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Home My WebLink About4805-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sou~hold, N. Y. Certificate Of Occupancy No. Z~I~8 Date October 17t lg 73 THIS CERTIFIES that the building located at . .JaCObS. ~S ............. Street Map No... ~ ....... Block No .... ~ .... Lot No. ~X .... 8o~tho~.d ................. conforms substantially to the Application for Building Pemit heretofore filed in this office dated ........ J.~lne..~t ..... , 1970.. pursuant to which Building Permit No. ~ed ........ J.~me..~t ...... , 19. F.Q, 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 ... ~gr~.m~.t~.~J.. atora~e .bu~l.~.d~.~ .................................. The certificate is issued to ... H.*..D. $.~.k.e.V.s.o.n...&..o..~..~.~. ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... ~ ............................ UNDERWRITERS CERTIFICATE No..P?.n.d..~.. .................................... HOUSE NUMBER l~00 Street Jacobs Lane Building Inspector FOILM NO. 2 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? 4805 Z Permission is hereby granted to: .............. JeJtlm.tA ........... J,,~, ......................... at premises lacated at .......... ~d~.~J¥l~lJl~..J~J~ ............ ~ ................................................ ................................................. Jml.t~4,1A ........... ii,.~, ...................................................................... pursuant to application dated ....................... ~ .............. ~ .......... , 19.....~ and approved by the Building Inspector. Fee $..~e~J(J ........... Building Inspector BUILDING DEPARTMENT/- / ~ ~ ~ ~ ~ TOWN CLERK'S OFFICE 0 ~TH~D, N.Y. ~o ~ ................ · , ................. , 19 ........ Apali~fion ~o ............................ ~ u ........................................ , ~it ....................... APPLICATION FOR BUILDING PERMI'T (~ ................ ............................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjo n ng pram ses or pub ic streets or areas, and giving a detailed description of layout of property 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY/v~DE to the Building Department 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 Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo t on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ............................... ................................. ta S te wFIdther applicant is owner, lessee, agent, archih · ngineer, general contractor, electrician, plumber or builder. Name of owner of '~remises /~ D/C If applicant is a corporate, signature of duly authorized (Name and title 'of corporate officer) 1. Location of rand on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ .................................................................................. ...................................... 2. State existing use apd occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. .~....~.,~9~..~. '7~ ~1 ! L~ / IU ~' .~ ,.5 t~ ~ Z"' ~ ~'?'1~ ,'~ Z).Z)/T /O~/A 'Po ...?...-... b. Intended use and occupant,' .............. ..~. ........ ...T~.. ~/~ 3. Nature of work (check which applicable): New Building .................. Addition /~/' .................. Alteration .................. Repair .................. Removal~ ----,, ~ .................. Demolition .................. Oth~ Work (Describe) ........................................ 4. Est mated Cost .................... .~[/....~.~...~.....~.. ................. Fee .......... .~....'~......~ ..................................................... (to be paid on fi!lng 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 alterations or additions'. Front .................................... Rear ............................ Depth ................................ Height ............................ Num~per of Stories ................................ ~ 8. Dimensions of entrire new construction: Front .......... ..~......~...i../....O. ........ Rear ............................ Depth .....7...~..~..~. ...... Height ...... /.~. ....... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........~...~.~....'~...... Rear .................................... Depth ........ ../...~...~...~.....'~.. ...... 10. Date uf Purchase ............... .~....~...0...~..,?. ........ ./...~....'~...~......Name of Former Owner ............ ..~...~....~....'~'..~..../~..~........~....~...7.,.... 11. Zone or use district in ~vhich premises are s tuated ................. ..~.....~...'~..../....~,..~....~....'~...~...../=.. ............................................ 12. Does proposed construction violate any zoning'~aw, ordinance or regulation? ................ ...'~......O. ................................... 13. Name of Owner of prem scs ..~....~../..~...~....~..~....E~...~..~....~...~.~'-a~ss ................ ..~..~.?....7~....~...~.. ..... Phone~N~o.~....-....~...~',...~.7 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 names and indicate whether interiOr or corner Jot. ~ 1 1~' ~/~ ~' V I I~ ~ ~'~D/~ ~ STATE OF NEW YORK, COUNTY OF ................................ . ................................................................................................. being duly sworn, deposes and says that be 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 ~ile 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 application filed therewith. Swam to before me this hlota~ ................................................. ..~.. Coun~ ...... (SignatUre of applicant) ............ ELIZa. SETH ~Nrl NEVILLE ~OT~,RY PUBLIC. State el New York No. 52-8125850, Suffolk Cou~t~ Tarm Ex~ires Ma~ch 30,