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Home My WebLink About5849-zFORM NO. 4 TOWN OF SOUTHOLD BUn,DING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No.. . 3o3 ..... Date ... J.u~,y. 26 ................ ,19.73. THIS CERTIFIES that the building located at . ~.~. ~l~ii;tans. [~_~e ........ Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...i.~ay..2 ............. , 19..7.2 pursuant to which Building Permit No.. ~..8~..9.~. dated ...liar..3 .............. , 19..7~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... Private..Swimming. Pool ............................................ The certificate is issued to .... ff~',..Dollald. SaOt~; ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... I~.,R, ..................... UNDERWRITERS CERTIFICATE No .................... P..~....5.1~$. ................. HOUSE NUMBER ...~.~ ......... Street , .C.X'.i.t...*c~n..~....I~n..e..&...B.e.a.c..h~..o.o..d~.~.o?..~..o..~. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 58 9 Z Permission is hereby granted to: ~ ,.,. ,lt~e&t,e~li..,I~..&~· .l)e~..~ .......... &q~mt~e .............. 111~ ........................ at premises located at .......~A~¢.1~ ..................... ~I~I,~;,llV~I~ ............................................................. ............................ g~A~ee~..~e..O..~ea~wa~l'"t~ .............. a'e~M~la' .................. ................... pursuant to application dated ...................... I~l~' ......... ~ .............. , 19.~..., and approved by the Building Inspector. ~1~ 1~ll~l~A~e Building Inspector I PERMIT INCLUDES APPROVAL TO F, EMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADJNG LOT DRIVEWAY CON-cTRUCTION CESSPOOL CONS i RUCTION CELLAR CONS~'RUCTION OTHER ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Application No. ~ ~ .Cf.. ~ INSTRUCTIONS e. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to si:ale. Fee according to schedu!e. 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 diagram which is part of this application. ~, c. The work covered by this application may not be commenced before issuance of Building I~?[mi~l.' d. Upon approval of this application, the Building Inspector will issue a Building Permit to tl1~lNicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose who{ever un~ a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Departmen_t for the issuance efta Buildi~n~q Permit pursuant to the Building Zone Ordinance of ~he Town of Southold, Suffo[l~ County, New Y6rk, and ethemapl~lica~l[ Laws, Or~n~flce~'o~ 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. State whether ~ppficant is owner, lessee, a~ent, arcf tect, engineer, general oon~cractor, electrician, plumber or builder. Name of owner of premiss ......... ~,. ~,~~ ' .2 ~ If applicant is a co~porate, signature of du~ au~~r~. '~ ' ,' ~ ~ 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. Street and Number .....~~.~'~..~..~....~t~-~. -~.. ............ ~~ .......... 2. State exis,ting use and occupancy of premises and intended use and occupancy of proposed construction: a. xis ing use and occupancy_ i iii iiEiiEiE ii ii b. Intended use ~nd occupancy / 3~ ~ Nature of work (check which applicable): ' ' ~ ' ' ' ' New Budding ....................... Addition ..................... Alteration ............... Repair ............. ............ Removal ......................... Demolition ............... (to be paid on filing this application) S. 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 usa ..................................... 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 ............................................... Height ................ Number of Stories .............................................................. 10. Date of Purchasa ..................................... Name of Former Owner ............................................................................ 1 1. Zone or use district in which premises are situated ...!~ ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~...'. .......................................... 13. Will lot beregraded..--~. ....................... Will exce,ss fill be removecl, f, rompre,mises: ~ Yes [ ] NO 14. Name of Owner of premises .~)a~c~...'..~'.. .......... ~ ...... ' ............................................... (Address) (Phone No.) Name of Architect .......................................................................................... , .......................................................... PLOT DIAGRAM ',,Loc~l~ cleal:ly and~d'istinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from pfo'l~erty lirt~'.~GIV~'s~reet an~d b OCk ~u~nber or descr'pt'on accord'ng to deed, and show street names and 'nd'cate wheth- er in~erior or corner lot. .................... He is the ...................................................................................... ~ ........................................................................... of said owner or owners, and is duly authorized to perform or have~rforrnld the laid work and to make and file this application; that all statements contel .~ed' in tl~.[ .~pplicati°n are true t° the best of~. I~'~~T~' _~~ ~ ,~ 'AO£LE'~li~"~that ~1~ work will he performed in the manner set forth in the eP~ication*~%~ed therewith. . . ~ ~ ~....~.~ --...~,~". _ . L ............. ~..~. ......... day of ........ ,,~..~ ............... 19 ~. ,o 52-3041000 __ -- - ~ ~ ~ ,/~ ~ / ~ .... ...... ~is~ ~ires~arch~, 19Z ~ ~ / // ...................