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Home My WebLink About3631-zFORM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. CERTIFICATE OF OCCUPANCY No...Z. 3~38... Date ...... .~.I~;I..3...4, ............ , 19.6.8. THIS CERTIFIES that the building located at .~.a~/'. ,~.Ve, .................. Street Map No ........... Block No ............. Lot No. ~:C~0c-/U.~.,, ..L: .I.o.:..N:.Y.: ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated Sel~.g... ~..~ .... 19.67. pursuant to which Building Permit No.Z dated ..... Se.P.g~. 2~ ......... , 19 6?.,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 p~iva~:e one £amil~' ~e~.ling The certificate is issued to Claud~ I. IOulb~'ec~t~e (owner, lessee or tenant) of the aforesaid building. ~ ~ ~ Suffolk County Department of Health Approval ................................... ..... ........... ....... 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? 3631 Z DaCe ................... ,,,~.~.~. .................... .~.]*,,., 19.~.~.,. Permission is hereby granted to: . _ ~n~one Outchogue ct premises located at .................................................................. ~ ........................................................ ,u~s..o,~ to opp,¢o,on ~oted ........................... .S.~.L...~! ............. ~ ,~...e..7...~ on, oppro~ed ~y the Building Inspector. Fee $ Building Inspect~ · FORM NO. 1· TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , 19 ........ Permit No ............................. Disapproved o/~~ ............ ]~ ....... ~ ............... .................. ~ (Building Ins~r) ................................ APPLICATION FOR BUILDING PERMIT Application No. '~ ~'~'/ ~ Date Sept 21 67 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 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 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 and regulations. ~ ~ Antone Chituk (Signature of applicant, or name, if a corporation) ~, ,~o~,~,~ utcho ue ............... g ........................................................................ %'~' .......... (Address of applicant) State whether applicant is owner, lessee, agent, erchitect, engineer, general contractor, electrician, plumber or builder. ............................................... .......................................................................................................................... Name of owner of premises ..... g.].:.a..~...~..e.....~..o...~..~...b.r..e.g~.e. ...................................................................................................... If applicant is a corporate, signature of duly authorized officer· (Name and title of corporate officer) 1. Location of land on which proposed work will be done· Map No.: ............. ~.~...~. .................... Lot No.: ....~.. ............. Street and Number ...'.B..a:.~.....A..v.?. .......... ..O..~.~.~.~...o..g.~?. .................................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..d~.fl~L~.$~').~ .............................................................................................................. b. Intended use and occupancy same with add~ 4. 5. 6. 10. 12. 13. koca property whether Natpre of work (check which applicable): New Building .................. Addition ....... ,,~i~:... Alteration Repj~ir .................. Removal .................. Demolition .................. Other Work (Describe) ' ' Estimated Cost ............ .~.~.~lO..~.JJ/[ .......................... Fee ....~.O0 ........... J (to be paid on filing this application) If cjwelling, number of dwelling units ..... OJl.~ ................Number of dwelling units on each floor If g".arage, number of cars If .~usiness, commercial or mixed occupancy, specify nature and extent of each type of use Di~ensions of existing structures, Jf any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories Dimensions/ of same structure with alterations or additions: Front .................................... Rear / Del:jth ................................ Height ............................ Number of Stories ................................ D,~ens.ons of entire new construction: Front ..... .~.~. .......................... Rear '"3'~: .................... Depth .....~...~...J~.. HeiJaht .................... Number of Stories ........ 9~,~l. Size of lot: Front ............................ Rear .................................... Depth ................................ Dot of Purchase ........................................................ Name of Former Owner Zor or use district in which premises ore situated ..............!!&?...~-,~t, Doc proposed construction violate any zoning Iow, ordinance or regulation? .............. No?e of Owner of premises0~J,~M~t,e..~,.*l.l~l~1,1~Address ........ 0~t,e.~g~'ae ............... Phone No. Nol~e of Architect ...................................................... Address ............................................ Phone No, No~e of Contractor ...A~o~e.....C~.'L~LI~ .............. Address ............... ~,lJ..~O~j~l~ .......Phone No. PLOT DIAGRAM ~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions nas. Give street and block number or description according to deed, end show street names and indic :erior or corner lot. q STATE al NEW YORK, Icc COUNTY J OF ............ I At't~O~e gl1~.~.dd~ h~ ~,~ duly sworn, deposes and says that he is the applk .(Name of individual signing application) (Contractor, agent, corporate officer, etc.) of said o~,ner or owners, and is duly authorized to perform or have performed the said work and to make and this appliCation; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ork will be performed in the manner set forth in the application filed therewith. Sworn to I:jefore me this / Notary P~. blic, .£)/~.)£CZz~."~..C~.,.~~ ....... County gnature of applicant) ~lo. 52-3233120 Suffolk b . ,Term Expires Ntarch 30, Lj~L~