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Home My WebLink About6837-z1~0~ NO. 4 TOWlq OF SOUTHOLD BUll.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupency No..E?~.~3 ..... Date ........... ~b ....tO ....... , 19.~. THIS CERTIFIES that the building located at ...1~/8 .t~r&r~. AVe .........Street Map No.. ~ ........ Block No..lin ......Lot No...x~. · ~att~tuek..ii,~E, ........ conforms substantially to the Application for Building Permit heretofore filed in thL~ office dated ...........Aug. · .21,..., 19. ??,. pursuant to which Building Permit No..~.Z. dated ............ ~v.~t'' )+' · ', 19. ?~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ued is.. l~lv~.t~ · one. t~i. ly. ~,e~ ~ .~r~e '~.~- · a~. aaal~io~ ................. The certificate is issued to . .~e~. l~ssa~ ...... 0~m~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .1~, R, .............................. UNDERWEITERS CERTIFICATE No. I~e~a.i. ng .................................... HOUSE NUMBER .... I~.~ ..... Street. ~.~ma. Ave .......liattitl~r ........... l~O~j~ NO. 2 TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI4OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6837 Z Permission is hereby granted to: C~.g.~&~..~..F:rmu~ ~ ~..~L~rcl ................... ........ ~.m~l...Ave ................................................. .................... N~-t._~,~ck.-..-N-~-~-,. ..................... to ,~...~...~.~.~.o..n...,o.~....e.~,~ ~.~..~.~.~.~.~,.~ .............................................................. at premises located at ~.~L..g~-a__~, .~.~..&..i~',OOd,~t~2...D,~ ........................................................ ...................................... ~,.t ~J.i;~.... ~J,:Z....: ................................................................................. pursuant to application dated .............................. ~1~.....~ ......... , 19.~..~.., and approved by the Building Inspector. Fee $.~:.~..~....07.. .......... Building Inspector '\ ; \ ~ J___I ..... _ j I ~ j I ' -I ! ~ ' TOWN CLERK'S OFFal SOUTHOLD, N. Y. Examined ....~.....¥... ........... ,19..?...J Approved ............... ~..~.........~. ............ , 1~.?.~... P, rmit No.~..~....Z~. Application No..: ............... .?... .......... Disapproved a~ ........................................................ APPLICATION FOR BUILDI~ PERMIT ~ ~ Date ................. A'~g..~.'~.....~......, 10..2.~.~.? INSTRUCTIONS ~ ~.ng ~.~ a. This application must be completely filled in by typewriter o~, in ink and submitted in triplicate to the Gui Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan 'showing location of lot and of buildings on premises, relationship to adjoining premises or pub c st~ee~o~ areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this appllbl~. c. The work covered by this application ~ not be commenced before issuance of Building Permit. , ~. d. Upon apprOVal of this application, the Building inspector will issue a Building Permit to the app cant. Such peq~it~) shall be kept on the premises available for inspection throughout the work. ~ L ~ei, L No ,building ~al! .be ..occu_pi.,ec~ or u. sed in. whole or in pa rt for any purpose whatever until a Certificate of Occupancy/ sna, nave oeen gramea oy me uuiiaing Jnspector. ..~ / / APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Gu'Id ng Permit pursuant fo th~ .Buildln.g' Zon,e O~inance of the '1', .o~n ,of. Southold, Suffolk Cou.n. ty, Now York~ and other applicable Laws, Ordinances dr t~egu atlons, tor the construction ot Du,,afngs, additmns or a terahons, 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. .............. ........ i , of applicant, name, if a Grand Ave., Mattituck N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner- builder Geo~g.~ L~ ard Name of owner of premises .................. {~.~.....: ................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot bio. ~ ...... Street and Number .............................. W~.~.....l~a21d...A~e. ...... 4vne.:l;.t,i.~l.~ir ~^~. ......................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....o...zl,~....~..~..~'....~g.~..:~]gg ............................................................................... b. Intended use and occupancy ... s~me wit;h ~n N~teur~ of~work (check which applicable): New Building .................. Addition ....A~.. ........... Alteration XX Repair .................. Removal Demolition ............ i ....... Other Work (Description) 4. Estimated cost .................................................... L ....... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ....OTle, ................. 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 ......... I ............................................................. Dimensions of same structure with o[teretions ori additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... L...~). ........................ Rear ..... .1..c). .................. ,- ,. ~8/ 27 ~eptn ........................ Height .................... Number of Stories .............~. ............................................................................................ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of purchase ................................................. i ...... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated "~.." d:J.~t . 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... D'..O. ........................................... 13. Will lot be regraded ..... T),IR. .................. Will exces~ fill be removed from premises: ( ) Yes (Z) No 14. Name of Owner of premises ...Oeor. ge..T.ass~:d.~. ........... Address ...~a.f,~13,¢~. ...... Phone No ....................... Name of Architect ................................................ ~ ............. Address ................................ Phone No ....................... Name of Contractor ...... .s....a~....e ............................................. Address ................................ Phone No ....................... PLO'/' DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ndicate 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 comer lot. ,STATE OF NEW YORK. I'S S cOuNTy OF ....... $~;~,]~ ........ ~' · I ....... Ge org,.e. Lessard · ...................................................................................... being duly sworn, deposes ond soys tk~t he is the opplic~nt (Name of individual, signing contracf) above named. Owner - builder He is the ......................................................................................................... (Contractor, agent, ~orporate 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 oil 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 ................... .......... , q // Notary Publi~.'.~unty J .~..~..~ ....................... ~r JUDITH T. BOKEN ' ~' (Signature of applicant) Notary Public, Slate of New York No. 52-0344963 Suffolk CounJ[~9~.- ~ornmission ~xpims March 30, 19~