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Home My WebLink About4492-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No..~ .~.~.7 ...... Date ......... ~.e~.~;.e~.b.e.~.. ~.6.~...., 19.7.3. THIS CERTIFIES that the building located at ... g-',.-~sau..I~,, i~oa~ ....... Street Map No. ~ ......... Block No. 1~ ........ Lot No..7..&. $ ... gutchog~e ............ conforms substantially to the Application for Building Permit heretofore fried in this office dated ...... Ootobor. · 6~ .... , 1969 · pursuant to which Building Permit No...~d~ dated ....... 0ot~Lor.. ?, ..... , 19 69., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~s~ed is P~:~va.t¢ · olxc, .f:a:~'~:l2. ~l~ell:i ~g ........................................ -~-"""~e certificate is issued to .. 2oI~er.t .~dac~er ...................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. g,R, ............................. UNDERWRITERS CERTIFICATE No..~...~..rA~ ......................................... HOUSE NUMBER...2~.~.~ ..... Street.. ]~-~S~l], .P.o:~,XM~ .ROa~, .......................... .......................................... Cutchogue ............................ Building Inspector FO~M 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? 4492 Z Permission is hereby grante~e 4~1.~t~1 4~l~l~t~, ~ at premises located at pursuant to application dated ~, 6 19..~.~...., and approved by the Building Inspector. Fee $ ........................ BUILDING DE'ARTMENT ~ TOWN CLERK'S OFFI~ ......... ................... , ' ~ ., Appraved ........................................ , 1 ~ ........ ~i~ No, ,,~ ......................... ........... ........... APPLI~TION FOR BUILDING INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building O. 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 propertymust be drawn on the diagram which is part of this application. c. The work covered by this application may 'not be commenced I~efore issuance of Building Permit. d. .l~pproval 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. '~'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 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 and regulations. ~..~ ~ f (S'onature~lf app leant, or name, if o corporation) (~/[,~,~ (Address of applicant) State whether applicant is owner, lessee, agent, architect~erol contractor, electrician, plumber or builder. If applicant.~s a corporate, si~ngture of duly authorized officer. (Nc~:je and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No: ........................................... Lot No: ..~....'~....~... .... Street and Number ................. f.~ .......... .~..v.~ ............................. ~ .............................................. Municipality 2. State existing use and occupancy of premises andintend~euse and occupancy of proposed construction: a. Existing use and occupancy ........................ ..-~...~~J"~/'~'~ ............................................................................... b. Intended use and occunancv .... '~~ ............... tz.,' ....................................... ............................................................... 3. Nature of work (check which applicable): New Building .................. Addition .......¥;~.,........ Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ................. ~..g~.~.-.OJ0 ......................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ..~.. .............. Number of c~welling 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 of Stories ........................................ 8. Dimensions of entire new construction: Front ............ ,~.~. ......... Rear ....... ;..~..~. ............ Depth .......~.g:?. ............... Height .......... /..~. ............. Number of Stories .......... ./. ................ 9. Size of lot: Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...................................................... 13. Name of Owner of premises------ ".~.R/~f.~......l~..c~/..¢~. ........... Address..M~...G.~iL~.~...~...~...~...~.~...~.,. Phone No. .................... Name of Architect ...................................................... Address ....................................... '. ..... Phone No ..................... Name of Contractor .~.'.~..J~/~.~ ............................ Address ..~,~,~...o.....~'..A'.......~...~....C'..".~Phone No....7....~..~.....%~..o..~O PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing qhproposed, and indiCat, e all set-back dimensions fram numbers~n~°~f~rJ~tL°n acc~l~l/to~_! deed, and sh~w street names .and indicate property'lines. Give street and block whether interior or corner lot. STATE OF NEW YORK, ~. - - .......... ............... ~..~;'~T4% ......... .~3'Xd~',d.~'. .................... ~ .......... being duly ~orn, dep~ and ~ys that he is the appllc~t (Name of ~dividual signing applicat,~ able ~m~. He is the ................................................................... ~.~ ............................................................ (C~tractor, ~ent. co.orate officer, ~c.) of said owner or ~nem, and is duly authoriz~ to ~o~ or have ~ormed the ~id work a~ to ma~ and file this application; that all state.nb contain~ in this a~pli~ation are tree to the ~ of ?s kn~le~e a~ ~llef; and that the work will be ~rfo~ in the manner ~t to~h in the applicati~ fil~ thee,th. ....... ... ..., .. ~ Yj ~ ~ I I '~ L._ · j ....... ~t-.~..u~.~.....~ ................................. ~ No[52-8125~0, Suffolk ~ ~pires March 30, 19~ ~ '