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Home My WebLink About3789-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...Ha~.l~;on .~ve.. ......... Street Map No. Rav. atol~ ·. Block No... Y~ ..... Lot No..2~. &. 26 .... C.u..t.e.h. qg~..~. ......... 8e~c. ls Map comorms §ubstantially to the Application for Building Permit heretofore fried in this office ~%~d ..... Feb,. %, ......... , 19.6~ pursuant to which Building Permit No.. dated ..... ~rQla. ~,f ........ , 1968., 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 ...I~r~..v. ate. 6ara~e. (ac.ces so.r.y..1)l~lg.. ) ............................... The certificate is issued to .. J~eon~=d. ],[o.d~.l.e.w...aJ~. ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I~,~, ............................... UNDERWRITERS CERTIFICATE No...N,~I., ...................................... HOUSE NUMBER .... 200 ....... Street ... ~.i~.t. qa...A.v.e.: ....................... ..................................................... ? ................ FOB~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD,~ N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 3789 Z ~' ................. ~~ ...~......-.-,'9-....~°c'' ................. :...1..1,:'.1~ .................... ~.//~. ............ ~....~.:., ................................. "57777 .................... to ar.~..-~.,'--. ..................... '~"'~"; -"''W' .............. .,~.a~..../:' f.'. ........................................................................... .... at premises located at ....~.--~....~~.....~~ .................................. pursuc~t to application dated .................... d~.~.~.....~.. ......... , 19.~..~, and approved by the Building Inspector. Rider* which may be used with Standard NYBTU Form 8041, rev. 11/78 S('IIEI)UI,F, A (Dl'scliption of l'~emises) ALL I~at cerUda pict, piece or parcel of land, with the buildlnfs and improvements ~ereon erected, situ- · ,e,~ ~ ~ at ~lee~a Heok~ O~o~ ~o~ of ~o~hold, Co~ of ~fo~ an~ ~e of ~ ~o~ ~ ~i~arly kno~ and demig ~ed es ~d ~ ~he lo~e ~a. ~n~Y Five ~ ~nb~ix (25 ~ 2~ on a oe~a~ ~p entitled "~p of P~F of ~one R~I~F Co~ ~ion, O~cho~ ~ Yo~m Se~%~on 1" ~%e~ ~ole~er 12~hm 1930 and filed ~ ~he offioe of ~he 01e~ of ~ Oo~by of S~fo~ on ~ce~er ~, 1930 as ~ by %he ~p No~ 539. T~O~TH~R with a fr~e an~ tmobstruoted right of ~y over ~d ~n rlee~od an~le or ~hiclee tO ri~t and pri~le~s of ~ for ~t~_p~nea t~t ~ of the beach at ~t C~ ~ek l~ee ~terA~ ~ a ~int ~ed y a ce~ b~h ~ on ~id b~e~ ~ ~ of ~F to the ~e of ~id bsa ~o be to ~ ~i~ ~ t~ see~ ~ t~ir ~nteea, lessees, euccesso~ and TOOET~ wi$h ~he ri~h~ to ~he use of the right of ~7 EUGENE ~RSEK as showm om ~ap ot Fleetwood Oove a~ Ou~chogue, 3uffolk County, N,Z, dated April 1998, t~I3 fro WAT~, L,S, OZS~ER BAT, SUBJECT to any state of facts an accurate survey may she The Seller will provide a Certificate of Occupancy from the Southold Town Building Department for the garage, which is presently on the premises. Approved ........................................ , 1'9'. ....... Permit No .................... D, pproved APPLICATION FOP. BUILDING PERMIT ........ ................................... INSTRUCTIONS o. 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 a detailed description of layout of property must be drawn on the diagram which is p~rt 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 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 oil applicable laws, ordinances, J~i~ding code, housing code,,and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) ~' I I -? (~ ~'- /~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................... .~..~..~.~....~.......~.....6~,.../,~.e..~. ............................................................................... ,....., ....... Name of owner of prem,ses .............. : ..................... .~.......~.......~ ................................ .~-....~-'.. ............... ~-....~.= ...................... If applicant is a corporate, signature of duly authorized officer. ......... .~~~.~~~~~.~~~~~~.~~~~~~~~~~~~~~~~~~~~~~~~.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~(Name and title of corporate officer) ~. ,ocation of ~and on which proposed work w," be done. ~op No.: ......... at ~a' ~.~..~..~... Street and Number ...... ~..~.....~..!../....~..~.....~.......~....~...~... ...................................... ...~......t~....~.//~..~..M...~. ............... 7~ ~' '~ ~ ~ 0 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................. ...~... D.....~....~.... ................................................................... 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 ...... ~, . . .~ ................... e ........................................................................................... (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 ..................................... ~ ................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............. ~i.. Rear ..................... i ......... Depth Height .............. ~ ..... Number of Stories ~ Dimensions of some structure with alterations or additions: Front ................. ~ ............. ~eQr ......... ~ .......... Depth .............................. Height ......... ~ ............ Number of Stories ........... ~; ................ 8. Dimensions of entire new construction: Front ...... ~.~.~ ..................... Rear ........~.~.~ ......... Depth ;...:~..~ ............ Height ...... ~.~ .........Number of Stories .............. O ....... ~ .............................................. ~ ............................................ 9. Size of lot: Front .......... Z,,~,.~,~ ..... Rear .............~...~..~..L ......... Depth .......... Z...~. .......... 10. Dote of Purchase ..... ~,..~.,.~7..(.~.~.. .......... Name of Former Owner ...~..~..~.~.~.J~,.:~./~[./C.~..~ .... 11. Zone or use district in which premises are situated ............................ ~. .................................................................. 12. Does proposed construction violate any zonieg Iow, ordinance or regulation? ................. ~.~ ................................. 13. Name of Owner of p ................................................ I .... t .......................................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ................................ t.. Phone No ..................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing er proposed, and indicate all set-~ck dimensions from property lines. Give street and block number or description according to deed, and show street names whether interior or corner lot. STATE OF NEW YORK, ~ c c C.?T or-- -- .......... .~..,~:~......Y...~..'~..~,'"~" ........................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ........................... ~~.~......~....~ ................................................. ! ............ (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 ore 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 bef~ore me thi~-~ ........ day of ................. £ -/,,'...(/. fL,. t"' Notary Publi,,~,//[~,~ ....... ..~...-.../.(,~~_/f---~ ,C, ounty (Signature of applicant) 3WNER / / 4t :ORMER OWNER ;7) / .-.x STREET N S Vt LLAG E W I~[CO~D CARD DISTRICT SUB. ACREAGE TYPE OF BUILDING LAND IMP. TOTAL DATE, REMARKS ~)~/~x ~ AGE ~ 0t~ BUILDING CONDITIC~ . NEW NO~AL BELOW ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD / /~ ~. "~'~-) .......... .x ~ ~A'2~~m~ /~c'~ ~,.~'-C/, illable Hlable 3 Foodland wampland rushiand 'otal