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Home My WebLink About3175-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY conforms substantially to the Application for Building Permit heretofore filed in this office,, a~ted dated ......................... ;.~..~.~ ............, 19.~.~.., was issued, and co~forms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ....... : The certificate is issued to ~TO~,~I ~t~1, c~O1" (owner, lessee or tena,nt) of the aforesaid building. Building I nspector~'"' FOl~l~l NO. ~ 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? 3175 z Permission is hereby granted to: I z~l~z ..~;hi~.. A/.C.....~f~ ..~¢~.o~. ................. ................... ~ ;~.i;:l..~'~k ....................................... to ..l~i3zl..~...ane...i'a~,~¥...~l~,.~3&ltag ..................................................................................... at premises located at ....~.~.....}~.~,¢],¢~[[a..Z{Q~J~...(.~,.~2~..}:.:~;..~ ./~..:[~';~9.~}.l~a..a~'9 ...................... ..... . ........................................ ~e/C~_~,e~t..,.,~ .,. , .............................................................................. pursuant to application dated ......... ~ ....... L...:...~.~,~......: ...... ~. ........ 19.....~.~., and approved by the Building Inspector ' Fee $~L~,J~) ............ FO]~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned'... ........ L., Approved ........................................ , perm,t No. Disapproved o/c ....... ~ ............... APPLICATION FOR BUILDING PERMIT Date ................................. ~1;~......2.9. ....... , 19.66 ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 o detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuence 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 HEREBY MADE to the Building Department for the issuance of o 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 alt applicable taws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) Mattituck (Address of-applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. Contrac tot Name of owner of premises ..... ....................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........ .:Y~...:~ ......................... Lot No.: .....~...~. ............... Street and Number ..]~f~.t~'~.~ gR2.2 & W:L~m A~.~ ~a.Ct4.tuck ................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~.~,g.~,~.~...~'.~,~...~...~..~..~,:~,l~..~l~,~.~J~ ............................................. b. Intended use and occupancy ....... 0.~...~.9,~:~....~.~.~,,~.$~[ ............................................................................ Locot~ property whether 3. Nattire of work (check which applicable): New Building ..~ ...... Addition .................. Alteration ................ Repa'ir .................. Removal ..................Demolition .................. Other Work (Describe) ..................................... 4. Estin~ated Cost .....~+OlD.0..I~4~I ................................. Fee ........ :1,0 .......................................................................... (to be paid on filing this application) 5. If dV~elling, number of dwelling units ~iG~ ..................... Number of dwelling units on each floor ........................ If gcirage, number of cars 6. If b~siness, commercial or mixed occupancy, specify nature and extent of each type of use ........................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Heig,ht ........................ Number of Stories ........................................ .~u' ................................................................... Dimensions of some structure with olterot[ons or odditions: Front ................................. Reef ........................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimtnsions of entire new construction: Front ................... ~:0. ......... '..'~eor ........ K0. ............... Depth .......~... .......... Number of Stories .......... ,.1~.~ ................................ , .................................................................. 9. Sizeiof lot: Front ..... t'&l~ll..~e~&j~r .................................... Depth!..~ ............................... 10. Dot~ of Purchase ........................................................ Name of Former. Owner .................................................... 11. Zonb or use district in which premises are s~tuated ..~.....0i$.~ .............................................................................. 12. Doei proposed construction violate any zoning law, ordinance or regula~i?? ......... ~II ......................................... 13. Nar~e of Owner of premises ...... ~Ol:ll~.*~::l.l:lOl~. ......... Address ...... l~tt, t~l.~;~tlCle ................ Phone No ................. No4e of Architect ................................. ' ..................... Address ...................... : .................... Phone No ................. PLOT DIAGRAM cleorly and distinctly all buildings, whether existing or proposed, ~ncJ inc~icgt~ all set-bock dimensions fr~ ~es Give street and bock number or description oqcording to deed~ and ~Sb~)w street names and indic, STATE O[ NEW YOIgI~:, _ t S S COUNTY IOF .... ~A~V~.J,~f, .......... ~ ' · ........ ,. ....... ~'. ............ ~ ;L~it,~.. ~Ll..t,~ :L~ '1 ................................... being I(Name of individual signing application) duly sworn, deposes and says that he is the applic abow~ nar~ed. He is the ..................... .~.O.~.~.~{t,.~.~,.~.~' ....... ~ (Contractor, agent, corporate officer, etc.) of said o~,ner or owners, and is duly authorized to perform or have performed the said work and to make and [ this opplic~ation; that all statements contained in this application are true ,to the best of his knowledge and belief; that the wbrk will be performed in the manner set forth in the application ltl/ed therewith. Sworn to I~efofe/me th s ' / ......... ....... of ................... ............... , / ,. - ~, /~ , .... t..x,,,~/',~.f-.~....~.~ ~.....~ .. ~¢c~" .'~"'"'~ ' Notary Pub,e, County ............... .? (~ MARION A, REGENI / ~'erm Expires M.areh 30, 19~'