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Home My WebLink About4927-zFOKM NO. ~ TOWN OF $OUTHOLD~ BUILDING DEPARTMENT Town Clerk's O~[ice Southold, N. Y. Certificnte Of Occupnr cy THIS CERTIFIES that the building located at . .N./.$i, H~!. :A..v9 .......... Street Map No. ~ ........ Block No....~ .... Lot No....1~.~...8..o~..t~o.1..d...N.., .~.~ ......... conforms substantially to the Application for Building permit heretofore filed in this office dated ............ A~lg .. 2~.., 19.70. pursuant to whie~ Building Permit No..~'.9.2.7.Z. . dated ........ A.~.,~...2.7. ...... , 19..7~, was issued, anc[ conforms to all of the require- ments of the applicable provisions of the law. The occuP~ancy for which this certificate is issued is ...P.~.~ .V.a.~.~.,..~.., f..~.~.~.~..y..~?.? .1.1.~.~.~., (.}1. Tp.).. ,~.~.h..g.~.~..g? ................ The certificate is issued to I~.I.a?.o.q..M.~.9.~.$~qh.....Oy~...~ . ........................... (OWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N.;R.; ............................ UNDERWRITERS CERTIFICATE No...N.~.R.,. .......... ............................ HOUSE NUMBER . .87~ ........ Street .H?..,~..e.~. ?.v.e.. ............................ ~OT~ c need's trellis attmt. Building Inspector | FOl~l NO. ~ TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE: UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~927 Z D~e ............. ............ ~ ....... ~..., Permission is hereby granted to: at premises located at ............ ~.~'""]~ll~,'~"~'~Jr ........................................................................... ................................................ ~en~t .............. ll~'~''~ ......... ~ ........................................................ pursuant to application dated ............................. ~l~J .........~....~:..., 19....~ and approved by the Building Inspector. Disapproved a/c ............... ~ TOWN OF $oUTHOLD BUILDIHG DEPARTMENT ~ TOWN CLEEK'S OFFICE APPLICATION FOR BUILDING PERMI'I' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to ad alning premises ar public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whlch II part of thle application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application the Building Inspector will Issue a Building Permit to the applicant. Such permit shall be kept on the premises avai ab · for inspection t~.roughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pureuant to the Building Zone Ordinance of the Town of Southold Suffolk County, New York and other applicable LawJ, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os heroin described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ............. ........ ........................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar builder. ............................................ gm~tm~kct;~ ............................................................................................................................. Name of owner of premises ....~'~1,~'.¢.0.....]~/,.$.~.~.~.~1:J ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. ~ (Name and title'of corporate officer) I. L~otion of land on which proposed work will ~ done. Map No.: ...... ~ ............................ Lot No.: ....... = ........... ~ Stre~ and Number ...... ~...~m~el..&~e .......... S~ol~ .......... ~.,~, ............................................................. ~ I ~ ~ ~ Munlcl~ll~ 2. State existing u~ and occu~ncy of premises and intended use and occupancy of prop~ construction: o. Existing ~se ~nd ~cupancy ...~.t.~.~...~...~.~.~...~.[~.g ........................................................................... b. Intended use and occupant, ...... same...w~th...pr.;~v&te..g&=&~ ................................................................. 3. Nature of walk (check which applicable): New Building .................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ............................................................ Fee ,..~..~).O. ............................................................................. (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 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 ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ......... .8.0 .............. Rear .................................... Depth ....1..~O ..................... 10. Date of Purchase ........................................................ Name of Former Owner 11. Zone or use district in which premises are situated ...... ~,.....C[t,q.t, ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ..~.~..qg...~.t~.~.~.~f~hAddress ..... i~.OLlJ;b. Oqe] ................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly oil 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. ) Term Expires Iqllrch 30, l~l.~/ STATE OF NEW ~O~lf,, couN OF ..... ............................................. ~....~Z..T_.L.." ......... .t~/..~..'zJ ........... being duly sworn, d~oses and says t~t he is the applicant (Name of individual signing a~c~ti~ . . above named. He is the ....................~.,~ ........................................... ~; ....................................................... (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have p~fo~ed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the applicati~iled therewith. Swam t,~~ _ __day of me this ............... ............ ............... ,