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Home My WebLink About5408-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No./'~.~.09 ....... Date ........... De.~... 28 ....... , 19~... THIS CERTIFIES that the building located at . COx. l~eck. Rd .&. Medal,. Ay Street Map No. Toll,~ood. Block No ........... Lot No]P.~..."~.. ~.~.. I[~t..t~..~.~.Ok...~ ~.~,... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. July...1~19 .71. pursuant to which Building Permit No. dated ......... .J..u~y .... !5..., 19.7.1., 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 .. Pr. ivata .one..fam~y. dW. ell~ng ...................................... The certificate is issued to . .14i. l iam JSo$cnla ..... O~a~er. ......................... (owner, lessee or tenant) ofthe afores~d building. Suffolk County Departmentof Health Approval House ~ 2220 Cox Neck ~0 ~eday .N~R.: .............................. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5408 Z Permission is hereby granted to: · ~t,a~l,eX...~....~..l~a,..ileN~l~ ...... ............. Matt:tt~k ............................................ ................................................... I~,t~lJlii ....... 1.1[~ ....................................................................... pursua:n$ to application dated ........................ ~'li~ ........ ~6 ............. , 19..~J.., and approved by the Building Inspector. ,Fee $..~'.~J~J ............ Building 'lhspector / IPO*B~f ' NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥o ~Ynmin~,l . ~ / ~ "~/ ............ 19.....'.. Approved ........................................ , 19 ........ Permit No ............................. Application No. ~'~'~ Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PERMI'r ,'~ Date ........ ~....../....~. ......................... , 19.~..[........ .... ~'~ INSTRUCTIONS Ct a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin-'g~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationshil~ to adioinir~ premises or Public streets or areas, and giving a detailed description of layout of property must be drawn on th~diagr~m which is part of ~his applicatio~zl,/A. 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 permitX shall be kept on the premises available for ir~pection 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 Ordin~ of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for th· ~truction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinance~ building code, housing code, and regulations. (Address of al:~licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....~..~....~h~~ ............................................................... 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~.....~...t~../~,.~k.~..../~..~r...~..~.~. ...... '~..4~..t: '- -- c. '" 2. State existing use an~l occupancy of Premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~.....~..~....~..[~..~... ........ ~..~..~.~...(..~l&.(~. ...................................... b. Intended use and occupanc,,'. ..................... ~..~..~IL~,.. ................................................................................ ~ 3. Nature of work (check which applicable): New Building ~ ................. Addition ....~... .......... Alteration .................. Repair ............ .~.;~. Removal .................. Demolition .................. Other Work (Describe) .................. i ..................... 4. Est mated Cost ...[./~....~.~1. ................................. Fee (to be paid on fiffng 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 ..... ...,~.....~L.. ............... Depth .....~:...~. ........ Height ........................ Number of Stories .................. /.. ........................................................................................... Dimensions of same structure with alterations or additions: Front ....,~..~......~.. ................... Rear .5 - 3 - Depth .....,.~,..~-.. ................. Height ............................ Number of Stories ............. ./. ................ 8. Dimensions of entire new construction: Front ............ /.~ ................. Rear ......... /....~'.. ........... Depth ........................ Height .................... Number of Stories ..................................................................................................... 9. Size of lot: Front ...... ./.J...~. .......... Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ! 1. Zone or use district in v, hich premises are sJtua;ced ..................................................................................................... 12. Does preposed construction violate ~l~y zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises JA/,~l..'..I/.C~.~,~..~...LA....Address .J~~.f,/.~.,~ ...... Phone Nc~..~.~...'.~...~. Name of Architect ...................................................... Address ............................................ Phone No ..................... ............................................ Phone Name of 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 N~, .................. ;~;~;.:...::..;.~...;.....~.:.:,~,. ........................ bein~¢[ll~lly, j~qr.n, cle~oses aj~cJ says that he is the applicon! IINarr~ of individual signing j~li~atippJ~ ~ ~ , above named. He is the .................~..~. .............. ~..~.~.~...'.:......-T:~...?/,~..~ ................................... (Cont~L~or, agen~coq>orate officer, etc.) of said owner or owners, and i.s ~l~y~ autbor, iz.~, to perf~rr~ 'gr I'~g~l~ I~lrfor~ed the said work and to make and file this application; that all s~atefmlnt* ~on~in~cl ~n this al~pllecJti~h'art~tr~e tO the best of his knowledge and belief; and that the work will be perfOrmed in the manner set forth in the application filed therov~ith. Swam to before me this /~ ,, , --~- .' e // ............... Nota Pub,c,. ................................ ......... .....................