.T. iek,..0rierttal~0cear~i~t
Map No. ~ ......... Block No.. ~ ..... Lot No.~ .... Fishers..Island ..
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ....... E8.~ ' · · 20 ' , 19. '70 pursuant to which Building Permit No..
dated ........ ~4ay .... ~.$. ., 19 '~0 was issued, and conforms to all of the require-
ments of the applicable prowsions of the law. The occUPancy for which this certificate is
issued is . .Prt~ate. ~e. family..dwel].~ng ......................................
The certificate is issued ~o ...Robert. H.,..~ge.Xh~ff ....... 0~e~ ..................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ..... P.O~d~g ......................
~ Building ~pector
FOR~ NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT~
TOWN CLERK'S OFFICE,
SOUTHOLD, N.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 759 Z
Permission is hereby granted to:
.......... ~,~ ~...~i.~...,~;~. ;[;h~:~:. .......... '~ .................
................. ~:~at~:~,.~a~l .............................
........................ ~.~.~ ....... 0.~&~0 .............................
to .......... .~.,. ~.. ~.~:o. ~.,.o....n,~....~:~:~: ..~:~;L~;~; ..........................................................................
at premises located at ........... .~'~l~,8J~..~.~..O~z~..~V~..~"~'~,~,.~..4~ .......................
.................................................... ~:~'.~:$...~1.a~ ................ i .........................................................
pursuan¢ to application dated .......................... ~' .......... ~,6j ...... ~....., 19~0..., and approved by the
Building Inspector.
Fee $...~[,~.~0.0 .........
FOP~V~ NO. !
TOWN OF SOUTHOLD
BUILDING DEPARTMENT:
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
hppraYed ........................................ , Ic) ........ Permit No ...............................
APPLICATION FOR BUILDING P~R,MIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in i~k and 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
ureas, and giving a detailed description of layout of propertymust be drawn e.n 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 throughouf the progress of the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 [ej~c~vol or demolition, as herein described.
The applicant agrees to comply with oil applicable laws, ordinances, buil~ij~o~e gO~ re. oul~Jcc~ ,r~ /}
.................
(Signature of applicant, o~]fame, if a c~,,ppration)
Fishers Island,. New York
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Owner
Name of owner of premises Robe~'t M. E.cje I ho'i~f
If applicant is (3 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: ~.g.b,g.q.l....~.j.~i~p.j..(7.~ ........ Lot No: ....................
4ap , //4
Street and Number ................................. .......... ............... ......
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~?esiden~cial vacan~c lot
b. Intended use and occupancy ............. .~9..~.j..d...e..n.~.jg.J ................ i .........................................................................
3. Nature of work (check which applicable): New Building ...... .X. .......... Addition .................. Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
$ 0 000.00 Fee ..,~.~..,..0..0.. ...........................................................................
4, Estimated Cost ...... .~...z ...............................................
(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 ................................
7. Dimensions of existing structures, if any: Front ........ ~/..A. ........... 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 ............................ See attached plans
9. Size of lot: Front ............................ Rear ............................ Depth ................................
10. Date of Purchase ..... ~.a..y......9.,......~9.7. Q ....................... Name of Former Owner E.,..I..,...kl.~.LI.i..g.y....g.~.,.,...J.n.c,~...
11. Zone or use district in which premises are situated .................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ........ l~f} ..........................................
13. Name of Owner of premises .l~o.be~..i::...~.,...E,oe.[.ho.~ldress ~.J. sB.en.s...l.~l.alxd.t...N...YP~one No. 7..88..'.7.2,05.
E.~lbeff Add " "
Name of Architect Robert MA tess ............................................ Phone No .....................
Name of Contractor ..F..t.,.la.~.e~....ta[oad..Jl.g. Ll.~.~.'Address ............................................ Phone No. 7..88..-.7.2~11.
Company, Inc.
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 numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
See Attached plans.
STATE OF NEW ~P~.
COUNTY OF ;,.x'.~..'~........~ '~' /
................ (~'~"of individual signi~ot~n)
above named. He is the ................ ~~~J~ ...................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove 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 a~ication filed therewith.
Sworn t~ore me this
da of
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