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Home My WebLink About5489-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .. Dogwood. L~ ............. Street Map No.Gal,~.,..T~&y g~pck No. ~ee. II-..Lot No. ~00 .&. 101 .. F~et. l~,lol~ · .N~.~., conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Sept .... ~..., 19.~1. pursuant to which Building Permit No...~ dated ........... aept...~..., 19.7~., 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 -Private. ~e. fa~ly, dwet-l, im~ ....................................... · · · OWRe~ ....................... (owner, lessee or tenant) The certificate is issued to .. All~rt~ Sehatt~r. of the aforesaid building· Suffolk County Department of Health Approval .. llouse ~ 30 Fet 2d ~ FORM NO. ~ TOWN OF $OUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o. ~9 z ~e ................. ~.......'2... ......... Permission is hereby granted to: ~"tjJ ........... at premises located at .... '... ........ ............... .?..., ..... Building Inspector. Fee $ ........................ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~TH~D, N. Y. Disapproved a/c .~ .................. APPLICATION FOR BUILDING PERMIT 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 and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty 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 o 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, Ordinances 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, housing code, and regulations. ...... ....... .............................. (Signature of applicant, or name, if a corporation) (Address of app icant) "' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ ................................................................. Name of owner of prem Ses J~l~ .~..~: ..~..I ~0 ¢~'~' If applicant is a corporate, signature of duly authorized officer. ..7~.~ ~ z./rO .................. ......... Location of land on wh ch pcgposed work w bedo e MapNo ~tZ~) ~&V~--~' ,~.- ~Oi 1. ne. .: .................................. .,..... ~ot No ............. ! ........ Street and Number .......... .~.~..~...(~1~.~..~ ........ . .~.~.O.~.~. ............... ~.~...?.. /~.O, 1~.'.~.~. i ....... , Municipality .............. 2. State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ...................................................................................................................... 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 path type of use ............................ 7. Dimens OhS of ex st ng structures, if any: Front .....~....~....~. ........ Rear ....~.. . Depth h · Heg t ........................ Number of Stores I .................................................. Dimensions of same structure with alterations or additions: Front .....~.../.. ......................... Rear .....~'..../. .......... Depth ........~....~...I. ................ Height ....... .~..../..¢. ............ Number of Stories ../....~.... .................... ' ....... 8. Dimensions of entire new construction: Front ... I (~1 ~,1, .. Rear .../..~..~...~. ~. .......... Depth ...~....~.. !. Height ..~.~....~. ........... Number of Stories ..... I. ............................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ I0. 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;) .~..O.. 13. Name of Owner of premises ~...~..:....~.'..~.~...~.!!..e...l~.......Address .~.~K,.-...~.~....~...:...~'..q..~?...~...0..R~ne No...~..'77.T!...O.~? 1.4Lgs dd Name of Architect ..~.~..~...~ ....................................... A ress ............................................ Phone No ..................... Contractor ~ (l.)r,~t~ ~. A,l,lr~,, ,.~o~eo ~J~'~ ~-~ ~ e~- ..................... Name of ............................................................................. ~...~,~...~... ..... Phone No.'?6S 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 comer lot. STATE OF NEW YORK, COUNTY OF ................................ .. ......................................................................................... Demg duly sworn, deposes and says that he is the applicant (Name of individual signing ap~olicatioo) -r~.~ ~-----r above named. He is the ...................... ..~..~,~...~.....e~.....~... (Contractor, agent, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Swam to ~fom me this ....... .............. ................... Note~ Pub c,~...~...~.~Coun~ (Signature of applicant) JUDITH T. BOK~N Nota~ Public, State of New York No. 52-0344963 Suffol~ Coun~ Commission Expires March ~O,