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Home My WebLink About5687-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~b. 69.0. ....... Date ............ ,lime ...... 29 .., 19.22 THIS CERTIFIES that the building located at . .l[&ssau.. Poi. at Iloa(l ..... Street Map NoJla.~)S o. IH;.. P~ No ........... Lot No..%6? ..... Cui;~hogt~.. }~,Y · ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Jan.. 3 .... , 19.72 pursuant to which Building Permit No..~68~.. dated ............ Jar. .... 3 · ', 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 ...PriYa;e one. family .dwet.tin~ ..................................... The certificate is issued to. l~erman .ioro~si~z ....... Owr~el, ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ]i,R., ........................... UNDERWRITERS CERTIFICATE No ..... l~l.eP~e ........................................ HOUSE NUMBER..,~ ~00 ...... Street .... I~8,,5~t~.11 .l~t,. l~,O~. ............................. ................ ~.73 ~.. ~me~,:~;a. ~.cl ........................................... ./',~4:~..::..--:... ~,c,~ ~. Building Inspector 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) 5687 Z Permission is hereby granted to: , , ~ · ................. ~'~~ ......................... ................. ............... ~.~..s.~.~.. ~,~1~ ..~ .............. .~t~ .......... il,~.~ .......................... ~llM~ ,~ ; 19..~... , and approved by the pursuon¢ 1o opplication doted ............................... , .......... ; ................ , ....... Building Inspector. ~ee ,.....~.~.~.~ ....... FORM NO. 1 TOWN OF SOUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Pemit No ..................................... Application No.....~....~.....~../~. ............... Disapproved o/c ...................................................... ......................... ' 'Buil ....................... APPLICATION FOR BUILDING FElt. MIT INSTRUCTIONS Date ........ January 3 19.72 a. This application must be completely filled in by typewriter or in ink and Submitted in duplicate to tFm Bui~ing~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street~or~ areas, and g v ng o deta ed descr pt on of ayout ofproperty must be drawn on the d agram which is part 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 p~mit.. 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 Occul~ncyl[~ 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, ordinances, building code, housing code, and regulations. Midgley & Horton (Signature of applicant, or name, if a corporation) Cutcho .g~_e (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ ........................................................................................................................................... Nome of owner of premises ....... ~O~'~a~r~,,~O~,~,~a, ........................................................................................................ ~ If applicant is a corporate, signature of duly authorized officer. 7'- <~ - ~' ' ~ 1. Location of land on which proposed work will be done. Map No.: ....... .N...a..s...s..a..u....?...t. ........... Lot No....!.~....-~. ............ , W/S Nassau Point Road Cutchogue N.Y. Street and NumDer ................... ~ ...................................................................................................... 7'-/ I ~ 3 ~ (~ 0 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy dweZZ~ng ................................................................................... b. Intended use and occupancy ......... same...w~t~.a~..a=d.i.%.iea. .................................................................... ' 3. Nature of work (check which applicable): New BUilding .................. Addition ...... ~.. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...OT~e .................. 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: Frontl,.bc ................................. Rear ........... .1.~ ............ Depth ........ ~-~ ........... Height .................... Number of Stories .~'~,, ........................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .......... !t..j~. ~...~.~.~ ........................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... '}TO ............................................... 13. Name of Owner of premises ..N.,..]:[oZ'.oW£t~. ........... Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW~'ORL(, J. - J- ~-~\ COUNTY OF ....~..~t..~.6.,~1~ ........... $~-~ ....................................... -~.~..l..~.~j~m..j~-~-~.~.~.~ ..................... being duly sworn, d~oses and soys that he is the applicant (Name of individual sig~ing a~icot~on) above named. He is the ............. ~.~.~.9.~.9.~ .................................................................................................................... (ContractoG agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke ond file this application; that all statements contained in this application are true to the best of his ~owledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to ~fom me this ............... ....... of ............. ........ :....., / ~ ~._ ~_~ / !_ . ~ .~ ....... ,~~.~.~.~..~.~~ ..... Not, coon X Ho. 52-8]25850, Suffolk County Term Expires ~arch 30. zg~