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Home My WebLink About4828-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificste Of Occupsncy No. 7.. ~8~ ..... Date ............. ,Trine.. ~1 ..... , 19.70. THIS CERTIFIES that the building located at .. Pgl,.&dtse. PS, .Roa~, ...... Street Map No.. -XX ........ Block No ..... X~ .... Lot No..XX ..... 8outhol. d · · · 1~,¥, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~tme- 6' ', 19. '70 pursuant to which Building Permit No.. t~82~Z. dated ........... 3tll~ .... ~)., 19 .?0., 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 ... Pr.~,vate..]oath .house. (Acees sor~..Bld~) ........................... The certificate is issued to ...Rob~r.t. L, .Stott ...... 0~mer. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ ]~,R.~ ........................ l/ou~e ~ 900 FORI~ 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) Permission is hereby grented to: = i ~ ~ ~tt ot premises located at ..................... ~{~-...~;~..-~-f~.-~[~ .................................................... ........................................................... ,~ ~u~o'~ ......... ~ .'~'~-" -~- ......................................................... pursuan,t to opplicction d~ted ................................. ~ ....... ~ ....... , 19..~0, ond opproved by the 13uilding inspector. Fee $..~..~)0- ............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... , ]9 ....... Appra ed ........................................ , ,,.....'.:. Permit ..... Disapproved a/c ........... ~ ............... APPLICA. TION FOR BUILDING ~..!MIT ........................... ...... 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 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 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 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 pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordin.ances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and/regulations. ..... (Signature of applicant, or name, if a corporation) (Address of applicant)/ State whetherapplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of prom sos ............................................................. If applicant is a corporate, signature of duly c~thorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ............. ~i .............. Lot No.: ........................ Street and Number ~.....~....~..~..~~~....~'~...7.~..,. .............. Municipality State existing use and occupancy of premises and intehded use and occupancy of proposed construction: a. Existing use and occupancy ..... .~..~ ..................................................................................................... b. Intended use and occupancy ....~.~~ .............................................................................. 3. Nature of work (check which applicable): New Building ....~... ........... Addition .................. Alteration .................. Repair ................ .. RemovaID~ ............. ...... Demolition .................. ~ (~t.~Ot er Work (Describe) ~¢c~.....~.~/__ ..... 4. Estimated Cost .....d.. .................................................... 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 alterations 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 ....~....~...~..f. ................. 10. Date of Purchase ........................................................ Name of,Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ...~~ .............................................................. 12. Does proposed construction .v~~~°rdinance or,/x~ c,4'.re~lulati°n? ..~....t~.. 13. Name of Owner of premises~..r.v.....:..:..' ......... Address ~~...../..;... Phone No ..................... Name of Architect ...................... ,4' ........... ~ ................ Address ......~ ............. ,~ .................... Phone No ..................... 'Name of Contracto~'.~...'.'..~..: ....................................... dd ss'.~....'r...................,........,...... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from ~scdp~Lun u~_u~di'hg~o"deea, und show street names and indicate property lines. Give street and block number or whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ ~ ~,"~' _ ~{'[qo~s~f~ning applicat~).., obove 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 . ......................... f:LILAU~-TH ANN NE~LLE NOTABY PUBLIC. State of ~ew York No. 52-8125850, Suffolk Co,~ Term Expires ;March