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Home My WebLink About7830-zIPO~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's OHice Southold, N. Y. Certific; te Of Occupancy No..Z7873 ..... Date ............ Sept.. B .......,1972.. THIS CERTIFIES that the building located at . .Ma..r.a.t.o. ok..a .R.o..a.d .......... Street Map No. XX ........ Block No....x.x .... Lot No.. xx... Matt,.tuck ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Apr..16 ., 19.7.~. pursuant to which Building Pei~mit No..7.8.30Z · dated ........ Apt. S1 .~8., 19.?.~, was issued, and confox-ms to all of the req~_~re- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .. privat~ .accessory. sto.~a~e, b~ilding. ( shed ) ..................... The certificate is issued to ...Jam. e.~ D.o.R..o~.c.l~o ..... .~.w~..e~,. ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N....R: .............................. UNDERWRITERS CERTIFICATE No..N,lt, ....................................... HOUSE NUMBER .. 235 .... Street .. Parat~mka. f~(~ad ..... Ma.it :tuck ....... Building Inspector ( FORM NO. 2 TOWN OF SOUTHOLD BUILDItiG DEFARTIV[EtiT TOWH CLERK'S OFFICE SOUTHOLD, tl. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 7830 Z Dote ......................... ~,p~11.....%8 ......... , 19.~2.~.. Permission is hereby granted to: ................ .~.e...s....9.,:... ~.o. ~..c.h,e. .......................... .................. Y.~.tif~uck ...................................... at premises located at ..~/~..~e,r~:~c~oka..-~o~d .............................................................................. .................................................... ;~ .~.t: J~.¢.~ ......... I~*.-*Y.. ................................................................... pursuant to application dated ............................. Ap:~J.~....~.~ ..... , ]9~.~..., and approved by the Building Inspector. Fee $.].~.,.~. ........... Disapproved a/c~....t ......... APPLIGA?ION FOR BUILDING PERMIT Dote ............... INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 sets 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 public streets of areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part 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 Building Inspector. 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 Regular ons, 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.,/, / ................................. .................................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................... ............................................................................................................. Name of owner of premises .........../"%----~.~..~.......~)_.:....~..0.~ ......................................................................... ;;;;;;;;;;;;;;;; If applicant is a corporate, signg, ture of duly authorized officer. , ~ ........................................... .................................. (Name and title of corporat, e officer) Builder's License No ............... ,,'~,, ,,,~.,, ........................... Plumber's License No ............................... Electrician's License No .......... .~....~ ..................... ~, Other Trade's License No. ~ ~-~ ~ M o 1. Location of land on whi~;h I~roposed work will be done. ~p N .: ..... :~ .................... ~ ............ Lot No ......................... Street and Number ..~..~..~.~/...~/~.~..~...~....../~....~.~..2~...?~../../~..~..4.~../~..~.~.....~.. ................................... Municipality 2. State existing use and occupancy of premises and intended use c~nd occupancy of proposed~nstruction: a. Exisiting use and occupancy ..%~...¢..'..~;...,.;;....: ......................... ..~....~. .......... ~..... '"-""""'ti"' b. Intended use and pa y ................. ~ .......................................... ~. ............................................................. Nt~ture of work (check which applicable): New Building.......~. ........... Addition .................. ,~ter~tion ................. Repair .................. Removal .................. Demolition .................... Other Work ................... ~'....].' .~. ........................ / ~ ~z ~,~ (~'4scription) .~4. Est mated Cost .,~.._~'~..L,~_,O,~. ............ Fee .......,.~...~,,~.~ .................................................. -- (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... . .~.~... .............. Number of dwelling units on each floor .. -,.~...~... .............. f 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 ..E.,~'.~....'. .................. Depth ......'~...~. .......... Height ..... .~... .............. Number of Stories Dimensions of same structure with alterations or additions: Front ................ .T. ................. Rear ~ Depth ........... .-~........"-. ........... Height ........ ~ .............. Number of Stories '-'-'-- B. Dimensions of entire new construction: Front /~ f. Rear ........../...~..~ ........... Depth /~ / Height ~.../. Number of Stories --o -- 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ..~ ....................................... Name of Former Owner ...~.:.~.~..~./~..~_ ................. 1]. Zone or use district in which premises are situated ...... ~7...~...~./.~/~. .................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: .... ~...~. ............................................ 13. Will lot be regraded ......~.~. .................. Wil excess fill be re~_oy, e_d_ from pJ3~pises' ( ~Yes ( ) No 14. Name of Owner of premises ......~..~..._~:~....~.:....~.. ................... Address ..~./.~....~.... Phone No. ...................... Name of Architect ............ ..,~'....~'.. ........... Address.. ,~...~... ........... Phone No....~...~. I~o~ne of C~ntroctor ..,..iiiiii ' ~'~ ..... ': ............... Add ss.''''''~ .......... re .~...~- ................................................................................. Phone No ..................... PLOT DIAGRA~ · Locate cl~arl? dfl~l distinctly al .bu dings, whet.her exis~ing~or proposed, and indicate al set-bock dimensions fram property lines. Giv~ street and block number Or description according to deed, and shaw street names and indicate whether interior or corner lot. I t STATE OF NEW YORK, lc c COUNTY OF ............................. ....................... .-~....~..../~....Z~....../.~....../...c~...~ ........................... being duly sworn, deposes and says that he is the appliconl (Name of individual signing controciO above named. He is the ~ CL/,~J (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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . ........ day of ...... .................... N~ ota~y- Public, ....: ................... ~..,~,;d~...¢~COunty ...¢~~.~.~.;.~..~...~~ ....................... · ~-~ / ~ / -, ^ , (Signature of app cant) ,,,~J~T^RY pUBLIC State of I'1o. 52-8125850, Suffolk Term Expires March 30,