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Home My WebLink About5012-zFORM NO. i TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z.~169 .... Date .............. 14ar~... 12.., 19.7.1. THIS CERTIFIES that the building located at ...I~,..L~g~n..~.~.~ ......... Street Map No... ~ ....... Block No..~ ....... Lot No...~ .... ~.$t~ .............. confoms subst~tially to the Application for Build~g Permit heretofore ffl~ ~ ~s office dat~ ........... 0C~.... ~., 19. ~ p~su~t to which B~lding Pemit No.. ~0~.~. dated ............ 0~.t... ~.~., 19~., was issued, ~d conforms to ~1 of the req~ men~ of the applicable provisio~ of the law. The occupancy for w~ch this ce~fffca~ is issued ~ .. Rriv~te. erie. f~ily, dwel~ ..................................... The certificate is issued to .. G., .Kaat .... ~e~ .................................. (o~er, lessee or ten,t) of the ~ores~d building. Suffolk Cowry Department of He~th Approv~ . N.,R, .............................. ~euse ~ 2~ / '" .... /~B~ding Im~ ........ TOWN OF SOUTHO~D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL Permission is hereby granted to: ~,, .~:L~..~..so~..t~....~/~i.{~...~t~ ............. ~e.t, tJ.~ ...... ~,3:~ .......... .~ ................. to ...... 1ti~ ~..1.~l...~ta.. ~ .t..%&.ol~,-.e~ .. e-~.~., ~.'I.~..~t~e.~-~ ........................................................ at premises located et ................... -I~-,...[.~-~.~01~-.~ ............... ! ......................................................... ........................................................ ~.t,~k..--;B,;~.,~ .......... ; ......................................................... pursuant to application dated ............................... .O~t~ ....... .~........., !9..~0.., (3nd approved by the Building Inspector. Fee $..~e.~ ............ ................. : ........................... ......... Building I~lSPecto~r I /OB,M NO. I OWN OF souT"oLO BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥o " * 19..~ .... Permit No......~....~.../..~..~.. Approved ........................................ , Disapproved a/c .............................................................................................. " APPLICATION FOR BUILDING PERMII' INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premleee or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whlch Is 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 part for any purpose whatever until a Certificate af Occupancy shall have been granted by the Building In~ector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pureuant to the Building Zone Ordinance of the Town of .Southold, Suffolk County, New York, and other applicable I. awl, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal Or demolition0 as heroin d~crlbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. .... ................... '. ........................ (Signature af applicant, or name, If a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................... Can~r. ac.t o~. .................................................................................................................. Name of owner of premises .~...~...~,~.~ ................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) ~ Location of land on which proposed work will be done. Map No.: ..... ~,.~.~. .................. Lot No.: ...................... ~ ~ Street and Number Mattituck N.Y. ............ w.,...Le.t. Kq n.. Awe ......................................................................................................... State existing use and occupancy of premises and intended use and occupancy of proposed comtruction: a. Existing use and occupancy ............. .O.~'.e,],'l'i~ .................................................................................................. b. Intended use and occupon:', . ............... ~.~.eL..~.~'L.~i,~..JiJ~tl::~a~. ............................................................. 3. Nature of work (check which applicable): New Building .................. Addition ....~... ......... Alteration .,~1::1~ ........ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..-? ................................ 4. Estimated Cost ..........2.iJ~O~..:t'. ................................ Fee ..... ~,,QO ......................................................................... (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ...... DIB~ ............... 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, Jf 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 ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear ................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... .n,A,?...rtiLS.t, ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~[~ ............................................... 13. Name of Owner of premises ..fi,..]F~-~:l; ..................... Address ..~l.~;.t,.1.::l;.%l, cir .................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....... ~,^..~e~'..~:..,qol:~ci ...... Address ....... .I~...~.t;...I.~.IA~.}K ............... Phone No .................... PLOT DIAGRAM Locate clearly and distinctly oll 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 indicate whether interior or comer lot. KAsl' STATE OF NEW YORK, t S.S COUNTY OF .~l,~£D.~lr. ............. ~' · .......................................... ~Io;L"~&la,..~,e.t.~[~r. ....... ; ............... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................................ .C..9!~t~:~(LI;J2~. ...................................... .~ ........................................................ (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 before me this .................... ~.c) day of ................... Oc.~ ................ , 19....~0 /'? 'Y'i- ...... .......................... Notary Public, ~~'~~ ...... County~ (Signature-of applicanf ~IOTARY PUBLIC, State of flew york No, 52-8125850, Suffolk Co,~t~ Tm*m Expires March 30,