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Home My WebLink About7567-zFOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy No. Z~01~ Date &~a~ 1 19.7..~. THIS CERTIFIES that the building located at ....M~...l~'...Rd..&. ~ .... Street Map No. ~ ......... Block No.. ~ ...... Lot No...~... ~.~...N~?' ...... conforms subst~ti~ly to ~e Application for B~lding Pemit heretofore ffl~ ~ ~ office dated ............. 8ep~...~0, 19..~ p~u~t to which B~ldMg Pemit No. ~.. dated ..........~.~t.. ~..., 19.~., was issued, ~d conforms to ~1 of ~e req~ ments of the applicable pro~sio~ of ~e law. The occup~cy for wMch ~sued i~ ...~..~. ~$~ .~. ~. ~ .~.~$~ ................ The ce~ificate is issued to (owner, lessee or ten~t) of the ~ores~d b~ding. S~o~ Count~ ne~ment of Helm A~rov~ .... ~:~ ........................... No.. ..... ............ HOUSE NU~nER ..... ~ .... S~reet ...~.~ .~ .......................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT ('THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7567 Z Permission is hereby granted to: ~rnest Jones A/C John Sidor Jr Mattltuek l~r~' s Road & ',~'ickham Ave at premises located at ........ . ................................................................................................................. ................................................ ~,.~,.s;.~g~ .......................................................................... pursuant ~ a~lic~ion d~ ......................... ~......~9 ............ , 19...~, aM a~ ~ ~e Building In~or. Fee $..~.~.~Q.Q....~ ...... a/c ¢ ...,_o.,o..u,_.._ b. P~~i~ I~ti~ of I~ o~ ~ ~ldi~s ~ premiss, mlatio~ip o~ ~O~ ~1~ of I~t ~P~ must ~ d~n on c. ~~ ~ ~ls ~hc~i~ ~ not be ~mme~ b.fom igu~e of Bulldl~ ~. d. U~oI ~ ~s ~llc~l~, t~ Butting I~c~r will I~ = BuiMt~ Pe~lt ~ t~ ~ ~t. ~ ~lt ~11 ~ ~ m ~e p~i~ ~Jlable for i~cti~ ~ghout the p~ ~ wo~. ~ e. No ~lldl~ ~11 ~ ~cupi~ or u~d In ~ole or in pa~ for any pu~ whate~r until a Ce~lf~ of ~c~y · s~ll h~ ~ g~ by the Buildi~ In~r. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the R~eeiludi~la~Zor~, O~.. inonce.of t..he To,.~ .o.f..Southo!d., Suffolk C. oun.W., New Y, ork, and other appllceble Law~ Ordinances or eg ar~ons, mr me construction aT DUllalngS, additions or alterm~ons, or tar remova or demolition0 al heroin dem:rlbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (^ddress of a~'l'~nt) State whether applicant is owner, levee, agent, architect, engineer, general contractor, eleotrlclon, plumber or builder. ...................... ...................................................................................................................................... (Name and title 'of corporate officer) A' . Location of land on Which proposed work will be done. Map No.: ............................ ~.~ Lot No...~..... ................. Street and Number ...~.R.~..~.....a~...~.~...~,~.~...~/~:~....~... ,~...'~'.~.~.~......~.~.~.= .................. :. / Munl¢lpa Ih/ ' State existing use and occupancy of premises and Intended use and occupancy of propoeed comtrtmtlan: a. Existing use and occupancy ..... J~..~...~-m... .............. .. b. Intended ues and occupon~'. ...... ~,~,...~.~.~.~.....~,....,/~/~...~,..~,,e,.o,./~l,.'..~;-~r.,,..e~,......~ ..... Name of owner of pramisel ....... ..~...O..k.~. ....... s~....~.f~.~......J~.. .......... ~! ....................... If applicant Is a corporate, signature of duly authorized officer. 9. 12. 13. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .............. ~, Removal .................. Demolition ............... .~.Ot. h_er Work (Describe) Estimated Cost ..~..~:R.~...~...~... ................................... Fee ..../.?....~f.r"'u .................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ......... /.. ................ Number of dwelling units on each floor ..,~ ........................ arege, number of cars If business, commercial or mixed occupancy,' specify nature and extent of each type of use ............................ Dimensions of existing structures, tf any: Front .....~..~; ............... Rear ......~.~ ............. ; ........ Depth .~. ............. Height ...J.~.~ ........... ;.. Number/of Stories ...~. ............................................................................................................ Dimensions of same structure with olteretions or additions: Front ...... ~ ......................... Rear ....~... ................... Depth ...6(.~..~...dl~..~.~.' ..~......~-~eight ....... /./~..~ .............. Number'of Stories .../.. .......................... Dimensions of entire new construction: Front ...~I~...~.~.:.Z.:. ............ Rear ..~..:...~....~.:~.... Depth../.~..~ ............... Height ....~.~..'. ........ Number of Stories ../. ................................ ~ ............................................................................... Size of lot: Front ..... /.~.2~ ............. Rear ..Y(~.~..~ ........................ Depth .~.~...~. ................... Date of Purchase ........................................................ Nome of Former Owner ........................................................ Zone or use district in which premises am situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ Name of Owner of premises .;~1~.~.~,~.~. ,~....~..~..'.....Address .,/~.~.7~.~,~..~t~;......~..,~... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No; .................... Name of Contractor ~...~r~..~....~.....~....~.....~. ........... Address ~.~.'~ ........ ..~/.~..'.... Phone No.~-~...~ .~.J('...~.~. 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 indicate whether interior or comer lot. : .T .... / STATE OF ~,~, ,,~i.,~- ~ ,~ ' .. ~ ~ r . ...................'"~' ~ ~ ~~......T..[.....~.../...~ ........ ~ ............................ being duly sworn, d~s a~ says t~t he is the applicant above named He s the .................................................. . · ............. ~.~.~..~....~ ........................... . ........................................... (~t~or, ~t, co~m~ officer, ~c.) of said owner or ~ners, and is duly authoriz~ to perform or h~e ~o~d the ~ld wo~ a~ to ~e ~d file this application; that all statements contai~ in this applic~ion are ~e ~' ~ ~ of his ~l~e a~ ~lief; and that ~e work will ~ ~o~ in the manner ~t fo~h in the appllcatl~ fll~ ~i~. Swam ~e~.~i, -~. ,~ . ............... ...... · ....... ..... ... .......................................... N~a~ ~ublic, . ................... ;...~~.~... C~n~ . ~m of applicant)