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Home My WebLink About5363-zFOBM NO. ~ TOWN OF SOUTHOLD BUILr~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy NoZ..~52 ...... Date .............. ]~ov. ..~.0..., 197.~.. THIS CERTIFIES that the building located at H.iawatha .&. Nakom~.s ...... Street Map No..xx ......... Block No.. yacx ..... Lot No .... o~x~: .... So~.thold-..E o~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Jur.~e...18., 19..71 pursuant to which Building Permit No..536~.. dated ............. June.--1 $, 19.. ?$ was issued, and conforms to all of the require- ~e_nts o_~the'~a~plicable provisions of the law. The occupancy for which this certificate is · ~,, .-msual-xs .Prmv~,~ · ~me. f~nit~i' .dweid:ing ....................................... The certificate is issued to . .Leo..Aauch ........ 0w,,er ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Nov... 4i· '~97~' ' .By. H....V~.l.l-a ..... House ~ 10~0 Eakomi$ ~d ~?O Hiawatha ...... /.~ j....... .............. /. ....... ~ 7 o Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMEN'I TOWN CLERK'S OFFICE~ SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 5363 Z Permission is hereby granted to: ...................... ,,~¢~,,, 1.~:~]. ...................................... to ........ '~.~.Z~.. ~; ..~..a '.~a.],h~...~b,~e.~ .~;~ ................. : .......................................................... at premises located at .............. ~,~,~&:~t~...~):)..:~...~J~..~lJ, ............................................... ..................................................... ~,~-~.t,,~o:,L. ~. ...... .~¢ ,~.,, ....................................................................... pursuon,t to application doted ............................. ~.~'11~. ....... .~.~..,i.----, 19.~..1..., and approved by the Building Inspector, Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. P~rmit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. Ohie£ of Ge~erat ~!ne~rfr~ NOV-4 lg71 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 ad oining premises or public streets or,j> areas, ond giving a deto led description of layout ofproperty must be drawn on the diogram which is p~rt of this application.l~ 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 Building Permit pursuant to the Building Zone Ordinance of the Town of South01d, 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, ordinances, building code, housing code, and regulotions. ....(3ignature of '~' :'e-'"o' ' ' "'1~'" '~"'~' ' '~': '~'~'~",'~ ~ ~ ~:' '~-' '~ ~;~',' "~' '~ ' ~ ~,, ~i ........ ?H ~ '--/ Southol~l _l._ ~7,~/-~ ( re;;s';~;~";~ii;;;';;f) ............................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... ..C..e~.l;z.~g.1; .e~. ..................................................................................................................... Name of owner of premises ..... ~f~.~...~13,9.~. ........................ . 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.: ........ ~ ......................... Lot No ....... ~ ........... ..~ Street and Number ....... J:~L~,w'~.~i~,..~..~a,l~,eal~..~cJ ................ ~e~l.~. .................................. 2. S ' ' g ,,u ~u~,~,,~y u. premises ana intenaed use and occupancy of proposed construction: a. Ex(siting use and occupancy ....... .I[.~,.9.{t,T~..,~,e.~. ................................................................................................. ' b. Intended use and occupancy ............ ~.e....~'..~.]~.~....~.~r.~.~.~,~,l'~ ...................................................................... 3. Nature of work (check which applicable): New Building ...~ ........ Addition .................. Alterotion .................. Repair .................. Removal .................. DemOlitio~ .................. Other Work (Describe) ........................................ 4. Estimated Cost ............... .1..~.,~.0...0..0......_.+ ....................... Fee ....~..1...0..~.0.~ ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ .q~,~ ............. 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 ..... 2,~...~,.~ .... Height .................... Number of Stories ..¢1~,~[ ............................................................. 9. Size of lot: Front ....1G(~ ................. Rear ....... 1.20 ...................... Depth ..... ~[.1..~ .................... ~,10. Date of Purchase ........................................................ Nome of Former Owner ........... ~.~C}~It ............................ 11. Zone or, use district in which premises are situated ..... ..~?....C~L~.~ .......................................... 12. Does proposed construction violate ony zoning law, ordinance or regulotion? ............ .~..~.. .......................................... 13. Name of Owner of premises ..~..~...~.1~.q~ .................. Address .......~.~.~.'I;~Q],~I, .................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .............. .~.P,~,~. ............................ Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and iE~icate property lines. Give stre t and block number or description according to dees, ~ld. shew whether interior or corner lot. 0 ] all set-back dimensions from street names and indicate STATE OF NEW' YORK, ~ S S COUNTY OF ......... ~,~'.~;]L~ ...... J' ' ................................................. · [,ee.'~,~t.~ ............................ being duly sworn, d~oses ~nd,seys t~ he is t~ epplioent (Nome of individuul signing o~lication) ebove named. He is the ........................... ~..~e~..~ ~ .............................................................. (~ntmctor, ug~t, co~o~ officer, etc.) of seid ~ner or owners, end is duly uuthorized to perform or h~e pe~o~ed the suid work ~nd to ~ke end file this epplicetion; thet ~11 stotements contoin~ in this ~pplic~ion om t~ the best of his ~ow edge end be el; end thru the work will be performed in the monner set fodh in the ~plic~im ~ the~ith~ Sworn to before me this Nota~ ............... Public,~'~""~ :; .~. ~'~~~~~, 19..~...~~~Coun~ .......... ...... ............................. ~ ELIZABETH kNN NEV~L~ ~ "' · fl0TARY PUBLIC, State of New y~rk No. 52.8t25850, Sutfolk C0g~a Term ~pires Ma~ 30,