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Home My WebLink About1112-zFO'I~M NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CEHTIFfCAT~ OF OCCUPANCY Z 807 August 26 60 No ......................... Date ........................................................... , 19 ...... ' w/S Camp Mlneola Rd., Matt/tuck THIS CERTIFIES that the building located al .................................................................... Street _-Map No ....................... Block No ..................... Lot No .............................................................................. conforms substantially to the Application- for Building Pea'mit heretofore filed in this office June 16 60 Z 1112 dated ............................................... 19 ........pursuant to which Building Permit No ......................... MH J%me 17 60 4ated ................................................. 19 ......... was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is PRIVAT~ ONE FAMILY DWELLII~G RUdolph Ltbath, owner This certif~cale is issued to (owner, lessee or tenant) of the aforesaid building. TOWN OF $OUTBOLD BUILDING DEPARTMENT TOWN CL£RK'$ OFFIC£ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1112 Z Permission is hereby granted to: ........ ~.t;..~.~..~.~ ~ .....~.,:~.,..: .................... ~. ........... at premises located ot ...~J~.....(~s~L~J~...~/~Tle~...'~OJ~d .......................................................... · ........ :..' ...................................... ~t.t&~k~.....li~. ...................................... ~ ............................................ Bgildir~ Inspedtor Fee $.~O.,qO, .......... TOWN OF SOUTHOLD I~UILDING DEPAP, T/vlENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ....................... ~ Application No. I Lt ~ (Buildirlg Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su~omitted in duplicate to the Building Inspector. 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 the diagram which is part of this location. c. The work coYered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HERESY 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of a~licant, or name, if a corporation) (Address o~c~ppliconT" State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on wh ch proposed work w be don~ Map No: .......................... ~. ................. Lot No: ....... ~ ........ ............................. Street and Number /" // '" L~ Municipalrty State existing use and occupancy of pr. emises c~nd intended use and occupancy of proposed construction: o. Existing ase and occupancy ............... ........................................................................ b. Intended use and occupancy .............................................. 3. Nature of work (check which oppkoble): New Building ......... ~....Add]tlon .................... Alteration .................... Repair ....... ~.. Removal .......... Demolit on ............. Other Wore (Describe) .................... 4. Estimated Cost...;~..i Z.~.~,.~...~'.~..O' ~ 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~f ~]ories ..... ~'""~'"~'""i' ...... .............................. 8. Dimensions of entire new construction: Front ....... ~...~.~Reor ~.~......~..~.. Depth ..... ~.~t ~, Height ............................ Number o~ Stories ........ 9. Size of lot: Front ..... ~ .......... Rear .......... Z~Z ..... Depth ......~ ....... 10. Date of Purchase ........... ~~..Z~,.Name~ / ofu~ ~ ~F~rmer Owner ..... ~..~ ............. 11. Zone or use district in whiCh premises are situated ................ ~..::...~.~~ .................................... 12. Does proposed construction violate ~ny,zon~g law, ,orfli~ance ~r regulation? ,~.~ ..................................... 13. Name of Owner of premise~~..:~~....~ _ , ........... Phone NO ..................... Name of Architect ........;~..;~~ddress~~, . Phone NO. Name .... ..................... of Cont ractor.~..~.L~~Add ress ................... '~'":?'"'"' .............................. PLOT DIAGRAM Locate clearly ~nd 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 d~ ~d, and show street names and indicate whether interior or corner lot. STATE OF NEW//~O~,.,, /~_/ }, S S COUNTY OF ~~)' '~ ........................ ~~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual si~ing~tion~, j/' ,~L,~/~ ~/~/,g,4 above named. He is the .............. ~_r.w.~..~ .............................................................................................................. (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 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 fil~d ther~th.' Sworn to befor~ me this ~ ~ JUDITH , .......... /~.~doy of ................... ~~19.~.D..~tery ,u~,~ o~ ~E~'(~J~notur~ of oppl~nt)