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Home My WebLink About4449-ZFO/tM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~ .36~ .... Date .......... ~ee ..... 8 ........ , 19. ~ THIS CERTIFIES that the building located at .. #~.dd.~Le · Roa~. (CLX?) .... Street Map No..XX ......... Block No...XX ...... Lot No. xx .... Matt~tuck...I~.Y~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... 8®pt.. 8 ...... , 19.69. pursuant to which Building Permit No .... ~ Z dated .......... .8.~.p~ .... 8..., 19~9.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. l~,~ate..olde, fa~. dwallLu~ ...................................... The certificate is issued to ..... Georp.. ~td®rer. ...... [~nel' .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... 1~.~, ........................... ......... .... FOR~I NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? Z Permission is hereby granted to: .............. I~t~.teele ........................................... at premises located at ................ ~L....~.~IIUI, ..................................................................... ............................................... l~-$~ek ....... I1,,1~.~, .......................................................................... pursuant to application dated ............................ ~ll~t~ ......... ~- ......... , 19..~11~, and approved by the Building Insp~tor. TOWN OF SOIJTHOLD BUILDING DEPA~,TMENT TOWN CLERK'S IOUTHOLD, Approved ........................................ , 19 ........ Permit No ......................... Application No ........................ ~... Disapproved a~ ................................... ~ .................... (Building Inspector) APPLICATION FOR BUILDING PERM. .... ~ ....~..~ ............................... , ~9...~..Z.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises: relationship .t~ adjoining premises or public streets or areas, and giving a detailed description of layout at property must be drawn on the d~agram 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 pregress of the work. e. No building shall be occupied or used In whole or in part for any purpose whatever until a Certificate of Occupgr~cy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the i~b~a~:~-Sf ~"1~u-i1~1i~' p&~nit 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 qf buildings, additions or alterations, or for removal or demOlltiorr, as berlin de,scribed. The applicant agrees to comply v~ith all applicable laws, ordinances, building code, housing code, and regulations. (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. ~.. E~.~.,¢./ ~,~t~.~c.t~.,-. ' . .... Nome of OWner of premises ..... ~..~.,.....~....~.~.D....~...~....~..'...~'/~'~...~..~..~...~.%./~... ............................................................... , ............. If applicant is a corporate, signature'of duly authorized officer. (Name and title Of Cc~o~ate officer) /_ i ~ ~:/r~. ,,~ I/./- ~¢, ~ ~ I. Laotian of land on ~ich p~ ~ will b done. ~ap No.: ........................................ ~ No.: ........................ Str~ and Num~ ...~.~.~ .~... ~¢..~ ~ ..... ~. ........... ~ ..~.~.~.~.~.."....~* . ....... · ~/- ~ / 7~ ~ ~7 ~ ~ ~"'~'~"~ ' ........ ; .... 2. State exi~ing use and ~cu~y of pmmi~ a~ inten~ u, a~ ~cu~of pr~ ~i~: ~. -~ 2/,,~ · ~ ~ ~ .. ~,st,., .. on~ ~,~ ..... /......~......~,~. ............... ~ ................................................................................ b. In~nd~ use a~ ~cu~y ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ................. Alteration ................. Repair .................. ~emoval ..................Demolition .................. ~rher Work (Describe) ........................................ 4. Estimated Cost ......... .~....~...~..~.. ................................... Fee ...~ ............ t/~. ..................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... /. ............... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify natu,re and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...~c2..../..~.....~.. ...... Rear ...~'...~. ........................ Depth ..~...~.....~ ...... Height ........................ Number of Stories .......... ~ .................................................................................................. Dimensions of same structure with alterations or additions: Front ...... ./~..~..~.~/ .................. Rear ....~..~.:.~.../..;i~. ....... Depth ...... .~;).~ .~... ........... Height ....$A~...~'..A~... ........... Number of Stories ..... ~..~..~...zT.~. .............. 8. Dimensions of entire new construction: Front ~;~ ~'/~ ~ Rear ...~...~. .................. Depth Height~?~g.;?.~;{'....~... Number of Stories ........ /. ........................................................................................................... 9. Size of lot: Front ..... ~.~/.~. ............. Rear ......... /?..~ ................. Depth ..../.~../. ................... 10. Date of Purchase ..... ../~....~'~..~..:.../~..;../.~..~...?:.. ................ Nome of Former Owner ..~.~.../.?...~,.~2,,.,~.. ................... 11. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or reg,ulation? .......... ~..~..: ........................................ 13. Nome of Owner of premises ..~-...../~'.i..O....~...~....~....../).../~...~?...Address .../~..~.~..~..~.~'...../.~!...~..: ....... Phone No. ~.~.~.~./'.Z~.... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~.L..,~5.~4~£~z' ................... 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 NEW~)R~ J//~ ( ¢ c COUNTY/'?//"/~ OF~..~~:C.....( '"'"" ..... .~-S~.....Z.....~ ..................................................................... ~ing duly sworn, d~oses and says t~t he is the applicant (Name of individual s~n~i~) above named. He is the ......... ~ ................................................................................................................... (Contractor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke ~d file this application; that all statements contain~ in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the ~plic~i~ fil~ therewith. Sworn to ~e me this ~ , ................. .......... ............ ,