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Home My WebLink About3154-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sonthold, N. Y. Certificate Of Occupancy No, .~v}°~]13 ..... Date .............. ~?'.~;...~ ......, 19.73. THIS CERTIFIES that the building located at .. ~.¢~De..DF. &..gn~;~-a.r. la.. Street Map No. 1~I99~. ~9.v.e. Block No ........... Lot No...2~ ....... ¢'9,.¢,g~,0g~. 0...~y~t .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Ju&y ...... ~ :1.., 19,66. pursuant to which Building Permit No. dated ........ Aug..~ ....... , 19.6.6., 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 . Pr.:t',ra~;e..garage...(.aeceaaory)., A~prO.~:er~. bY. .~;l. AP.p.e~.z .......... The certificate is issued to .R.O~.a.n.4. ~.o.J,.~..m.a~ ....... 0;.m~r .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......... ~.,.R.: ...................... UNDERWRITF, RS CERTIFICATE No.. ~A...I](~ ........................................... ttOUSE NUMBER,..890 ....... Street .....~D~, .DtTJ,Y~ ............................... ........................................................... / ........ ," .... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT N? (THIS PERMIT MUST BE K~:PT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3154 z Permission is hereby granted to: ~o.:t~.~ .:~.,.'..~oz~- ......... ~ ............................ ....... ~b~..D:~i.v.e .............................................. pursuant.to application dated ..........................~),~. ....... ]~ ........ 19...~)~, and approved by the Building 'inspector Fee $ ..U-~. :'~ ............... ......... L../-...:~ .................. . .................... -¢. ................... Building Inspector ~ FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No...~.../....~..~.. ........... Disapproved o/c .....~ ...... .~...~....Cm-..~ ........................ .................................... ................ ( u~ drag inspector) APPLICATION FOR BUILDING PERMIT Dete .7. " '- , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink or~d submitted in duplicate to the Building Inspector. 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 of property 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. tJpon 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 progress of the work. e. No building shall be occupied or used in whole or in part for an~/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 Regulations for the construction of buildings, additions or alterations, or for removal or demo~tion, as herein described. The applicant agrees to comply with all applicable laws, ordina/na~e~uilding code and. regu,L~ons. : ..... /('~i~;:~:;e of oppli~};~'~r;e, ifa corporat;;'n) ,' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. o, ................................................................................................................................................................... Name of owner of prem,,e, ........ ..................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ....~..~...~..-.:~..'.~. ...................... Lot No.: ....~...q' ............... Street and Number ..~;~.¢.~.~P/.~.~.z...Z.?.~.c.rf.~: .......... ~,.:.~.~S...?-......%..~?..f..~:..?.:..'t?..q~..!;./.':'.% ............................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................... t, ......................................... ' ............... = ......... .~, ............................... b. Intended use and occupancy ................... ~.:......~..~ .................................................................................... 3. Nat Re 4. Esti 10. 11. 12. 13. Nar Locat property I whether in ~re of work (check which New Building .................. Ac~FoH<~..~..~.... Alteration :ir .................. Removal .................. Demolition .................. Other Work (Describe) noted Cost ............................................................ Fee (to be paid on filing this application) If dwelling, number of dwelling units ............................ Number of dwelling units on each floor if g~rage, number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use D~rflens~ons of ex st ng structures, f any. Front ........ ] ................... Rear ................................ Depth Height' ..1..~....'-- .............. Number of Stories / Di~ensions of same structure with alterations or additions: Front ....................................Rear Dep}h ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front ........ ~ ........................ Rear ...... ~ ................. Depth Height Number Stories ......... Siz8 of lot: Front [~ ' . Rear / ¢' ¢* ' Depth ..~...: ..................... Zo or use district in which premises are situated ................. ~..:'....~..~.~ ............................................ Doeb proposed construction violat~ any zoning law, ordinance or regulation? ....... ~ ....................................... Na~e of Owner of premisesff.tZ.:Z/.f;.(~.("/~(.f.. .......... Address .............. Phone No.'..C.%..¢./ Na~e of Architect ...................................................... Address ............. :.f ............................ Phone No. ~e of Contractor .................................................... Address ~ Phone No. PLOT DIAGRAM ; clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr nes. Give street and block number or description according to deed, and shaw street names and indic, erior or corner Jo.t._ STATE OF' NEW~YORI( } c ~ ',(~ome o{ individual sionin~ opplicotion) tho ........ .......................................................................................................... j (Contractor, agent, corporate officer, etc.) of said owher or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and beiief; that the w~k will be performed in the manner set forth in the application filed therewith. _ Sworn to b~fore me this , ~ ~ ...... ....... .... .......................... , Notary Public, ,~¢~.~ .......... County } ,big~ature of apphca ) ~e 52-2760800 Qu~hhed m Suffolk Coflnty~ *~ Commlsmon Expires March 30 1~