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Home My WebLink About7626-zTOWN OF SOUTHOLD BUF[.t)IXG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupency No. Z6362 ...... Date ............Mszeh...'1.% ..... , lg. ~.5 THIS CERTIFIES that the bt~ilding located at ..... ~u%h. Road ............ Street Map No..~al~.~..K;LsldBlock No ........... Lot No. ~ 9J6 ...... l~ai;.t, itUCk.. ~...~, ..... conform.~ substantially to the Application for Building Permit heretofore filed in th~.~ office dated ...........~ov...ll .., 19.7.1~. pursuant to which Building Permit No. 7~26F* · dated .........Nov.- ~.1 ...... , 19.?1+., was issued, and conforms to all of the require. ments of the applicable provisions of the law. The occupancy for which t_hJs certificate is issued is..l?r~.v, ete..Qne, f.~u~iLy..clw~,~z~g...~,th. ~n. a~lcl:tt:L.c~ ................ The certificate is issued to . ]~lar~Lzl. G~'t£fln ....... 0~aez'. ........................ (owner, lessee or tenant) of the aforesaid building. Su~olk County Department of Health Approval .N.:~.. ............................... UNDERWRITERS CERTIFICATE No...l~endin$ .................................. HOUSE NUMBER .... .....Street .... ........................... Building Tn,pector J FOU~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEBK'S OFFICE SOUTHOLD, N~ ¥. BUILDING PERMIT (THIS P£RMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLE~ION OF THE WORK AUTHORIZED) 7626 Z Permission is hereby granted to: ..................... t,~a~,~,~.~u~ ..................................... to hu.t3~z..a~..~d..~.to~..&..~3.~:~t 2~n~. ~r~..e~t~..~i3~2nl ............................... at premises located at ...J~I.t;h...P, cmcL .................................................................................................. ............................................................. Y~,t.~J,~;:~c}~ .... ~I.o)~., ............................................................... pursuant to application dated ..................... ~.o.v.....~.'~ .................. , 1~.~-...., and ~ppr~cl by the Building Inspector. Fee ~ ~..,..0...0. .............. TOWN OF SOU'THOU) BUILDING DEPARTMENT TOWN CLERK'S OFFICE o SOUTHOLD, N. Y. E am,n ........ .......... , ................. '.'. .......... :! ......... , ......... (Building Inspector) / APPLICATION FOR BUILDING PERMIT / Date .................. ~..~..T. ....... .1..li ........... , 19...2.br.....Lr( INSTRUCTIONS a. This application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plar~, 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 public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port 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 permit shall be kept on the premises available for inspection throughout 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 Build ng nspector. 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. Jo5. Deerkoski (Signature of applicant, or name, if a corporation) ...... N~ ~ti.tu~k ............................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... ........................ . .................. Name of owner of premises ...... ~VJ~..~.~TL..~'~'~..~,..... ................... 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 ............................................. L Other Trade's License No ............................................... //~' 7 ~ / ~ ~' Location of land on which proposed work will be done. Mop No.: ~ Lot N~ .......... Street and Number Ruth Road Mattituok Municipality State existing use and occupancy of premises and intended use and occupancy of propped construction: a. Exisiting use and occupancy ....... ~ll~w~g ........ . . b. Intended use end occuponcy same with addition & alteration 3. Nature of work (check which applicable): New Building.. ................. Addition .....3Q~3; ..... Alteration ...... 3QiL ..... Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 4. Estimated Cost ................. ~.~.~)~....+,~ ....................... Fee ....li~.e.~. .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....o..~...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, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number af Stories ........ ;~...~,~ .............. 8. Dimensions of entire new construction: Front ...~..0~:~.....~.,~ .............. Rear .....~1:~ ..8. .......... Depth ..1..0...~....~1.~. ...... Height .................... Number of Stories .....~ ........................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1t. Zone or use district in which premises are situated hA" ~ist 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ~Q .......................................... 13. Will lot be regraded ...-,'3D ................... Will excess fill be removed from premises: ( ) Yes ( 30 No ] 4. Name of Owner of premises .....~..~..t..Jl:.~.....G...~.~.~..~..~. .............. Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..~l~,S.^..~g.e.Z~,Q,S~;l, ........................ 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 indicate whether interior or corner lot. STATE OF NBC2 Y, flRK,._ I c c COUNTY of .............. ......................... ~TD~.o...D~,eZ'.~D.s~J. ...................................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the b'd.'l 'Id. er (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. Sworn to before me this , N v be 7~ ............... ........... ." ........ _., ,0..../_ Notary Public, ~...~...;.~ounty .... .T'~.?~C~.....,ffr'.'/'/".'.~..~.~ ...................................... ~ /~/ // (-Signature of applicant) JUDITH T. BOKEN ~ ' I'lota~y Public, Slate o~ New Y~)rk ~'4o. 52-0344963 Suffolk Coun ~ Commission ~Xpire~ March 30, I;~ '