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Home My WebLink About5621-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...Z.~..37 ?. .... Date ..... J..~.. y..2.? .............. , 19. THIS CERTIFIES that the building located at ?0~...~.a~t;. ~::~.dc]. ;~r. iv.~ .... Street Map No ............. Block No ........... Lot No ................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated /!o.v.e.'.??y..1.0 ...... , 19 71 . pursuant to which Building Permit No. ~21 ... dated November 10 19 71 ....................... , . .., 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 ...4.¢.a.e .s.s.°..' .~'~....B.u:i..~.~.~. g ........................................ The certificate is issued to Mrs, George (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... NoR · . .............. UNDERWRITERS CERTIFICATE No ................. NAR: ...................... HOUSE NUMBER 70~ Street Capt ~idd Drlve~ M~ ,~tituak Building Inspector . FOR~ NO. 2 TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE sOUrHOLD, N. Y. BUILDING PERMIT .(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) to at premises located at ..... ~O.~.--~.--.~-.[~S~--~ ................................................................. .............................................. ~.~t..£1~..~rtw .............. ¥~tttt~k....l[,~.~ ........................... pursuan¢ to application dated ........................ '~0~' ......... '1~' ............. , 19.~.., and approved ~ by the Building Inspector. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ............................... ~.r'~~ L.~.., 19..~7...l Approved .................................... , 19 ........ Pem~t No ..................... D~sapproved a/c ............................................................................................ .............................~(Bu,ld,ng lnspectori ...... '"~"~ APPLICATION FOR BUILDING PERMIT ................. ....... INSTRUCTIONS o Th~s apphcat~on must be completely filled m by typewriter or ~n ,nk and submitted m duplicate to the Buildir Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adio~nmg premises or pubhc streets. areas, and giwng o detaded description of layout ofproperty must be drawn on the d~agram which ~s part of th~s applicatio c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Budding Permit. d Upon approval of this apphcation, the Budding Inspector will ~ssue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the progress of the work e No building shall be occupzed or used ~n whole or in part for any purpose whatever until a Certificate of Occupan, 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 tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buildings, addztions or alterations, or for removal or demolition, as harem describ~ The apphcant agrees to comply w~th all opphcable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) ......... ........... '. ............................ (Address of applicant) State whether apphcant ~s own~ lessee,/~g~nt, architect, engineer, general contractor, electrician, plumber or build if apphcant ~s a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) land on wh,ch ro osed ork i I' done Ma No Street and Number ....l~..~.~:...~-~ ~/4 ~ ....... ~'~~Mun,cipality ................................................ 2 State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a. ExlsJting use and occupancy ..... '..~...~..~. .................................................................................................. b Intended use and occupancy ......... Z~.......~/~.':...¢~.....~......~."-'~/ ...................................................... /! 3. Nature of work (check which apphcable). New Bumldmg ......... .IX. ..... Addmtion ...............Alteration ........... Repair .................. Removal .................. Demohhor ................. Other Work (Describe) ........................................ 4. Esbmated Cost .......................................................... Fee ~ ~ (to be po~d on filing this application) 5 If dwelling, number of dwelhng umts ..... /....~...~ ...... Number of dwelling umts on each floor ........................... If garage, number of cars .......................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ...~ 7 Dimensions of ex,sting structures, if any. Front .......................... Rear ................................ Depth .................... Height ........................ Number of Storms .............................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ........................... Depth ................................ Height ........................ Number of Stones ............................. 8. D,mensions of ent, re new construction. Front ........... /...8 ................. Rear ........... .......... Depth ...../...~.. ........... Height .................... Number of Stories ......................................................................................................... 9. Size of lot. Front ............................ Rear ................................ Depth ................................ 10 Date of Purchase .................................................... Name of ~orme~' Owner ....................................... 11 Zone or use d~strict ~n which premises are s~tuated ..... /~ ........ ~' .................................................................... 12 Does proposed construction violgte~.x~~ - -'any zoning la,w, ordinance or"~1. ~regulotm~ ..... .~.....x~.. ............................................ 13 Name of Owner of premises ..l./'.~..~..~...^ddress .... .?....~...~:.0..... ................ Phone No .................... Nome of Architect ...... ~'Zi~'/~ "~F ............. Address ............................................ Phone No .................... Nome of Controctor ..... ~ ...... .~c~..._.-...¥'r ........ .x ........... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex,sting or proposed, and indicate oil set-back dimensions from property lines. Gwe street and b~ock number or description according to deed, and show street names and indicate whether interior or corner lot. STATE Of NEW~'OJ~,_ ~r ~ ¢ c COUNTY OF '""'~'"7~ ........ ~'L~.. ~ ~. , 1 ~ ......................... ~ ...... ~ ..... ~ZC.~ ............ being duly sworn, d~oses and says that he is the applicant (Nome ~f indiv,~al sign,ng a~l.cat,o~~ above named He s the ..................... ~.~_~.~ ......................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized ta perform or have performed the said work and to make and file this apphcation; that all statements contained m this apphc~ion are true to the best of his knowledge and belief, and tha~ the work will be performed in the manner set fa~h in the appli~i~ filed therewith. Sworn to before me this .- - ................. z0. ............. .... ...... t H )_. ..................... ................................ ~ .... ~kI~ETH A~NEVILLE NOTARY PUBLIC. StYe of New York ~erm E~p,res M~rch