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Home My WebLink About4760-zFORM NO. 4 TOWN OF SOUTHOLI BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Ju~¥ 2~ 1973 19 73 No. Z.~'276 Date ..... ~. ..................... , East side of Hidge St. F.I. THIS CERTIFIES that the building located at .... i ....................... Street Map No ............. Block No ........... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office '~ ~ ~7602z dated ~ay 20 19 70 pursuant to whibh Building Permit No. May 21 70 dated ....................... , 19 ...., was issued, an~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for Which this certificate is ~ Accesory issued is . ,. ............................. William H. Buekley The certificate is issued to ........................... ............................. (o~vner, lessee or tenant) of the aforesaid building. Suffolk County Department o£ Health Approval ...... i- ............................. UNDERWRITERS CERTIFICATE No ............................................. E/S Hidge S~, Fish®rs Island HOUSE NUMBER .............. Street ............. ~ ............................. Building Inspector TOWN OF $OUTHOLD i BUILDING DEPARTMEN'I~ TOWN CLERK'S OFFICE' SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 760 Z Permission is hereby granted to: ............... ~.~..t.~..~-,...~ek.]:e~...' .................. ................... '~,~t~'~"~'t ......................................... to ............. ~.-r~ew..a~ce~ ~o~r~"t~u~-~g'-" (c~.'£o~.'~ee~..~..~$~a~ .... ct premises located at ................ ~;/~'""~"t~ .................. .......................................................... pursuon,t to application dated ............................... ~,:~ ........ ~0'"!'"'" ]9'""~i~)and approved by the Building Inspector, Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. om,ned ........ ., Approved .................................. , I9 ........ Permit mo ............................. Disapproved a/c .................................................................... Application No. ~/"./,';7,,.,~,,..O. ............ APPLICATION FOR BUILDING PERMIT Date ........................... ......~ .......................... , ............ 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 end of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of I~yout of praperty must be drown 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 app'licant. Such permit shall be kept on the premises available for ir~pection throughout the progress of the work. e. No building shell be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shell have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 Lcn~s, OrdirmnCes or Regulations, for the construction of buildings, additions or alterations, or for removal or demo t on, as here n~described. The applicant egrees to comply with all applicable lows, ordinances, building code, housing code, and regulations. ___ ....................... .................... ................ ................ (Signature of applicant, or name, if a corporation} ........ ................ ................................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of ....................................................... ~ ........................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which propo~_ecJ, work ~,ill be done. Mop,No .......... ,...~ ........ Lot No.: ...... ...~... Street and Number . ..~...~... ~..~...~ Municipality 2. State existing use and occupancy of,~remises and intended use and occupancy of proposed construction: a. Existing use and occupancy ""~"~i use and occupancy ..... ...-~...~ ..........~..~...~......~.....~...~. ........................... b. Intended · 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........... ~...~. ................................... 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 ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with olterations 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 construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... 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 name~ and indicate whether interior or corner lot. STATE OF NEW' YORK, COUNTY OF ................................ ..................... ~ ........................................................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (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 ........ ......,,~,~ Notary Public, . ........................................................... Count~ ' ' ' ................