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Home My WebLink About4423-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No...~..~.. ..... Date ............... ~.~...~...., 19..?~ THIS CERTIFIES that the building located at C~O~. l~ek. lkl .&. Ii, calco&teStier Map No..l~ ........ Block No...:l~ ..... Lot No.. v?. I~tt~tu~k .... lq,~, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... A~...¶8 .... , 19.~. pursuant to which Building Permit No.l~ .. dated ........... A.~...~..8 .... , 19~).., 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 ...A.~.~e~.Q~. ~[d. 1.~lqll. ~M~ .t4nltil Xe. l esld.ence, hu$1 lng. The certificate is issued to . .¥el~.sal. Hold~g. Col, p .... O~el'. .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~.~R. ~ ............................ Hou~e ~ 2~0 breakwater Rd ,~ ^ .( ~-~'~-' Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER. tm (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4423 Z Permission is hereby granted to: at premises located at .................. ~JlI~W..~..~..~l[..~l~r~.....~.~..~ ................ pursuing' to ~:~pli¢otion doted ........................ ~ ............................. , 19 ...~..., and ~ppro¥~:t by the Building Inspector. Fee $...~. .................. / 'ro~N m ~OUT.OLD ~"~ ............. ........... , ........ . pp .~ ................................................. ; ....... +~ .................................................................................................................. ~~ - u D.'~C O. . APPLICATION FOR BUILDIH~ PE~I~ ' ~. Plot ~lon s~owin9 I~otion of lot ond of buiMinos ~ premiss, ~lofi~8~J~ fo o~oinin oreos, ~ oiYJnO ~ ~foi~ed ~scri~io~ of I~ o~ p~ m~ ~ ~n an the ~ w~ic~ c. ~e work covered ~ this op~l~fion ~o~ ~ ~ c~enc~ ~fore i~ce ~. O~on ppprovol of th~s applicoti~, ~ BuiMing Ins~or will i~ue ~ BuiMJng Permi~ s~ol~ ~e~f o~the ~i~s o~iloMe for im~i~ th~uO~ ~e p~r~ of the ~. e. ~ build~9 s~ll ~ ~cupi~ or u~ in ~ole or in pa~ for any pu~e whatever until a ~c~c~ shall h~e been ~anted by the Building Ink,tar. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bud ng Perm t leursuant to thee ~Build!ng ~lOne. Or.dinance of the Town of Southold, Suffolk Count~, New York, and other appliCable Laws, O~inances or Kegulotions, tar me 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~ h~u~ng ,code~,~ond regulbtio~ns. (Signature of applicant, or nan~li~ration) Cox Neck Rd & Brea~ater Rd ~attituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plurr~er or builder. If applicant is a corporate, signature of duly authorized officer. ,~. (Name and title of corporate officer) 1: Locahon of land on which propoeed work will be done. Map No.: .......... ~ ......................... Lot No.: 2. State existing use and occupancy of premises and intended-use and 'occupancy of proposed Construction: b. Intendiuse and occupancy same with an addessory building ir 3. Nature of work (check which applicable): New Building .................. Addition 3aCIE~ Altel~tion 3rgT · Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ............................................................ Fee ~*00 (to be paid on filing this application) 5. If dwelling, number of dwelling units .....t,~.ee ............ Number of dwelling units on each floor ............................ If garage, number of cars ................................................................................................................... , ....................... 6. If Husine~, commercial or mi×ed occulxmcy, ~:if~ nature and extent of each type o?~ .................... 7. Dimensions of existing structures, if any: Front ............................ R~r ................................ D~th .................... Height ........................ Numl:~r of Stories ................................................................................................................. Dimensions of same struatur~ with afferations or additions: Front .................................... Rear ............................ ~th ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... .~,0 ...................... R~or ..... ~.Q .................. D~th ....... ~ Height .................... Number of Stories ........ olle ....................................................................................................... 9. Size of lot: Front ............................ Rear .................................... D~pth ................................ 10. Date of Purchase c ....................................................... IN~m~e of Former Owner .................................................. ~[ 1 1. Zone or use district in which premises are situated ....... ."..~..~...~..~..t:}. .......................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation.;) ........... ~qn .......................................... 13. Nome of Owner of premises ..1~.e3:a&~..~Jol~lzl~..g~T-4Jess ........ .~,..~..~;t...~.~..~.~. .............. Phone No. ~: ................ Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ......... .s....a~...e. .................................. Address ............................................ Phone No. ~ ................. PLOT DIAGRAM O Locate clearlyj~Ld distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Gj~lleet and block number or description according to deed, and shaw street names and indicate whether interior ~ lot. STATE OF NEW,,YQI~K. t S S COUNTY OF ...~..'~....z...o.'...~... ............ ~' · · ................................................................................................. being duly sworn, deposes and says thot he is the applicant (Name of individual signing application) above named. He is the ................ ~.~J:J,t~...O.~...¢.~l ......................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized' to perform or have performed the said work and to rnoke 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 rnanne~l~t forth in the application filed therewith. Swom to before me this~ ~ ' r/'~ Notary Public,~~..{,~,d'ff~.~'..~RC~r,C~+~l~oa~~ (Signature of applicant} /-/ · NOTARY PUBliC, State f~f Hew'York Term Expares ~h 3,3. ]~