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Home My WebLink About6144-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk'~ Office Southold, N. Y. Certificate Of Occupancy No..~'~.?.1, ..... Date .......... ,~q~.t.e~be~'..201..., 19. ?3. THIS CERTIFIES that the building located at . Euge~.e.~ .Ro~,~t. ~..~J~. ~e~a~ Map No... XX ....... Block No. X,~ ....... Lot No. X~ .... g.~;¢h0g~$ ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated .........~el~t.e~be~'. ~9 .?2. pursuant to which Building Permit No...5.~..1~..~. dated ...... Sep.~:~b.e~..26,.., 19.72~, 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 .. P~.~,v.a.t.e..a..a.e.e.~..s.o~y..b..u~.~.c]~..rig ....................................... The certificate is issued to..~. ~ael~hy. ...................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .l~,~... ............................. UNDERWRITERS CERTIFICATE No...P.O.~.d..~I1. g. ....................................... HOUSE NUMBER... ~.00 ..... Street...]~ll~o.l~ ,l~,~ ........ L~t~le l~ee~ Re~ ............. ...................................................... g~tcho~ue ................. Building Inspector FORM NO, 2 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? 6144 Z Permission is hereby granted to: ~ aa aA~ltiea ea e~at~ aeeea..e....~.. at premises located at ...l~.Zlllm~.~el~..&.~,tt3,e..llmmlt.~A ........................................... pursuant to application doted ................................... ....~...~......~...~.., 19...~...., and opproved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...~.~....~.. .............. 19..?....?' Approved.. ~ '~ ~../. ..~.. ...................................... , 19.2..~.. Petal, No .... ..~.. .~ .... Application No ..............~ ................ Disapproved a/c ..~ .................................................... APPLICATION FOR BUILDING PERMIT Date ....~.....~....?. ............. , 19....~.~.. a Th INSTRUCTIONS Building' · 's application must be completely filled in by typewriter or in ink and submitted in triplicate to the Inspector, wKh~ 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 or arees,]~td~ giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. ke~)n ? d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be 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~n~ 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or~q~me, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ .................................................................................................................................. Name of owner of premises ..... ~ ....... .~..L~. ................................................................................................. 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 ............. Street and Nu~I~....'.~....~ .......... ,~. ..................... /.~./.~,..... ,~.,.....I..... ,~.. ................ u.,T,,~)...~°.....~ ............................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: /~ ~_C ' e) ,~ C.. ,~_ .......................................... a. Existing use and occupancy ................... !..~. .................................................................. b, Intended use and occupancy ............. ~.,.~......"rJ,,~....:,~......'-~..~ .......... ~.....~.~..,,.,~.,,,.,~.~ .]:-,z~ .................................. 3.' Natdre of work (check which applicable): New Building ....................... Addition ..................... AIt~erat~on.. ~ ......... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~ ^ ~ .~ ~ {Description) 4. Estimated Cost .......~..;~;.;~...;.: .......................... Fee ................................................................................................. (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 ......... Z..;:. ........... Depth ....~n.~ ....................... He ght ........... ,L,~ ................... Number of Stories Dimensions of same structure with alterations or additions: Front ........ ~..~ .......... Rear ........ .~.~. ......................... Depth ....... ~,~..~.. ........................... Hmght ........... ,'.,= ........................ Number of Stor es ....... 6A.0/..~.- ..................... Dimensions of entire new oonstruction: Front ........ ,~,...~. ........ Rear ....... .~.~'. ............. Depth ....,~,.~.~. ................... He,ght ................... l..~. ....................... Number of Stories ..........¢.,~J..Y.;. ................................................................... - Size of lot: ~'" *~ ~ Front ..... ,~, ...... L, .................... Rear ........ .~..~.J...~ .................... Depth .....,~...'~.~.,.~...~......: ............. '; ..... Date of Purchase ....: .:~..,~.~. .............. Name of Former Owner ..... ~.~.,.y....,~...~...~,~.~..,~-~;J ............................. Zone or use district in which premises are situated ..... ~.~,....~.&~..,,../,.~.,,,, ........... .~.~.~..,*,,,~. .......................................... Does proposed construction violate any zoning law, ordinance or regulation: ...... .~..~ ........................................ : ..... Will lot be regraded. ~.~.~, ..................... Will excess fill be removed from premises: [~,-~ Yes [ ] No Name of Owner of prem{ses ...~.~..~.~......~./~.~..~.,.4..~ ....... ,...~.:~,~.,,, ...... ~..~. ................ ~..~..¥.....~.~.~.~..,. -- (Addgess) (Phone No.) Name of Architect ....... ~,~....~.~,.~..~,..~..¢ ...................................................................................... -- . . (Address) 7~ . (PhOne N§.I ' Name of Contractor ...... ~~yL~E~y~h?~`~`~f;~`~/t~"~ ......... (Ad'dr~ss~ ,. ? y.. ~ (Ph~ne'N~[.) 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 wheth- er interior or corner lot. ~11. 13. 14. STATE OF NEW~ ) COUNTY OF~ ) .............................................................. ~......:~ ............ 4....~ ............. ~ ~being duly swor@, dqpo?ps and say~ l~hat,:.be i~e applicant above named. (Name of inEivt~(ud signMg'contract ) - He s the ............................................................................................................................................................................................................. (~ontmctor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to performj~!~ .~ed the said work and to make end file this application; that ell statements contained in this epplication are true.~o th~b~l~/~cffulti~.~vp~&bel'ie~; and that the work will be performed in the manner set forth in the application filed therawith,~ N0':52-0~344963 Suffolk'CorneL '-:.-~ · ' ' // / Co~ssion ExpLrt~.~arch 30, · ............ ^. ...... ........................... i Foo r,'.~