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Home My WebLink About4657-zFOKM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIPICATE OF" OCCUPANCY No. Z;3~)1~ ................ Date ....................... ~y ....... ~ ........... , 19...~0 THIS CERTIFIES that the building located et ...... I~//,S--Ca~p..~.~aee~,ib..~ ..................Street Map No..~ ................ Block No. ~ ................. Lot No...-zrJEli.....Y4~.~.:~t~t_~ie ....... N.,.~. .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................... ~'lg~t ....... ~tf...., 19.70.. pursuant to which Building Permit No..~,6~r~.. dated ............................ ~:~h.....~l~......, 19..~, was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ........... · P z"J.~c e'"oz~e" Ts~[~.. '~r~' l'~:t~'l~ ..................................................................................... The certificate is issued to ..... ~8~gZ~tr...~ll/8.Z,(~B..~.~.~.~/~.~,..~i .............................. of the aforesaid building. ~ouse ~ 2700 FOEM NO. ~ TO~VN OF SOUTHOLD 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) Permission is hereby granted to: ~ .......... ...... ~,~...~.: ::.: ....... ........................ · llev..~.f..elh .......................... to ............. b~L~..~.~ ..add~a~..~ ..ma.. e~ttt ~.. 4ve;~.l.~.~ .......................................... of premises located at ...................... ~.~..~Q~I,..~I~.4~ ............................................................. ............................................................... 14a~;.~.tuoll ........................................................................... pursucrr~t to applicotion dated ........................... ~ ...... .~... ........ , 19.....~.., and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. Disapproved a/c ...~.L~ Application No. ~'( (~ 5' 7 ~ APPLICATION FOR BUILDING PERMrI' , Oate ............................... ....... .... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat plan showin.g, location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detaded description of layout of property must be drawn on the diagram which is port of this 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 of Occupancy shall have been granted by.the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Buildi.ng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable 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. Eugene Horton (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................ .~.O~,~:~&~ ~.Or ............................................................................................................. Nome of owner of premises~....E...d..w...a..r...~..~. ................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done Mop No · Lot No ' .... ~,,/. ~7~0 ,.W./.S Camp. mineola Road Mattttuok 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................ ..cl:.~..~.~..~LD.g ............................................................................................... b. Intended use and occupancy ........................ ,same...w:Lth..a~..azid~Lt:Lo~, ..................................................... 3. Nature of work (check which applicable): New Buildiqg .................. Addition ~ ........ Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............. .2t.80F"...+. .......... ~ .................. Fee ....~.. ........................................... J ........................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... O;l~e ............ ,Number of dwelling units on each floor ............................ If garage, number of cars .............. ~....Ce, Z'. .................................................................................................................. 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 ............ .2.3. ................... Rear ..... ..2.~. .................. Depth ....... ..2..~. ............ Height .................... Number of Stories ........ oz~e ....................................................................................................... 9. Size of lot: Front ..........1...~.~. ........... Rear ........ .1.~. ....................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....... !!.A:..!]....~.~..t[;. .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .............. ~'l~ ........................................ 13. Name of Owner of premises ............. ..~..~...~.~.~...~..s.. ......... Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~12g~e..~O~..'l;.O~ .................. Address ....~..e.'N'...~..Ll~..~...9.~.. ............. 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 indicate whether interior or corner lot. STATE OF NEW YORK, ~ ,. ,. COUNTY OF .... ~,.~.~ ~r, .......... J' ~'~' Eugene Horton ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................................... ~O~l:;~r~rC~COT ............................................................................................. (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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................ of ................. ............ , ...... ....................... Notary PublJc,L-A~--~.~..r.~ ...... County~l/r' (Signature of applicant) ~/ EliZABETH ANN NEVILLE NOTARY PUBLIC. State of New Ycek No. 52-8125850, Suffolk County Term Expires March 30, 19,.~_~