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Home My WebLink About5112-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT To~ Clerk's Office $outhold, N. Y. Certificate Of Occupancy No~. ~227 ...... Date ............ API'.~.!.. ~ ..... , 19.7.~. THIS CERTIFIES that the building located at ... Centex,. 1~% ............. Street Map No..xx ......... Block No .... Xx ..... Lot No ...... xx ....l~a.ttttuck ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Dee -. 2~ ..... , 19 70- pursuant to which Building Permit No..~[11 ~Z.. dated .......... ~eC...29 .... , 19. ?0., 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 ...... Pr~,v&te. accessory..bu~ldLu~. (s.teraf~ .bld~} ................. The certificate is issued to .., Rtchard, .J4a~;hevs ......... ~f~eF. ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Rouse f~ 200 Building Inspector FOI~M NO. 2 TOWN OF SO~TSOLD 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? 511~ Z Permission is hereby granted to: , ............. ~~...~,:...~~.~. .................... ......................... ~:eate~t..l~. ................................ ................ l~;4~:t,taaellS ............. ~. ............................ to ...... ~...~.. ~..e..e.~...~..~....( ..s.~.. )....~.z..a.. ~.~ ........................................................ at premises located at .......... ~..~lllTl~.t~a~...~.~ .................................................................................. .......................................................... .~.~la~l~ ....... ~:~.~ ........................ : ...................................... pursu~n.t to opplicotion dotted ............................. .~ .........~ ........ , 19..~.., and approved by the Building InspectOr. ~e~ ~..~..-...~... ............ TOWN OF ~ouTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .m,ned ......... ...... Approved . .. it . , 19...'.!... Permit ...... Disapproved a/c ............................................................. r' Application No. ~-/ ! ~ APPLICATION FOR BUILDING PIRMrT ~, Date ....... ~(.~--. ~/iCZ~.......~...~.3 ........... , 19Z~., ....... INSTRUCTIONS ~- a. This application must be completely filled in by typewriter or in ink und submitted In d~plicate to the Building/t Inspector. b. Plot plan showing location of lot and of bu_ildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram whlch is part of thio 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 t~.roughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pUmuQnt to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ond other appllceble 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. (Signature cf applicant, or name, If a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... .......................................................................................................................................................................... Name of owner of premises ....L.I!.~/.II2f.C~...../..,..../.~/.~F. t4..g..?.. ........................................................................................... If applicant Is a corporate, signature of duly authorized officer. (Name and title'of corporate officer) . I. Loc~.tLonof and on wh ch proposed work w bedone MapNo.: ................................... LotNo' . .... 7F - .DoO ..................... Street and Number ..'.C. CZ'J~/.~.........~....~.C~....~..~.. ......................................... ~.(2~'~/. ~./~.~. .................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: .:. ............. a. Existing use and occupancy ...... ~ , ~ ................. b. Intended use and occupant-, ...~.0.(~.~.......-~.../'2~...:......./~...O........O~..~...~Z2~/,,/. ............................................. 3. Nature of work (check which applicable): New Building .................. Addition ................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost ..... ..~...~.~..,..o...o. .................................... Fee .....~'....,~'.....o....O. .................................................................... (to be paid on fi:lng this application) 5. If dwelling, number of dwelling units ........................... Number of dwelling units on each floor .......................... If garage, number of cars ............................................................................................................................................ 6. If busine~, commercial or mixed occupancy, Sl~bci~ nature and extent of each type of 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 ........ /.~. ....................... Rear ...... /...O....'. ............ Depth .../....~. ................ Height ...... ~:~../. ....... Number of Stories ...... ~. ............................................................................................................. 9. Size of lot: Front ...... ~ .................. Rear ....~..O~...~. ...................... Depth ....~..'~....~ .................... 10. Date of Purchase ..... ~...~/~...:.~.~.. ............................ Nome of Former Owner 7~',5~.!~-...(~2U~. .......................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..,.~...O. ................................................. 13. Name of Owner of premises ~;~c~l....F.:../~l/Ja~U~kddress~c~'/?~...~.~......~aZ~z/,Z/~.~C... Phone No.~..?..~.....~....'.).(e.. Name of Architect .............~.~_Z1..~.. ............................ Address ............................................ Phone No ..................... Name of Contractor ........... ~).~)../?..~.. ............................ Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indica~'e whether interior or corner lot. Qe'~TI[ g, LOT STATE OF N L:~OJ~ ! S~ COUNTY OF ~ ............. ~' ................. ~J'~..~..~...~......~ ............................. .~eing duly sworn, deposes and says that he iS the applicant (Name of individ6al signing application) above named. He is the ...................... ,~-f~ZP,~,,~.;,~. ............................................... ' ......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 ti,at the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .......................c~. day of .....~ .............. , 19 ........ ?o ,~ ,,..,,,~..~ ~,..-,--./ I1. ff k ......................................... Natal/Publi~k,~~ ........ Countu~ (Signature of applicant) N~. 52.8J2~850, Suffolk Catty. Term Expires March 30,