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Home My WebLink About3803-zFORM ~0. 4 TOWN OF SOUTHOLD BUXLDING DEPARTMENT TOWN CI~ERK'S OFFICE SOUTI-IOLD, N. Y. EEETIFIOATE OF OOCUPANEY EI:I.s La (PVT) THIS CE~%TIFIES that the building located at . ~/~.. ]3~ew..]~o~d.& .... Street Map No...3~ ...... Block No.. XXX ....... Lof No.33¢X .... 80.Uthol¢%..]~.~Y, .......... conforms substantially to fhe AppHcat~,on for Bufldlng Permit heretofore fi]ed in this office dared ........... M~ ..... ~,2, ,, 19.68 9u,rsuant to which Buildin~ Permit No..36D3.Z. dated ........ ~1' ..... ~ ..... , 19..6~ was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy f. or which this certificate is issued is , .~l'.~va.l~e. olde..F&~il~ -dwel.~.;~g ......................................... The certificate is issued %o .. ~l;~aS. &. C.la~,~e, ,Lal%oeca ......... 0~T~e~$ ........... (owner, lessee or tenant) of the afore.said building. Suffolk County Department of Health App.roval ... ~l.l.y...$~..%~.. b~" ~;. ~'1~1']~ · ' · - Building Inspector{ FORM NO. 2 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? 3803 Z Permission is hereby granted to: ..... .~.t...a..o.....c...o..a.~.~.r.....c..o..~....*.~..~.~..=...~..o~,~ ............ JI~B.~.. ,~lo~.~.e.Z~ .. Axe...~ak m~,~... to .~.z..~ .. ~ ...~....o.~....t. ~..z~...~ ... Lz.~g ................................................................................... at premises located at ..~..~......1~......~.......~....~...~..e...%'......~...a...~.9.....~.....~..-~l, ....................................... ....... .(~e~rO.~ll~...O.,l).~,.~).....~.~tl~l~..~,L .......................................................................... pursua:n¢ to application dated ..................... ~:~.....2~ ..................... , 19.~.., and approved by the Building Inspector. Building Inspector / ~5 ~eseons ~t Elec r.l~i ¢, RI~D, ~es¢onset ~ 'L. I. $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal at ~ facil~ ies for a structure located have been inspected by this department and found to be satisfactory. District District Engineer Di.~pproved a/c .........;~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This opplicotion must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showin~ 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 ~s 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 app. lication, the Bui!ding Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises ovmlable for inspect,on 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 HEREByNLADE to the Building Department for the issuance of a Building Permit pamuant 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, building code, housing code, and regulations. L do Constr. Cor (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................... g.cm,t, ec. o . ................................ ........................................................................................ Name of owner of premises~...3:.:l:..a..a.....&.....C..~'...&.~.z'..~...~]~l.~.C~. ...................................... [ ........................................................ I.f....C~.. :i;:~.... ,..~. ~/~..................'..~ I.~. ~ ~;:~.e.d.. ]~f. ice r' (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .~..*...~.~..I~.~.9.ff~I,...I~.A~).A~ kot No.: ....~.~. ................ Street and Number ..~.~..~......~L~.~l,~..~Ot~.(1......~D. la.~hn'L~. ................................. i .................................................. Municipality 2. State existing use and occupancy of premises and intended us~e and °~Cupdncy of proposed construction: a. Existing use and occupancy .....T. IL~i~...3,~D,d, ................................................................................................... b. Intended use and occupancy .......... .o..~...e.....~...a~....J:..~.~-.....d..~...e.~.~,~g,g ......................................................................... 3. Nature of work (check which applicable): New I~uiiaing ..'.i...:~.... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..~. .................................... 4. Estimated Cost ....~..0..~.0....0~......~.~+ ................................... Fee ..1.;.0..?,0..0.. ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....O...~..e. .................. Number of dwelling units on each floor ............................ If garage, number of cars ...........0~,~ .......................................................... ;; ................ ..; ............................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type ~f 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 .....~..0. ............................ Rear ...... .~.0. ................. Depth ........ ~.~. ........... Height .................... Number of Stories ......... .O.~.? ...................................................................................................... 9. Size of lot: Front ...6,~.-.J~ ............... Rear ......... 1.br.6~ ............... Depth ~,~.../...~,,00 ...... 10. Date of Purchase ...... ~.~]~.~...~-~ ................................. Name of Former Owner ....~T.~..~.~]~,1~D,s~:L ......................... 11. Zone or use district in which premises are situated ...~.~..~...~.~-.0..~ ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ................. nr~ .................................... 13. Name of Owner of premises ...~...~....~....~Q.q.~.O. ............. Address ............................................ Phone No ..................... Name of Architect ~.~..:Le] ..]3~'.OD~S .......................... Address ............................................ Phone No ..................... Name of Contractor ..~.~...~..Q~.~.~...~g~'.~ ........... Address ......~..~.o....~f....O..~...~. ............... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-I:~ck dimensions from property lines. Give street and block number or description according to deed, and show street names an~,~ndicate whether interior or corner lot. F/M~l...~,c,,e~ ~F. ............................... l~Q~.t~..~,.~.~ ......................................... being duly sworn, deposes and says tt~t he is the applicant (Name of individual signing application) above named. He is the ............. ..~..~..s..~....~......~..:..O..~.....C...O.?.~. .................................................................................................... (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' filed therewith. Sworn to before me this ~ do,, of I) -/-- ................ ........... = ...... ................ , ........ . ......... .............................. Notary Public,/..././~L,Y~n~......~..-....../.~.~.... County (Signature of applicant) "- MARON A. REGENT NOTARY PUBLIC, State of New York No. 52-3233120 Suffolk Counl~/ Term Expires I~rCh 30, F1 = MONUMENT ~ = I PJZ~I~, PIPE t. E I"'IAP OF PP-.OPEI2TY SURVEYED FOR ELIAS LA OCCA AT f::OU'F biol.. D TOWN OF ~JOt. JT]-IOLD, N,Y, AS 5UI~VEYE D DEC.5 VAN TIJW L __IL _1%. Front Elevatmon -:FIroor ,Plan ,ri ,/ Ir 7"-?:'-_ Foundation Plan r Elevations & Sections I--J. i-Fi .;