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Home My WebLink About4443-zFORM NO. 4 TOWN OF SOUTHOLD BI. III.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate Of Occupancy No..Z..3652. .... Date .............. liov....6 ..... , 19.69. THIS CERTIFIES that the building located at . .8/$. Joek~lr .Creek. DZ.. Street Map No .... x~ ...... Block No.. acc ...... Lot No. ~cx... ~nutho3.d.. K,~ · ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... S~pt ..... 2.., 19 -69. pursuant to which Building Permit No..l+.~.lt~,... dated ............. ~e.~t..2,., 19.69., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this eertificate is ' issued is .... P.~iva.te. swtar, in§ .l~Oal · (ac~lssoz~} ............................ The certificate is issued to . .~itt. i~m. Rusch. &. -~,~ife · .. 0~era ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ lt,l~· ....................... Mouse f 980 FOR. M 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? 4 43 Z Permission is hereby granted to: A, ..~zeZ. tenbaek..,,'~.... A/~.....en..luseh ..... at premises located at ...~.,.~fdl~...~ll.~r~.~J,Ttl. ................................................................. ............................................................... ~mat, lml~ ...... ~.L ............................................................. pursuon¢ to application dated ....................... ~1~.'~ .......... ~ ................ , 19..~.., and approved by the Building Inspector. TOWN Of SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLiD, N. Y. Examined L~. Approved ........................................ , ............................ ~ Application No. L..I f~ Lt .~ Disapproved a/c ...................................................................... APPLICATION FOR BUILDING PERM~ ...... ....... .............. ............... 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 a detailed description of layout of property must be drawn on the diagram which is port 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 ir~ection 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 Bu Iding Perm t 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 demo t on, as here n described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Addr~ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, p umber or builder If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land an wh ch pF:~aosed work wilJ be done Map No · . ~ ,, Lot No .. . Number Street and f~' ....... ;;~" "'~:'"s~'~'- '-/" '~- ~' ................... ,,~,,~. ~...~ ......~ .................................... o. Existing ~e and ~cu~y .............. ~._ r_~. ~ ~ ~ . ~~~~'~ ...................... K ............ '~ ............ ~ ................... ~ ........... ......... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................. Other Work (Describe~ .~...~..~ 4. Estimated Cost ........... ~.~......~e...,...~..e~ ......................... Fee .......................................................................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelHng units on each floor ............................ If garage, number of cars ..................... ; ............ ~. .......................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or addition, s: Front .................................... Rear ............................ Depth ................................Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... ~ar .....:,. .................... Depth ........................ Height .................... Number of Stories .............. /.~...~.~.~.........~...~ .................................................... 9. Size of lot: Front ........ ./..~....~.. ....... Rear ....... ./..~....~- ................. Depth ......~....~.....~.. ............... 10. Date of Purchase ........................................................ Name o~ F~_~Owner ........................................................ 11. Zone or use district in which premises ore ~ltuoted ............ ,J~ ........ ~ ........................................................................ 12. Does proposed construction violate a.ny zon~g law, .ordinanceJ ,arr regu~lation? ... ._. ;~.~. ........................................ 13. Name of Owner of premises .~...~m~..../~--~-~..Address~ll~.~,<~r..~ Phone No ..................... Name of Architect,~, ~_~ "0,~:^ /'~,~_ ~ ,./~ ....... Address ~~' [J, ........... .v. ....... i .................... Phone No.N° ..................... Name of ContraCto~,,~e,,cs~,...~.F;.r~ddress ~~..~.'~.:f~j Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indi,cote 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 Y(~IRK, · COUNTY OF .~,,~.....J' '' ....... ~~....~.~...being duly sworn, deposes and says that he is the applicant - (Name~f individual signing a pplic~~ ~/~ff~. above named. He is the .............................. ~,,~..~....~...~..w~.~.~,,~..~ ........ J ................................. ' ....... ; ........................ (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. Swam to befa~'e me this .... of % l ,, ~m[ ~'a¥~[...,t..~.~12~,,r~ ............... ~..: ..................... · I¢0tary Publi [ Ne i n tur f Ii ant Notary Pubhc, · (Sg a e o app c ) _ ........ /') /J /) /-.,.~J ~" -,,. - - No. 52-$041000