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Home My WebLink About6473-zFO~M NO. ~ TOWN OF SOUTHOLD BUH,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~?8 ..... Date ...... 0~tobelt..~.8~ ......... , 19~3. THIS CERTIFIES that the building located at .. HU~i~g. Map No ...... XX .... Block NoJ~X ........ Lot No.. XX .... l~at.t~;U~. ............. substantially to the Application for Building Permit heretofore filed in this office ......... Apl'~.L J.Ot.., 19..73 pursuant to which Building Permit No..(~1~73~. dated ........ A~.].. 11~ .... , 19. ?3, 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 .. Publ~a..l~a~ .~tlx .Ut~Ltty. buiJ. dlz~ .............................. The certificate is issued to . .. I~a~t~.tllek. Paz~k. D~t~ot; ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk'County Department of Health Approval ....N.:R.., ............................ UNDERWRITERS CERTIFICATE No .... ~feR, .................................... HOUSE NUMBER ...~0 ...... Street ....... Peeon~ ~ .Ba~..Bled, .............. ................................................... Matt~.tuek .................. Building Inspector IvO~M NO. ~ TOWN OF SOUTHOLD BUILDIN~ 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? 6 73 Z Date .......................... Rp.~ ~..~. ....... ~"1 ...... , 19..r/.~. Permission is hereby granted to: .......... ~.:~ .'¢~ :LI;.~,~.~,.....~ ~,z:~....g..:l,.~ ~ ~.~ ~:.t, .............. pursuant to application dated ...................... ,'~'tt~'].'~(~ ................ , 19.~?.., and approved by the Building Inspector. Fee $.z~,~fie .............. BUILB~I~ ~FARTMENT TOWN C~RK'~ OFFIG! ~, N. Y. / ~amin~ ....... ~ ...... Z ......... , 19.~.~. ........................................ , 1 .. P~it N .................. ~r~ a/c ............................................................................................ ~ ~ ~ilil~.l~ATIOl~ FOR lUll. DING Flit, MIT (Signature of applicant, or name, if~corpuration) (Address of a~plicant) State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... ]'~ti~JilMll~,..]~ll~.l~..l~,~t.l;.]~,f. li ................................................................................ If applicant is a corporate, signature of duly authorized officer. .......... ..,{m.4z~ £~uLJ~{ue~..~m{m.4.m~J,{~ ............................. {Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ........................ ; ............. ' ........ Lot No ......................... a. This application must be completely filled in by typewriter or in ink and submitted in tril3[icate to the Building ~!ml3ector, 3 sets of plans, ~ plot plan to scale. Fee ~cordin~ to schedule. · ,b. Plot, pl,,ml.sh, owi.ng.locati, o,n of tot. end of buildingl on premises, relations.hip to adjoining.~rien~s or public streets or areas, giVing e oetell~] (3ascription OT layOut OT property must be drawn on diagram wnich Is pert of this apl~ication. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon el~roval of' this application, the Building. In~ector will issue a Building Permit to the applicant. Such permit,shall be kept o~ the premises available for inspection throughout the work. been( e. No building shall be occupied or u~ed in whole or in pert for any purpose whatever until a Ca.rtificate of Ocoupency shall have granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of e Building Permit pursuant to the Building Zon~ Ordinenca of the Tow~ of Southold~ Suffolk County, New York, end other applicable Laws, Ordinances or Regulations, for the construction of buildings, .l~ldi. t. ioal or alterltiom, or fo~ removal or demolition, es heroin ~ .The applicant agrees,.[to comply with all alN~licable laws, ordmancas, budding code, housing code, and regulations, and to admit authorized inspectors on premises and/rn I~uildk~gl ~ rl~ Street and Number ...]~ta;LaE..a.-~,...~.S.e..2uoa~,&..~a~..]~Z3r~t. ..................... llmds.t,S.~um, ml~ ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~ll,la:b~.l.~,..]['J.13~l...lta~..~.&z'tr ...................................................................... b. Intended use and occupancy ...... .BI,rtl ...................................... ; ........................................................................... 3. ~l~ature of work (check which applicable): New Building ..X .................. Addmon ..................... Alteration ............... Repair ......................... Removal ........................ Demolition ........................ Other Work .................................... j~' ~ (Description) Estimated Cost .........$..,~,~.~..~1~. ...... ..,=..: ....... Fee ..................... ~ .............................. ~ ................ ~ .............. : ........ (to ..~e peid on filing this ~j~;cation) ,.: 5. If dwelling, number of dwelling units ...JLA ....... Number of dwelflng units on each ff~or ......................................... If garage, number of cars .......... ~: ............................................................................................................................... 6. If business, commercial or mixed occuoancv, 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 ........................................ Dimensions of entire new construction: Front,....,~Q..~.~14 ...... Rear ...... ~,Q..~.ll.e. ....... Depth .....7...~..". ................. Height .....8.. f't., ................................ Number of Stories ..........~, ............. :.....:: ..................................................... Size of lot: Front ...................................... Rear .......................................... Depth .................................................. Date of Pumhase ..... .~gJl~ ...................... Name, of Former Owner .....~.~.,~..~..~.~..a..~.e.. ........................................ Zone or usa district in which i~emises a~e situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ..][e. .................................................... Will lot be regraded ~ .......................... Will excess fill be removed from 13remisas: [ ] Yes ~ No Name of Owner of premises ....[~e.t~=5.~u.air..~ll~'~..Z:U.a. li~;~l~l. ............................................................................ (Address) (Phone No.) Name of Architect .....~.~.~11~ ....................................................................................................................................... (Address) {Phone No.} Name of Contractor ..~#~J~ ....................................................................................................................................... {Address) (Phone No.) 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all butldinga0 whether existing or proposed, and indicate all set-back, d!mel~.~- .., property lines. Give street and block number or descr!ption according to deed, and show street names and · er interior or corner lot. ....... ~,l'~e~""'""~ ......... ~ ............................ ' g y , po ys hat he is the applicant above named. ~ ~difl~idual signing conh,a¢O, r , , ', He is the ....~- '.~..: F.-:. ~ ..;~.: ': : ::.: ................ :..:..::...:. .......... :.:..: ........ :.:..'.'.......: ....... ::.::.....'. ................................................ (Oaa~nzctor, ~, corpo~t¢ o/~ic~r, 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 kn~ .a_~[ belief; and that the work will be performed in the manner set forth in the appticati~ filed therewith. · ......... Zd , o, ----- / -/' -/ ..... 'T'"; ........ '~¥~'==~o,--- '~o. .u.,,c ....... ............ : .:<.._.._. ............... __