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Home My WebLink About5008-zFO/tM NO. 4 TOWN OF SOUTHOLD BUILDIiNG DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at W.l. lmar.th-An ............. Street Map No...xx ....... Block No. XX ....... Lot No.. XXX....O.~'e.~B10or.t ..... ]N.,¥, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ 0el, ... ~9, 19.. ?0 pursuant to which Building Permit No..5008Z · dated ........... Oct ..... t9 ' 19.70, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pr. Xvate..e~e..fami.ty .d~elling ....................................... The certificate is issued to .. Jo.$eph. ~)iaz .......... Owner. ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval House # FORM NO. 2 TOWN OF SOOTNOLO BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE;$ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5008 Z Permission is hereby granted to: , Building Inspector, ~:ee $.'..~[,~ ........... and approved by the [/ t- ; Buil~ling'TnspeCtor ~ , IO~M NO, ! TOWN OF souTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...~...../..~F......, 19....~..~ " * 19..~ .... Permit No ........... ........................................ , Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING Fll~l't ~ Date Oct .1.~.... 19..~..0. ~ INSTRUCTIONS -~ a. This application must be completely filled in by typewriter or in ink und submitted Jn duplicate to the Building~ Inspector. ;~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premiaes or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whlch Il part of thle 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 port 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 punmant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable LOwl, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os 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) ................ C~:~empoz-,l~ ........................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................... Ben. t~a~ .'ee ~, ..................................................................................................................... Name of owner of premises ..... J. osaph.~a~ .................................................................................................................... tf applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which pmpc)sed work will be dane. Map No.: ........................................ Lot No.: ....................... Street and Number ..... .lt~....~:L~l~l::~h..JLYe .......... g~,ee.l~r,t. .......................................................................... '~ /_/,~ Municipality 2. State exlstlng use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ I~l~,],~L,qg. ....................................................................................................... b. Intended use and occupan:', . .......... ~l~Le...WJ.1;h..B.~..&d(t::L:k~Ol~ ................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .,1~[. ........... Alteration .~[. ....... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Esti.~.ated Cost ....................... .1..t..O..O...O.o.~ .................... Fee ....... ~.,00 ....................................................................... (to be paid on fi~ing this application) 5. If dwelllng, number of dwelling units ........ ~.~ ............. Number of dwelling 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 same structure with alterations or additions: Front .................................... Rear ........................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................ ~ ....... [ .......... Rear ....... ~. .................. Depth ..12. .................. Height .................... Number of Stories ..........~.~L~ ...................................................................................................... 9. Size o~: lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... ! 1. Zone or use district in which premises are situated ........ ..~..~..~....~...~.~...~. ....................................................................... 12. Does propc~sed construction vlolote any zoning law, ordinance or regulation.> ............. ~ .......................................... 13. Name of Owner of premises ...~..~....D..~.~. ..................... Address ......... .~'.e.~D. pD.l~,. ............ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ............ .SSJ~e .............................. Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer Jot. STATE OF NEW YORK, ! e.e COUNTY OF ...... :~'~t~,~ ~ ....... ~' ...................................... ~O~13~,..~.~b~. ................................ being duly sworn, deposes and says that he is the applicant (Name of individual'signing application) above named. He is the .............. o~r~l~..ln~ 1 ~.e3:. ................................................. . ......................................................... (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 tha~ the work will be performed in the manner set forth in the appJj, cation filed therewith. Swam to before me this ~ ~ ~ ................ o, .............. ............ . I . _ ), hotor' Publ, /,6~._ /L....,~ /~._ .:~/. '~/J. -..~~-~...~ .... ~ y 'c, ~~U~r/,~'.F..~./~I/-,&~. Counhe]l/~rlg~,~/' (Sig'nat~re of applicant)/ ~ [LIZAe£TN ANN NEVI.t~t: York [J~ ~ - ' ' ~ / NOTARY pUBLIC, State of-Ilew ~ ~A- ~ / / No. 52-8125850, Suffolk Cou~.ty. L,- ~ Term Expires Ma~ch 30, 19,~j~