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Home My WebLink About4870-zFOP~IW NO. 4 TOWN OF SOU?HOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCL PANCY No. ~..3998, ............. Dote ........... , ........... ~e~t'. ...... .28 .......... , }9....70 THIS CERTIFIES that the building located at .... '~,~'~'~].~"~eOIl~'"B&~"[~ .......... Street Mop No. Na.s~...p.~,..C~o~ ...................... Lot No..)~$~ ......... gU~hO§lXe..]~o~:. ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... ~3A.~.~'. ......... 2.2....., t9...~'.O pursuant to which Building Permit No...b¢8.~0~. dated ............................. .e~t.'l-~¢ ....... .~._.., 19....?Q was issued, o~d conforms to all of the requirements of the applicable provisions of the taw. The occupancy for which this certificate is issued is ........ ........ Priva~e"eava~'""(~cces~or2'"B'ld'g') ............................................................................. The certJficote is issued to ....... ~Xt~2~l..'-,iS,'[~ ............ Oi~le~. ........................................................... (owneJ', lessee or tenant) of the aforesaid building. Ilouse # Building Inspector/ 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? 870 Z Permission is hereby ,granted to: _ _ to · pursucm¢ to application dated ........................... ~ll~....~J, ............. , 19.~l~J}.., and approved by the Building Inspector. FO~M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT u TOWN GLERK'S OFFICE ? /? SOUTHOLD, N. Y. ~ I r "'; ~' ~ ............ .................. ........ ~isopproved o/c ................. b~ ........................................................................ ....................... ........... ......................... (B~ilding Inspptor) Application No .... ,(. .... APPLICATION FOR BUILDING PERMIT · "~...~. '~ ...'~..%.'.'.'.'.'.'.'.~,.. .............. , 19.. '.J'~.. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ir~k and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, reloti(~nship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drown qn 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 ~ 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 puFpose whatever until o Cerfificate 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 Y~rk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or allerations, or fgr removal or demo t on, os herein described. The applicant agrees to comply with all applicable laws, ordinances, buildilng code, housing code, and regulations. .......... ~...~.. ~.. ~...~.x..c...,~:. ~.~ ~;. ~.~ :. ...... (Signature--of applicant, or name, if'~ corporation) ....... ,~...,~.....~-'Z..,c~....~,,.,,,.~ ........ ~.~.~....,r..~ ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general' contractor, electrician, plumber or builder. Nome of owner of premises ............ ~..x~.,~.,~..~./~. .......~...~./~...~ ....... . ........................................................................ If applicant is a corporate signature of alu,L? authorized officer. .................................... c~' ~.. :~ .................... (Name and tiffs/of corporate officer) 1. Location of land on which proposed work will be done. Map No. .~.~..~'.~r.. No.: .....~...~... ......... Street and Number ............... .~..Z~..~.~?.........~..~.~.'~.~..?~. ~..~..,.. .~.~....~..~..~...~..~..~.~' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............... ..~.... Z'..~'..'~.~/.~¢;.~.~..~/J.~.....~..?'~'..,¢~...~..~./...,~.'.~. ..................................................... b. Intended use andoccupancy ............ ~...../..'~.~.,~..,ZT..~,,~.,~../(/...,~.'~? ~ .............. ./.~..~.~,~ ' .~..~,..~.~__~ ¢ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ 6. If bus[ness, 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: Fr6nt ............ /..~.. .................. Rear ......... Z..~. .............. Depth ..... ~/..~ .......... Height ....... ~'...~.../. ..... Number of Stories ................. ./ .................................................................................................. 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? ......... /~...~. .......................................... Name of Architect ...................................................... 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 lot. ! I~$~ /'~,, STATE OF NEWY~R~ -- tee ....... .............................. ~ ........ ~ .......................... being duly sworn, deposes and says that he is the applicant (Name of indivi~al signing application) 4~ 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'~ l~U~' ' ~ ~ '~'~'~'~{ ~~. ......... ...... . ............................. ELI/ABETH ANN NEVILLE NOTARY PUBUC, S~ate of New York N~. 52-8]25850, Suffolk Co~ T~rm ~]ires March 30, 19~