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Home My WebLink About4767-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~..~2 ....... Date ........ O~t ..... 21) ......... , 19 70 THIS CERTIFIES that the building located at l~omaSerll .PAth ........... Street Map No.L~tl~ !S. ~. · · Block No .......... Lot No.. 6~ ..... 8o~tho~...].Y, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~ .... 2~. , 19..~0 p~suant to which Building Pemit No.. ~7~. dated ............ ~ .... 2~. , 19 70., was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is .Prl~. ~e. f~ .dwe~ ....................................... The certificate is issued to .. A~. ~h~ .~r. · .~er .......................... (owner, lessee or tenant) of the afores~d building. Suffolk County Department of HeMth Approval .... ~.~B* ........................... .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT 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? ~767 Z Permission is hereby granted to: .: .......... .c..~.~.,... !.~.~.e..~.....~/...c......~..~..t~e .~ 0 at premises located at ................ ;),~.~..~l.....~?.~.~3~J~...}~.ll.~.l .................................................. pursuon¢ to opplicofion doted ..................... ~ .........i]~ ................. , ]9...~..0.., ond opproved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ...................................................... APPLICATION FOR BUILDING PERMIT Dm ................................... , ...... INSTRUCTIONS a. This appl. ication 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 adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuorme 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 JrlepectJon 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 pureuant to the Building Zone Ordinance of th~ Town of Southo!d~ Suffolk County, New York, and other applicable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein d~scribed. The applicant agrees to comply with all applicable law~, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a carp.ration) ............................. ~'~:Jres~ "~"~pii'~"~nt"~"'" .......................... State;v(hether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~U~ ~./J -- ' Name of owner of premises ..... X~.Z~.../~'.: ............................... ' ......... ............................................................................. If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No.: ,.., .................... Street and Number /c'OU /'l b~ff~.~ ~....~.~../'/. ~ "50 ° 7'-~t( °l"~ r :,4q ............................................... ...................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .......... , ....... Addition ....,,/'.. ......... Alteration .................. Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ...~.~.t7.,~. ~./?. .................... 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 ....~....Z.,,~. ............. 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 .....~..6. ........................ Depth .~....~. ............. Height .../..?. ................. Number of Stories ....... .~...~,,~....:...~. .......................................................................................... Dimensions of some structure with alterations or additions: Front ....... .?.~ ........................ Rear ...?.~ ..................... Depth .... .~....~...~ ................... Height ..... ./..~. .................. Number of Sto~ries ....... z... ...................... 8. Dimensions of entire new construction: Front ........ ' .......................... Rear ..... .~...o. .................. Depth ..... ./.:.Y. .............. Height ....?...'..~.. ........ Number of Stories / 9. Size of lot: Front ....... ..~..e..i .............. Rear .......~.~ ....................... Depth ..... ¥...~'.o. .................... 10. Date of Purchase ........................................................Name of Former Owner ....~.!.~...L..~..~.....~...~'..~..~./E..z,./. .............. ~ ]. Zone or use district in which premises ore situated ..................................................................................................... ~2 Does proposed construction violate any zoning Iow, ordinance or regulation? ...... ..H..O. ...................... ;~,~' ................. 13. Nome of Owner of premises ~/.:...~...A...~.~...J...~.......4.(~:.....Address ~..2..~...~..~..~..~.~.[~.~...~.~.~ No.V./~.;..~..?..y.~.... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~...../.:..~...Y..O.!..-'..~... .............................. Address/~..~...~..,..d. ff.!..~...H.~...~.:.~.:.... Phone No.~....z.~.~..~..~.?...~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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 NEV¢ )~K~x' COUNTY OF .~..-~...~..~. ............. ~'~' .................'{~~.i.~h~of~fn~'~..i.~cohon);.......: ......... . .... :....: ...................... ~ing duly sworn, d~ ~nd obove homed. He i~ the ....~2~.~.~ ........................................................................................................................ (C~tmctor, ~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have ~rform~ the said work and to ~e ~ file this application; that all statements contained Jn this application am tree to the best Of his knowl~ge and belief; and ~ot the work will be performed Jn the manner set fodh in the applicati~ fil~ ~r~ith. Swam to before ~ this ....... ..... of ............................ , ~ ~ // ~ ,~.~ ....... :.Z..~.~I ........................................... Nota~ Public, (~,.~~...ff~.~~ V~ (Signa~re of a~licant)