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Home My WebLink About5284-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy THIS CERTIFIES that the building located at . .l~Ob~.~;. R.a~l~ ............. Street Map No.F0..~-de~.. e.z~51~4ck No...xx. ....... Lot No. ~ .... .~O..~.tJ~o.l.d. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... l/~y. ~ ....... , 192!.. pursuant to which Building Permit No..~.2..~..Z.. dated ....... l/ay..~.~ ........ , 19 F.~., 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 . .l~.v~;e. O~e./'~_~Y...dWe~...~ ........................... The certificate is issued to ...T, .E.*...~..3-.d.e.~z'...alAd.. ...... .o..~.$.~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .1[o~, .............................. UNDERWRITERS CERTIFICATE No. P~N]DIN~ HOUSE NUMBER..2.be3~. ...... Street .... 1~.O..b.~...~...~.O.~.d: ................................ ................................................ ~outho~d ....................... Building Inspector FO~ NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 525 Z Permission is hereby granted to: .A,..~..&..~....~....A/g.....~,,..~4eb~em~ to .~ut l~...~..ll~(j~t,tQ~..f~..ll3r~Ll~,~13~;..jV.~l;~l~ ............................................................. at premises located at ........~t~..~....~l~l..~t~.t~ .......................................................... ....................................... ile~l~--~mt .............. :'goG'd~.4 .......................................................... pursuon( to application dated .............................. ~ ..........~ ........... , 19..~1.., and approved by the Building Inspector. Fee $,.~..(')~ ............ · ~ Building Inspector Approved ... q , 19 ........ Pemit No ..................................... TOWN OF soUTHoLD '~ BUILDING DEPARTMENT '~ TOWN CLERK'S OFFICE .~ SOUTHOLD, ,. Y. ~ Application No ................................ Disapproved a/c .. APPLICATION FOR BUILDING PERMIT Date ......................... ~. .......2......, 19.....~..1... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building~'~, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperW must be drawn on the diagram which is part of this application._,~ c. The work covered by this appl cat on may not be commenced before issuance of Building Permit d. Upa approval of th~s apphcat~on, the Building Inspector will issue a Building Permit to the applicant. Such perm shall be kept on the prem ses 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 Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable 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, ordi nances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) Mattituck State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................... ................................................................................ i ................................................................ Name of owner of premises ....~]~J.~$,e]:~azz~ ............................................................................................................ 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. Map No.: ....~'.tll~l~.¢l.~,,~,%.~ff..~&~.ot No ........ ..~..Q ........... Street and Number ......... JJeb&z.t..~.eal~....~o..ff..~ztzt,(Le.z.s...l~a.:l;}:l. ......... ~.e~;J:LJk~.al .......................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... d,we.'l.~,,,%r~ ....................................................................................................... b. Intended use and occupancy ............. ~ume...~:Lth..~dd.:i..t:Lom .............................................................. 3. Nature of work (check which applicable): New Building .................. Addition ......~ .......Alteration ~ ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..........~00. .......................................... Fee ....~,0~ ............................................................................ (to be paid on filing this application) 5. If dwelling, 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 .................... ..8. ............. Rear .....8.. ..................... Depth ....1...0. ................ Height .................... Number of Stories .................................................................................................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated cae CltSt; 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~ ............................... 13. Name of Owner of premises ~.~..TTJ.].cl. eh:~aZl~ ........ Address ....,q~tthe3.Cl .................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .. A,...]~IgL3~I,)'. ........................... Address ............................................ Phone No ..................... Locate clearly and distinctly all buildings, wheth~ property lines. Give street and block number or d~ whether interior or corner lot. PLOT DIAGRAM STATE OF NEW~_ YORK. ~, . COUNTY OF ..~.~,,~,~.1~ ............. ~'a'a ................. ;'~ ........... 7'"':'""~e"'~t~ ...................... ~ing duly ~m, d~s and says t~t he is the Ppplicant t~ame ot indivi~r~~ion) above named. He is the ....................... ~.~..~g~.~ .............................. ~ ........................................................................... (~ntmctor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authoriz~ to perform or h~e perfo~ed the ~id work and to ~ke and file this application; that all statements contained in this applic~ion am tree to the be~ of his knowledge and belief; and thor the work will be performed in the manner set fo~h in the ~plic~i~ fJl~ ther~ith. Swam to before me this .................. ~.... dqy o ............ ~m~,~....: ..........., 19....~ ~ _ . ~ ~, ~ . _ / I ' q I .......... .............................. Nma~ Publ,c, ~.~.... Coun~ ~1~ (Signa~re of oppli~t) // .._ ELIZABETH N