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Home My WebLink About5869-z~t~ NO. 4 TOWN OF $OIJTHOLD BU~.r}~IG DEPART~RNT Town Cle~k'~ Office $outhold, N. Y. Certificate Of Occupancy No. -ZT~) ..... Date ............ Feb .... 22 ...... ,19. THIS CERTIFIES that the building located at .... Baa. er. Ave ............. Street Map No. l/att .H~.. Block No ........... Lot No .... I,.~. &l,I, ..... lta~,tituek.. N~o conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... gay... ] 2..., 19. ?2. pursuant to which Building Permit No. dated ......... F~lr ....12 ...., 19.72, 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 . Private..one. ~amll,y .dwell lng. wi. th. an. addition .................. The certificate is issued to ..~lohll. Sal~.~,ckl, .... /hmer ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N,ti, ................................ UNDERWRITERS CERTIFICATE No..pel2dJJl~ ................................... HOUSE NUMBER .... 9~. ...... Street .. ttaYer, tload ..... Mattitnck ............ Building InspeCtor FOB,M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5869 Z ~]'~/'f,- ~ ~ /~- pursuant to application dated ...........................~;.~ .......... r. .......... , 19.K....~., and approved by the Building Inspector. Fee $....~. ................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C,LERK'S OFFICE SOUTHOLD, N. Y. Examin~l ............ , 19 ........ Application Approved ........................................ ,19 ........Pernit No ..................................... Disapproved a/c ........................................................ L (Building Ir~pector) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot end of buildings on premises, relationship to adjoining premises or public streets o.r areas, ana~ giving a detailed description of layout of property must be drawn on diagram which is pert of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon ,pproval of this application, the Building Inspector will issue e Bu Iding Permit to the applicant. Such permit;~hall be kept on~ the promises available for inspection throughout 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, Suffo[l~ 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 regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signatur f ap cant, or name, if a corporation) · ........ ......................... . Name of owner of premises ,....~.~~ ..................................................................... If applicant is a corporate, signafa~ of duly authorized officer· (Name and title of corporate officer) of land on which proposed work will be done· Map No.: .................... Lot No......~...~)....~...~....~'.'~... ................ Location Street and Number . ~....~...~... 4~..~ ~ ..... -- 2. S~te exi~ing u~ and o~upancy of premiss and inten~d u~ and ~cupancy of propo~d qonstruction: b ntendedu~ando~uoancv .... ~.~ ~'--~[~ ......... ~ ~~' ~ . 3. Naturebf ' ' ' ' ~)~ ' work (check which apphcable): New Building ....................... Addition ...... ~....~ ......... Alteration ............... Repair ......................... Removal. .... .................... Demolition .................. . ... .. Other Work .................................... (Description 4. Estimated Cost ............. ...c~../..~ .............. Fee .Z..~......d~.....~ .............................................................................. (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 ......... ~/.~.. .......... Rear .../...~. ..................... Depth ..~ ...................... Height ................................................. Number of Stories .................. ~ .................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ....................... ~,,,~...~ ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .............. ~ .................................... 13. Will lot be regraded ............. ,-~ ................... Will excess fill be removed from premises: [ ] Yes [ ] No ' ~" '" "?" "~' '"~":~ ....................................................................................... (Address) (Phone No.) 14. Name of Owner of premises ~..c~ 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-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. S'rATE OF NEW YORK, ) COUNTY OF ...................................................... ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract} He is the ................................................................................................................................................................................................................. {Contractor, agent, corporate officer, etc. } of said owner or owners, and is duly authorized to perform or.~ave performed the said work and to make and file this application; that ell statements contained in this apl)licetion are true to the ~R~_~ ~.._O~wll~[g9 and belief; and that the work will be performed in the manner set forth in the appliq~tion filed therewith. ¢~'°'_.$2-t~:'~' $,o,~N ~ ~- ornmiat~.,~e4963 of New ................. ............ day of ................. ......... m o. ','.l/"'/'/--I/ / ,ota. ..... ....................... ($i&n~ure of app~ant}