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Home My WebLink About201-zFOI~IVI NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~O~...I~rl ............................ Street Map No.~_t~a.~'c~...~S~,SBiock No .......... conforms substantially to the Apphcat~on for Building Permit heretofore filed in th~s office dated .................. ~]~.~.4~bft~...~J,e ......... 19..~?.., pursuant to which Building Permit No ..~..~OiI ............. , dated ............. ~T~%"~r... aQ ...... l f~'~ ..., was issued, and conforms to all of the requirements of the apphcable prowsions of the law The occupancy for which this certificate is ~ssued is .......... .................................. · ~b.~t~'A~E..D~J~,~,I]~G ................................................................................... This certificate ~s ~ssued to .~.~t~oD....~, ..J~,S ......... ~. o'i~e~.) ......................................... (owner, lessee ar tenant) of the aforesa.d buHdmng FORi~i ~TO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES V~'~t~Sti'~,~i~lF4, ~P~P~I~,~,i6i',JlI;~$~F~Ji~;i~4~T~ii~I~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No . z.201 ... Permission ~s hereby granted to Harol~ R. l~eve. &..So~s ten.. Jenn~ngs to ..... I~Z¢I. new dwell.~n~. ............................................................................. at premises located at . ~.,.~OQI'I ~O~d ,/~ ... ~d~l.~ ~,~,t,~? .......................... ................................ Xoun~s...l~in~t.....~ttcl,.tnck~...1~,~o .................................................. pursuant to apphcation dated ........... ~)s~ellll~e,~...~-I .......... 19..~, and approved by the Building Inspector Fee $...lO.OO paid Building Inspector NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL F, le No ......~..~. O..].. ...................................... Date ............... *T..~.~..~?.~......~-~ ................ 19~... ..... .~. ~.~ .......................... ............ ~~.~ ..... ~ ................ PLEASE TAKE NOTICE that your apphcation dated .... ~e.ae~be~..~ .............. 19~... for permit to construct ~~ ................ at the premises located at ~~.~.~ · . ~q~.~....~g~ .................... Street ~~e~t ~-~* Map ., **** Block ***** Lot **** is · m~,~~ disapproved on the following grounds ............................................................ FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined...~.~......~ .......... 19...~'...~. Approved.....~....~....'~.....~..~.....~}. ......... tc~...-..'.~..Permit No....~..~..~ ........... Disapprove~c ..~..~.~~ ........ ~.~..~ ....... ~ ~ ......................... ........ /' .................... Application No.....~...D...../. ........... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This applicotion must be completely filled in bv typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing Iocotion of lot ond of buildings on premises, relotionship to adjoining premises or public streets or areas, ond giving a detoiled description of ioyout of property must be drown on the diogrom which is port of this locotion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approvol of this opplication, the Building Inspector will issue a Building Permit to the opplicant. Such permit shall be kept on the premises ovailable for inspection throughout the progress of the work. e. No building sholl be occupied or used in whole or in port for any purpose whotever until o Certificote of Occuponcy sholl have been gronted 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 and regulations. (Signature of applicant, or name, if a corporation) MATTITUCK, L.I., N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder. General Contractor Name of owner of premises ....... ~.t~'TC~...~.,....~..12~...'.~..g~ ....................................................................................................... tf applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Wertenburg Location of land on which proposed work will be done. Map NoH~?.~.¥~,~...~.~.t.~?..e..?.... Block .................................. Street and Number Raccoon Road State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occu-anc' Vacsnt Bui~ Lot b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building ................. Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost '~.28~,000.00 Fee / 0 ~ '" (to be paid o~ ' ................... FEES: 5. If dwelling, number of dwelling units.....~ ..................... Number of dwelling units on each floor ............................ If garage, number of cars ................. . ................................... 6. If business, commerical 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..5..5..~...'~...'.'. .............. Rear ..~.~..~.~.8..'.: ............. Depth ...~9...~...--~...~i ............ Height ....~.6..~...-~...~i ........... Number of Stories ....O..~..e. ................... 9. Size of lot: Front ...~.2.~..!:T ............... Rear '125~- Depth .~Q...~ ................. 10. Zone or use district in which premises are s tuated.....4..~.e.?~c~ent,:i.a--L 11. Does proposed constructio~ violate any zoning law, ordinance or regu at on? ~.o. ................... 12. Name of Owner of premises~.t;4~.qB..~.~.~..z~....'.z~.~.9.....Address ............................................ Phone NO ..................... Name of Architect...A~..~.z'..e.~...A..:.B..~..e...z'?.e...~. .................... Address ..?..8...N.~..:i~..?...~:..?...t~....a~..~.+".0..~.....Phone NO ..................... Nome of Contractor.~?..o..]-.~..~:~:.e..ez.e....&....S.9~.s' ........ Address ...,~.~.J:..~...c..~.z...N.:.~.: .......... Phone N .O-~..:.9..-..8.;~...8~: .... 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. ,I STATE OF NEW, YORK, · COUNT, ...... .............................. ; ............ ' ........... ~ .............................. oe~ng au~y sworn, aeposes ana says that he is the applicant (Name of individual signing application) above named. He is the ..................... (Contractor, agent, cor~rate 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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith· Sworn to ble~ore me this ....... ~ ............. day of '")7 :'~'~"'J'~"~'~'*~'f"'~'~/;/ r ....... 19.:'.~ Notary Public,.../3.~;;~J;... ~:~.~...(X.. ::!..q.~.~ ............. County (Singature of applicant)