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Home My WebLink About4771-ZFOP-M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. ?.3.6.0. ...... Date .............. .A.u.g...2.~. ..... , 19.7.1. THIS CERTIFIES that the building located at . .E/.S..~.e.~..S..u.f.ff.o.],.k..~.v.~ .... Street Map No.. ;XXX ....... Block No... xxx .... Lot No... x.x.x .... itat.tituclc..E.Z ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~ .. 2?...., 19..7.0 pursuant to which Building Permit No...1+.7.71Z. dated .......... ~l.a.y....2?. .... , 19 ?.0.., 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 . P.~.v.a.te. one. family..dwelling ...................................... The certificate is issued to ...E.u..g.e.n.e...Hg.r.t. 9.n ...... .0.w.n.e.r. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Inspector FOruM NO. g 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,° ~771 Z D~e .......................... ~,~ ...... .~. .......... , ~9.....~'0 Permission is hereby granted to: to .... ~..~..~..~.~..~.~.m..~...e...~..~..~:~..~.~..s.~.e.~....g.~.e....~...~..~..~ at premises located at ................ li~d....-~.~.~ .~..&~l~ ............................................................ ................................................................ /blst, ~J~t.~ ......... Il,Z, ....................................................... pursuant to application dated ................................... ~,1~ ....... ~......, 19...~.0., and approved by the Building Inspector. TOWN CLERK'S OFFICE A~d ........................................ , 19 ........ Permit No .................... Dimmed a/c ...................................................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled In by typewriter or in ink und submitted tn duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relat onsh p to adjoining premlee~ ar public streets or areas, and glviag a detailed description of layout of property must be drown an the diagram whlch Is part of thlz 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 appl cant. 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. B APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Building Permit pumuant to the uilding Zone Ordinance of tl~e Town of Southold, Suffolk County, New York, and other appllcab e Laws, Ordinances or Regulations, for the construction of buildings, add t OhS or alterot ohs, or for remova or demolition, al herein described. The applicant agrees fo comply with all applicable laws, ordinances, building code, housing code, and regulations. ....... ............................ '. ........................ (Signature of applicant, o~ name, If a corporation) Hew Suffol~ (Addresl of applicant) State whether applicant Is owner, lessee, agent, architect, eng Ineer, general contractor, electrician, plumber or builder, ................................................................. ¢1~1,~, ......... , ................................. Name of owner of premises ...~....~ ......... , .................................................................................................... If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) Location of land on Which proposed work will be done. Map No.: Zz . ~ g .......... ?,..... ....................... Lot No .......................... ~L~. ~. S fo Ave Matti~ue~ J2;Z 7 5 : ~ -. Munlclpa Ity ' State existing use and occupancy of premises and intended use and occupancy of propc~ed construction: 3. Nature of work (check which applicable): New Building ~ ................. Addition ........ ~ .... Alteration ~ ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .................~..0~..~,,.' ........................ Fee ..... ge.GO ............................................................................ (to be paid on fi!ing 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 ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ."Jk" 11. Zone or use district in which premises are situated ............... J~D.1; ................................................... 12. Does proposed constru~ction violate any zoning law, ordinance or regulation? .............. ~Q ........................................ 13. Name of Owner of premises -.S~t~ene..][e~t,e~ ...... Address ......~.e...~....~..~L~..~.O....]~.. ........... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ................... ~....a~...e.. ....................... Address ............................................ Phone No ..................... 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 indicat'e whether interior or comer Jot. So*... I ~O~ STATE OF NEW.,YQ~K.. t ~ COUNTY Of .....~...l~....~...O...J~... ........... ~'=.~. .................. ;; ..................... ~l~e..~;l~:~ ....................... being du y sworn, deposes a~nd says that he is the applicant [rqame of individuoTsigning aPPlication) . above named. He is the .............................. o~ez'...-..~)~l,~,c[e.~ ................................ '~ ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ~ ................. 2.~.. day of ................... ~ ................ , 19..~..0. EL ZABETH A/~N "£¥[T?~LE .. ,~ HOTARY pUBLIC. StBte of New york ~ No. 52-8125850, Suflotk Coul~Ye :Term Expires MBrch