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Home My WebLink About5704-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 .Ba/tmm~r. Road..(pvt~). .... Street ..ammen~gd D Map No. ~ass,~ .~'~.. Block No ........... Lot No... 1 .~.9.....c.u.t.c. hP.g~.e....N.:Y... ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... De~ · .9 ...... , 197.$. pursuant to which Building Permit No.. %?0~Z. dated ......... Jan..3.~ ...... , 19.7.2., 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 . .P. ri.vate, garaga .(acc. essor~)..bt~Ll~ng ............................. The certificate is issued to ...Tholnas .14uncy ....... ~el~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....N. :.R..: .......................... UNDERWRITERS CERTIFICATE No ..... N.,:Re. .................... : .................. HOUSE NUMBER... 1280 ..... Street .....Bayberry..Road ........................... · · Building Inspector TOWN OF $OUTHOLD 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) 570~ Z ~, ...... ...~..~ ....... ~...!~ .............. , ~9..~...~ pursuant to application dated ................... ~,~,..~:.~....~.. ............... , 19..~.L, and approved by the Building Inspector. Fee $...,,~..... .............. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Oisopprove o/c .......... t .............. ..................... ......................... ........................... ~t, ...... ~...~ ......................... ~.2~ ...... :~s,~uc, zo~s o. This applicotion mu~t be complotely {illod in by ~pawriter or in ink ond ~ubmi~d in duplic~t* to th~ Buildin In~pactOr.. b. Plot' plon ~in~ I~ti~o~ lot ond ~{ b~ildinos on pr~mise*, relotion*hip to ~djoinin0 premi~ or public ~reos, ond ~ivin~ o detoil~ d*~cription of I~yout ofpr~ must be drown on the di~orom which i~ ~ of thi~ opplicotion. c. The work covered by thi* opplicotion m~y not b~ commom~d b~{or* i*~uonce o{ Buildin~ ~rmit. d. Hpan opprovol o{ thi* opplic~tion, the Buildin0 Inspector will issue ~ 8uildino ~ormit to th~ opplicont. Such p*rmit~ sh~ll be kept on the premises ~v*ilable for inspection throughout ihepr~r~*~ o{ th~ work. e. ~o buildino *hall be ~capi~d or used in whole or in pa~ {or ony purpos* Wh~t~ver until a C*~i{icot~ of ~capancy/ sh~ll h~ve beon Or~nted by tho Buildin~ 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 L~ws, 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 oil applicable laws, ordi nonces,, building code, housing code, and regulations. If applicant is a corporote, signature of duly authorized officer. "f~- )/ , ;~ ................ ~l~;";~i title of corporate officer) ~--~1~ ~/ ~ ~ '~P~- "~ 1. Location of land on which proposed wgrk.will be dene. 'Map No.: ...... .../~.. ....... .'~...?..~......,...~. Lot No ....... ~.~. .......... ~ Street and Number ......... ...~..~...~ .............................................. ~~:.~ ............................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed Construction: o. Exisiting use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. 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 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 ........... s~.~. ................... Rear ....... ,~.~.. ............. Depth .....~....~.. ............. Height ........ /...2, ....... Number of Stories ....'. ............ ./ .................................................................................................... Size of lot: Front .......... Q'~...~) ........ Rear ................ ./..~..~. ............. Depth ........ .~..~.~ ............... Dote of Purchase ........ ~.....c~.~.. ............... ./.~..~./. .............. Name of Former Owner ........................................................ Zone or use district In which'~oremises ore situated ............................ .../~... ................................................................... Does proposed construction violate any zoning law, ordinance or regulation.;> ...... ~ ......................................... Name of Owner of premises ..?~..~.¢~.....~'...u~.~.~. ........... Address ..~.....~.~.~.[~..~..~./.iii~?!~P'~o Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~..c.~......~.~/.~.T>....~!v)J.~'F.(..~J..".n.~-......^ddress .,~"~...~e~.~.e.....~./v../~..~.... Phone No....~..~..~..~.~.~..~? 12. la. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, end indicate all set-I~ck dimensions fro~ property lines. Give street and block number or ription according to deed, and show street names and indica~ whether interior or corner lot. STATE OF NEW,,Y.O...~f,,. ~l.~ ' I S S COUN-r,,, · ................. · .~..~ ........ ~ ....................................... being duly SWam, deposes and says that he is the applicant (Name 6f individual signing application) (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 contoin6d in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swo~rn .to, before me this r-~ .... ......... ........ : ........ , ,'~ H.:_ ~,.-~/ i~ , 'I I 'n ~. ......,,o,.~....~....'c~ ......... ~ .................. Notary Public,~~.. County~ ~ (Signature of applicant) ................. ELIZABETH AN~ NEVILLE J/ - NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk County,~ Term Expires March 30. 19