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Home My WebLink About5023-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy THIS CERTIFIES that the building located at . Llttla .Pecanlc. t~¥. ~. Street Map No...Na.z.,. P.I;.,.. Block No ........... Lot No.. 2b. 1. &..pt2.~2...Cu.t.e. hog~e.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ 0c~; .....?., 19.. ?0 pursuant to which Building Permit No .... dated ......... .0.q .t ..... 2.3,.., 19.7.0., 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 ....P.r.$ .v.a.~.e...ag.c.e' s..spry...b.u.~.]:.d. ~. n.g ..... .( .aLit. py.e.d...by..~...Ap.p.e..a.l.a). .... The certificate is issued to ... &t.e.~hen .6. L:tnda. Ilartman ..... 0wner~ .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...~.¢:)~.'. ............................ UNDERWRITERS CERTIFICATE No .... ~:R.., ......................................... HOUSE N UM B [~ R....7~0 ...... Street .... Ll.ttle. P. econic. ~ay..k~oad ................. Building Inspector FOE~ NO. :~ TOWN OF SOUTHOLD I~UILDING 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) N9 5023 Z Permission is hereby granted to: ............. ~.~.~k~m~...[~.'.~.~.~m~ ............ ~ ................. ot premises located at ............... ~+~..~,~'.l*.-~,.~)~.....~Jl~t.~.~ ............................................... ;.*. --~ ............................................. ~t~-e:l,.-.~e,~t~ ~- ~ - · ~r~el~ . ......... pursuan~r to opplicotion dated ................... ~0~ ......... .~ ................ !~...., 19..J~'.O~ and appro¥oi:t by the Building Inspector. Fee $'"'~'a'"O0' .......... FOR~ NO. 1 o, soUT.oLD ! BUILDING DEPARTMENT TOWN CLERK'S OFFICE: SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT ~ Date . Oc..~....~. , 19,.~,0 INSTRUCTIONS g~ This application must be completely filled in by typewriter or in Ink and submitted in duplicate to the Buildin Inspector. b. Plot plan showing location of lot and of buildings On premises, relaiionship 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 thi~ application.~ c. The work covered by this application may not be commenced be,o~'e issuance:of Building Permit. d Upon approval of this application, the Building inspector wdl issue o 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 who{ever until a Certificate of Occupan 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.5~) Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows Ordinances or~, Regulations, for the construction of buildings, additions or alterations, attar remove] or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. Stephen Hartman (SignatUre cf applicant, or name, f a corpo~at on) Little Peconic Bay Rd CutchoEue (Address of appllca,~t) State whether applicant is owner, lessee, agent, architect, en.aineer, gener01 contractor, electrician, plumber or builder. .......................................................... Q3,~'~{9 :~. ........................................................................................................................... Name of owner of premises .....S,~..e.~3.~..e.~....~.....~.~d.~.....~.~...~..~.~.~. ................ If applicant is a corporate, signature of duly authorized officer. ' ~ (Name and title 'of corporate officer) ..~ .......... ~. ................ o~t No .......................... 1. Location of land on which proposed work will be done. Map No.: ~N~?9,.~ 9. iht Pr . 241 &:242 Street and Number S/~ ~;~tt~.e. PecQ.~..~.~ ~.a,~, ,~...o.~ .~,.,~..s.~..~..~.. ~.t~ ...C.~.~.c.~,o.~u.e.,.. .Municipality 2.State existing use and occupancy of premises and intended use a~d occupancy of proposed construction: a. Existing use and occupancy .............. ~.~.~.~.~.~, .................... i ............................................................................ b. intended use and occup~an;:, ~.~.~.~.....~.~'~.~{3~.~$.Q~y.~1~`~L~..3`~`~.1~.~C:.~.~..~ ........... & [~· l' .: New Building ...~7~. ........ Addihon .... . ........... Alterahor~ ............. Nature of wo~k (check w~cl~ app Ic~ble) Repair .................. Remove! .................Demolition .................. Other Work (Describe) ................................ 4. Estimated Cost ........................................................... Fee ................................................................................... (to be paid on fi',ing this application) 5. 1.~ dwelling, number of dwelling umts ....... ~t0~,f~ ........... Number of dwelling units on each floor ................... If garage, number of cars ............................................................................................................................................ 6. If business, comme~ctal or mixed occupancy, specify nature and extent of each type of use .... AC.O.G.8.:~O~.~'... 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 .......... .1.0 ..................... Rear ......... 1.0. .............. Depth ...... ~..1. .............. Height .................... Number of Stories ...................................... ~.e ........................................................................ ~2. Size of lot: Front .......... .1.~.~ ........ Rear ........... ]~.'E .............. Depth ....... 10. Date of Purchase ......................................... ~ .............. Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated ..... !!~.~]...~t,,~j~.~. ........................................................................... 12. Does proposed construct;on violate any zoning law, ordinance or regulation? ............ .~e~, ........................................ i3. Name of Owner of premises ~.~.....~..~.Z~.m..~.~.. ............. Address ....g..q.t..9..b-...O.g.~...e. .................. Phone No.: .................... Name of Architect ...................................................... 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 indico'i'e whether interior or corner Jot. /1 STATE OF NEW,~YORK. ! ~ ¢ CO[JNTY OF ..~.l~.~...~.p~ ............. ................................. ,~.l~,~a~..}[~.~l~&l~. ........................... being duly sworn, deposes and says that he is the applicant (Nome of ~ndividuol signing application) · above named. He is the ....................... ~'~/~G~'. ..... .~t~I,~.~,G~. ............................................................................................ (Coritroctor, 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. Sworn to before me this 19 ~.0 ~-'---'~ .................. .~.... day of ........... ~.0.~..~ .................... ..... ,.... . .................... NOTARY PUBLIC, Stele of Naw York No. §2-8]25850, Stlffolk Cou,gj~y,a` Term Expires Match 30, 19,~