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Home My WebLink About4884-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.Z!*!27 ....... Date ............... Jalx...!5 ..... ,197.!. THIS CERTIFIES that the building located at . .Ibrd. Road.-~//~. 14.. M~l. ~t Map No..~ ......... Block No..~ ...... Lot No. ~.. ~tt!~k...~ ......... conforms subst~ti~ly to the Application for Building Permit heretofore filed in this office dated ........ A~.. 3 ....... , 19.70. pursuit to which Building Permit No..~8~Z. dated ......... A~ ..... 3 .... , 19.70, was issued, and conforms to E1 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... ~v~. acce s s~y. ~ilding. -. B~t. house ...................... The certificate is issued to D~n! ~. ~$e~eri ...... ~r ....................... (owner, lessee or tenant) of the aforesEd building. S~olk County Department of HeMth Approval ..N~, ............................. B~lding Insp~tor TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? Z t~,te ......................... A~ag~tt ...... 3 ...... , l~.....~O Permission is hereby granted to: at premises located at ............ li~O,JJ~..~f..~U..~eOe¥..e...~..We$~,..}~..]l~l~ ........ .................................................. Ilatt.ttl~lr. ...... 31,~:, ...................... : ................................................ pursuan¢ to application dated .......................... ~ ......... ~ .............. , lC)...~l~J~, and approved by the Building Inspector. Fee $...~ ........... "'" Building Inspector 'POWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined .................. ~.. ................. , ........................................ , 19..I~.... Permit No ........................ Disapproved a/c ........... ~.._... ~ Application No. ...... (Buildiqg Inspector) APPLICATION FOR BUILDING PERMIT_ Date ........... INSTRUCTIONS q, a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Buildin~ Inspector. b. Plot plan showin,~ location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detai~ed description of layout of property must be drawn an the diagram which is part of thio application. c. The work covered by this application may not be commenced b~fore issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such perm~ shall be kept on the premises available for inspection throughout the progress of the wurk. e. No building shall be occupied or used in whole or in port for any purpose whatever until a 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 pureuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinance~building,code, l-)e,usin~eode, and regulations. ....... (Address of applicant) State whetherapp[icant~agent, architect, engineer, general contractor, electrician, plumber or builder. · f n f r l nome o ow er o p em sas ................................... ............................................ .............. ...................... If applicant is a corporate, signature of duly authorized officer. I. Location of land on which proposed ~10~'k will be.&one. Map No.: ........................................ Lot No.: ...................... Number~ !~~'~.'~ ,~.~...'~.. :.,.~..~T Municipality 2. State existing use a?d occupancy of p~...~_er~ise~s~.~l~nte~n,~ use and occupancy of proposed construction: o. Ex~sting use and occupancy ......................, ........... ,...~ ....................................................................................... b. Intended use and occu[:an:', . ............................................................................................................................. ..~... ~~....~ 3 Nature of wo~k (check which applicable) New Building f/ . ~ ................ Addition ................ Alteration ............. Repair ............... ~ Remora! ................ Demolition .................. Other Work (Describe) ................................. 4. Est mated Cost ~....../...~. ............................................ Fee ....................................................................... (to be paid on fi'.ing this application) 5. I.~ dwelling, number of dwelling umts ........................... 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 exist!ag sYructures, if any: Front'. ........................... Rear ............................... Depth ................... Height ...................... Number ef Stori~ ................................................................................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ H.~ight ......................... Number of Stories ................................ T-" 8. O,,n ns,ons co,structio,: Front ...... ............ ........... ........ Height .... .~,.0(~.... Number of Stories ...................................................................................................................... 9. S ze o: at: Front ..... /..'.~....~.'...,,~,;:, . ~tear / .~..0 Depth ~ ~'~ O 10. Date of Purchase ...... /...~...(?..r'~)...'..'.'.'' .......... "'""'"'""-'""'"'"'"" ""'"'" 'Z~''.'V'~''Z..-- r3 ,-, ~ ~..........~.........Name.~f~F~rmer~wner~..~.~.~.!.~.....~....~....!..~......~.~.E...~...R..G...~.' ! 1.Zone or use district in which premises are situated .................................................................................................... ~2. Does proposed construct;on ~iol~te any zoning law, ordinance or regulation.> .~ .............................................. ~3. Name of Owner of prem~se~..4.'../..~F......~:~.~.LAddres~.e~../..?Y..&..~£r../.L~.?... ~hone ~oA..V.?.~F..~ Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor .................................................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly oil 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 ;nterior or ccrner Jot. H O L~;)j2~,C)O I(' ~, Pr/"/~=- STATE OF NEW ~)01~, //J. ! SS 1m . ......... ~.~.~7..[~....~ ............. being duly sworn, d~oses and says t~t he is the applicant ,~ame of ind,viduaT sig~a~ti~w above named. He is the ............. ~.....~_..:..~.~ ....................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that alt stotements 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 forth in the application filed there,. Swam to before me this ~ ~ ~ __ ~ / I __ ......... 'H. ~~T'"':2Z' ......... .. ~. ~.~ ~~.~ Not~,/~,i~~..~ ........ co~,~~ ~s,~;~i;;~iil;;~ ............................ ~ ELIZABETH tANN NEVILLE ~ ~ ' NOTARY PUBLtC, State of New York No. 52-8[25850, Su[folk Term ~pires March 30, Count