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Home My WebLink About3901-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMEN~ Town Clerk's Office Southold, N. Yo Certificate Of Occupancy No..Z67.90 ..... Date ...... ~; .......NI~. .... 24..., 19.7~'. THIS CERTIFIES that the building located at H~'~.~g~o.~ .B~.v~. ......... Street Map No.P.e.c ,. $h .... Block No ........... Lot No..12~36... P. eeorde.. ~,'~Y, ....... conforms substantially to the Application for Building Per, nit heretofore filed in this office dated ........... 14~... 2.7..., 19(~.~.. pursuant to which Building permit No dated ........... ~4ay... 27..., 19~8., 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 . R~iYa.te. ga~zage..~ (. 2r~d. flnor, .~'oom .nq~;..finiahed..off) ........... The certificate is issued to . Oe.orgo. tloffmarm...0wrm~ ............................ (o',%ner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval , N.,R.. ............................. UNDERWRITERS CERTIFICATE No.. ~ot; .inspeete~ ........................... HOUSE NUMBER ... ~.~.00 ...... Street ...Httll.t/llgt°~. BI.Vd... P.®eonie ......... Building Inspectog TOWN OF $0UTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIsBS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 3901 Z Permission is hereby gronted to: .~.,?:..,~.~,~...~...~.~..,~.-,~.....x~..~.~.....~...~...~'~ ,- ,~, ' ~ & Wtt'e at premises located at ..~O~...~I~,..~,,.~4~....,[~.:.G~J~ ................................. :.; .................... ..................... ~...~!~1~.~.~ ..~.~ ....... .~.~.~.~.~. ~,~.~ . . pursuon¢ ~to ~pplie~tion doJ'ed ................................. :.~:~. ....... ~.~... 19.~.~; ~ end opproYed by tho Building Inspector. ,Fee $....~.*.~ ........... ; Building Ihsp~ctor Disapproved a/c ........... ~ ............................ ~ ........................................... APPLICATION FOR BUILDING PERMIT [~:~te INSTRUCTIONS a. This application must be completely filled in'by typewriter or inink and submitted in duplicate to the Building Inspector. b. Plot plan showin.g, location of lot and of buiJdings on Premises, relationship to adjoining premises or public streets or areas, and giving a detaded 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 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 HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southo!d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removql or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code/~housing co~;~e, and regulations. (S~atu/~of~pplic~ant, or name, if a corporation) (Address o~ applil~nt) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. Nome of owner of premises ~~. ~ ........................ If applicgl:~ is a'corpo, j;ate, ~i~nature~duly authorized ~ficer. · L~ation of land on which p~ed work will ~ done ]. llo0 ' .: ............ .... : ................. :' Str~ and Number ..... ~..=.......v-==...= .............................................................................................................. Munici~li~ ' 2. State ~istJng u~ and ~cupancy of premises and intended use and ~cu~ncy of pr~ con~mction: a. ~isting use and ~cupancy ..... ~~ ........................................................................................... b, In~nd~ use and ~cupancy ................................................................................................... 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 c~rs'. ......~.~L~.. ............................................ ; ..................... '.;.........~;;..',.; ....................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure witl~ alterations or additions: Front ~ ................................... Rear . ........................... Depth ................................ Height ............................ N.ul-~ber ~f Stories ............... } ................ 8. Dimensions of entire new construction: Front ......... ./...~.. ................. ,. Rear ,~...~. .................. Depth ..-~..../...~ .............. Height ..J...~.~ .......Number of Stories ...... ./ ............................................................................................................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....... ~.~,~.~. ...................... .......................................................... 12. Does prOpOsed construction viol~ate~. ~-anYl~'0ning law, ordinance or~regul~ion? .......~.?~...i:. ................. ~ ......... z/J' ............... Owner of prem,ses ~. ...... Address/~'~... ..... : ..... ~. 13. Name of ~_ ~, ~_~. /,,,~ Name of Architect ................. r; .......... ~ ...................... Address .......... :~ ............... · ............ ... Phone No...~ ................. Name 0' ContraCtor~..~/~~ ........ Address ......~../~ ....... Phone No...' ................ 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................................/~~~~'°' ............................. ~.....~..~............. being duly sworn, deposes and says that he is the applicant (Name of individual slgn_inaapplication) ' above named. He is the .......... .(,~....~.~.~...~.i~ ....................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rna,ke a~nd 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 before me this ~.~ ~' . ........ day of .......... , -- ,_/ . 9 ............ , .... .............................. Notary Public, .j'-¥..l.~......c~..,....-.JL~V'~.. County (Signature of applicant) ~l~Rl~ A. JRE6EN y pUBLIC, State of New York /'~ ' NOTAR , uffolk Coun~