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Home My WebLink About5020-zFOBM NO. 4 TOWN OF SOUTHOLD BUr~.nING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.Z~.8.$.~. ....... Date ............ .~..~.....~. ......., 19~... THIS CERTIFIES that the building located at ][Olmgll. AVe ................ Street Map No...X~. ......... Block No. ~ ....... Lot No.. ~1~ ..... .~.t.t.~.t.~k....N...~.; ..... conforms subStantially to the Application for Building Permit heretofore filed in this office dated ......... .0~..t.....~. .... , 19 ..~.. pursuant to which Building Permit No. ~.~0Z.. dated ............. .0q..t...2.3.., 1~.0..., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...VT.S.v.~..re...s.~.~..~..,, .(.~?.e.s.s.e..~.). ...................................... The certificate is issued to . .F.r...~k...~.~.z.$# ..... . .0~.~' ............................ (owner, lessee or tenant) of the sforesald building. Suffolk County Depsrtment of Health Approval ...~..~. ............................ UNDERWRITERS CERTIFICATE No..~.~...~. · .~. ..... .~.~..~....~.~..~. ............... HOUSE NUMBER . 3~.~ ......... Street .... ~O~ .&~ ......................... FORM NO. ~ TOWN OF SOUTHOLD- BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) N? 5020 Z UNTIL FULL Permission is hereby granted to: at premises located at ............ ;..]~/~..~13e~t~)~l..&~e ............. ;....~ ............... ;4 ...................................... ............................. ~t~ ~ pursuan¢ to application dated ............................. ~ ........ ;~.?...~,.,, 19;.]~ and opprov~ by the ~uildin~ Inspector. ~0~ ~}~e~ ~ ~ ~ , ! BuiJ~ing I,~speCtor 19 ........ Permit No. " TOWN OF souTHoLD SUILDING DEPARTMENT TOWN CLERK'S ~FICE Disapproved a/c .............................................................................................. Application No ............................. APPLICATION FOR SUILDING PERMrI' ~" Date ............................................................ o ............ 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 prlmiee~ or publ c streets or areas, and giving a detailed descriptlc~., of layOUt of property must be drawn an the ~agrom whlch Is part of ~hle application. c. The work covered by this aPp cat 6n may n0tbe cOmmenced before issuarice of Building Permit. d. Upon approval 6f. this application, the Building Inspector will issue a ~.ulldlng 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 us, ed in ,whole or in part for any pu~ose whatever until a 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 Perm t pumuant to the Building Zone Ordinance of the Town of SoUthokl, Suffolk County, New York, and other app cab a Law~, Ordinances or Regulations, for the construc~tion of b, ulldings, additions or alterations, or for removal or demo t an, al herein cle~crlbed. The applicant agrees to comply with all applicable laws, ordinances, building cod,~.,hOusing cede, and regulations. (Signature cf i~a~llcant, oi' name, if a corporation) ........ ................................ ., ......... State whether applicant is owner, lasso, agent, architect, ~ngln~r, general contractor, el~trlclan, plum~r or builder. Name of owner of premises ......... ~ If applicant is a corpor&te, 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.: .......... Strata and Number ........ ~...~ ~ ~ ~f- ~ Munlcl~ll~ ~ 2. State existing u~ and ~cu~ncy of premiss and Intended use a~ ~cupancy of p~ com~l~: ~isting use and ~cupancy ................................................................................................................................... ~te~de u ~ ~ ~ 3. Nature of work (check which applicable): New Building ....~ ........... Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost ....?'.~.,.~.~...O..;..~...~.. ......................... Fee ...~......'...-.'~.... ...................................................................... · . (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 ............................ .... , ~ .~R// 7. D~mens~ons of ex. sting structures, ff any: Front ...~.~......~.. ........... Rear ...~....2........~. .............. Depth ............ Height ...../...~..,: ......... Number of Stories .......... ..~...v~.,..~.. ........................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ ; 10. 11. 12. 13. Depth ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front ......... ............... .Rear ............ Depth ....~...~.....:. ......... Height ...-/..~...~. ...... Number of Stories .......... ..O.....~.....~-_... ............................................................................................ Size at: lot: Front ../..~...~...~. ............ Rear .../...~.~.....~. ................. Depth ..A:(....-..../....7...O....-.......~..../'~' O Date of Purchase .............. ~ ......................................... Name of Former Owner,~......~....O~..~.~..~...(,~.~....~...../. .......... Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation? .~...A~...~. ...... .o...~......~.,A~...~.~....C...'~. .......... Name of Owner of premises .~......5....7-../.~....~'.~-...~'...~...-- -- -- -- ....... Address .~.~.~/..~...~...~'...~Z~..~...u/..~.... Phone No ..................... Nome of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor ~....~..~...~.~.../.../.~.....L~.--.~.~ .............. Address ..~../....~..~-.---....~-,~.~.~.~./~.. .......... Phone N .o~.....~....~....~../~7. PLOT DIAGRAM te cie y and distinctly oll buildings, whether existing or proposed, and indicate all set-back dim ions f rn lines. ~;ive street_g_n_cLJ nnm~ and indicdte ~terJor or corner Jot. pmpert~ whether STATE OF -' COUNTY OF ,g duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) (Name of individual above named. He is ~the ........................ 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 thaz the work will be performed in the manner .~t forth in the applicatio%.filed ther~itl'h Sworn to .b~..~..~.~_e.e me this ~ ~) / ,,~ I/ · doy of ~ , 19 ''~ ~"7//-"_ /~/ V .................... ........... ,>, .......................... THE NEW YORK BOARD OF FIRE,UNDERWRITERS BUREAU OF EL.ECTRICrT~Y ' ~ 85 JOHN STREET, NEW YORK, NEW yORK'10038 F~ank Starzee, ~05 Youngs Ave.j Mattituck, L.I. teas examined [] ~.d r,. Garage, Outside $~tio. s~k and ~oufld to be ~n compliance w[th t~e requirements o~ t~[s B~rd. ~NG~ ~KING DKKS O~NS DISH W~HERS SERVICE DI~N~T ~. ~ S Feeder/s: 1-3~10 base to gar. Panelboa~d/s: 1-1cir. ~PE=IAL RE='PT E TIA~ O. OCKS BELL, ~ MULTI-OUTSET SYSTEMS NO. OF FEET NO. OF CC. COND. A.W.O. PER ,g C~ CC. CGf4D. EXHAUST FANS DIMMERS NO. OF NEUTRALS A* W* G. OF NEUTRAL 325 Youngs Ave. OmUALMANAOn Mat~ltuck, New York 11952 c., '~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.